Study name/Acronym Department CLINICAL INVESTIGATION PLAN (CIP) EN ISO 14155 Klinischer Prüfplan (MPG §3) Name of the Investigation Identifying number Version / Date Confidentiality Statement The information contained in this document, especially unpublished data, is the property of the sponsor of this clinical investigation…………………………………. (please adapt for your own study). It is therefore provided to you in confidence as an investigator, potential investigator, or consultant, for review by you, your staff, and an Independent Ethics Committee or Institutional Review Board. It is understood that this information will not be disclosed to others without written authorization from the …………………., except to the extent necessary to obtain informed consent from those persons to whom the interventional devices may be administered. Date Version Page 1 of 29 Study name/Acronym Department Device Name and Manufacturer CIP authors Academic investigators Document type Medical Device CIP Document status Date Number of pages Date Version Page 2 of 29 Study name/Acronym Department 1. SPONSOR, INVESTIGATOR, MONITOR AND SIGNATURES Clinical investigator (MPG § 3) Prim.Univ.-Prof. Dr.AB, Department of………., Medical University of Vienna, Austria _________________ ___________ Signature Date Sponsor/OEL (MPG § 3) Medical University of Vienna, Austria or company _________________ Signature Representative of CRO (EN ISO 14155 ) Name: …………. _________________ Signature Statistician ___________ Date Name: ………. _________________ Signature Date ___________ Date Version ___________ Date Page 3 of 29 Study name/Acronym Department 2. SYNOPSIS OF THE CLINICAL INVESTIGATION Provided preferably on a separate page, it should summarize all the central elements of the CIP (Clinical Investigation Plan), for example the rationale, objectives, methods, populations, time frame, and expected outcomes. It should stand on its own, and not refer the reader to points in the project description. (example - please adapt to your study) TITLE ACRONYM NAME OF DEVICE please enter (abbreviated title) Dev1 DESCRIPTION OF THE PROCEDURES The …dev1…. an investigational device intended to ….. in individuals suffering from ….. The device system is to be used only in accordance with the approved Investigational Plan on subjects who have signed an informed consent form. Device use is limited to the approved study investigators. OBJECTIVES The CIP shall identify clearly the hypothesis and objectives, primary and secondary, of the clinical investigation and the populations for which the device is to be used in the investigation. These shall include as appropriate the particular: ⇾ Claims and intended performance of the device that are verified This may include implicit in the intended purpose of the device as well as those made explicit in labeling, instructions for use or promotional material. It should be clearly stated wheter or not the determinations of the longterm effect are part of the objectives of the current clinical investigation, ⇾ Risk and foreseeable adverse device effects that are be assessed ⇾ Specific hypotheses to be accepted or rejected by statistical data from the clinical investigation. e.g. Primary Objective (May include claims implicit in the intended purpose of the device as well as those made explicit in labeling, instructions for use or promotional material) To demonstrate treatment efficacy of …. long-term dev1 (it should be clearly stated whether or not the determination of long-term effects are part of the objectives of the current clinical investigation) ………in comparison to ……., as measured by a ……………… e.g. Secondary Objectives To assess safety and tolerability of dev1 in patients with…… To asses effect of dev1 treatment on quality of live To assess differences in treatment efficacy in patients with and without……………. Date Version Page 4 of 29 Study name/Acronym Department TYPE OF THE INVESTIGATION Prospective, multicenter, randomized, parallel group, double-blind, controlled, PERIOD OF ENROLMENT First patient 1Q Last patient 1Q Last patient 3Q First visit First visit Last visit CENTER(S) X centers in X country. / COUNTRY(IES) Austria PATIENTS / GROUPS XY patients in X groups XY patients per group Randomization ratio 1:1, stratification INCLUSION CRITERIA . . EXCLUSION CRITERIA COMPARATIVE DEVICE CONCOMITANT MEDICATION/CONCOMITANT DEVICE if applicable, please specify (e.g. allowed, not allowed) EFFICACY ENDPOINTS TOLERABILITY / SAFETY ENDPOINTS QUALITY OF LIFE STATISTICAL METHODOLOGY Primary Endpoint Null and alternative hypotheses: H0 H1: Type-I and -II errors - power. α ß Interim analysis . Statistical methodology . Sample size calculation. . Main analysis set Other endpoints STUDY EXTENSION Date . Version Page 5 of 29 Study name/Acronym Department 3. LIST OF ABBREVATIONS Provide a list of abbreviations used in the Clincial investigation plan Date Version Page 6 of 29 Study name/Acronym Department 4. TABLE OF CONTENTS CLINICAL INVESTIGATION PLAN (CIP) ............................................................................................ 1 1. SPONSOR, INVESTIGATOR, MONITOR AND SIGNATURES ......................................................... 3 2. SYNOPSIS OF THE CLINICAL INVESTIGATION ........................................................................... 4 3. LIST OF ABBREVATIONS.......................................................................................................... 6 4. TABLE OF CONTENTS .............................................................................................................. 7 TABLE 1. VISIT AND ASSESSMENT SCHEDULE ................................................................................. 9 5. INTRODUCTION ................................................................................................................... 10 5.1 BACKGROUND INFORMATION ........................................................................................................... 10 5.2 RATIONALE OF THE CLINICAL INVESTIGATION....................................................................................... 10 6. OBJECTIVES OF THE CLINICAL INVESTIGATION (HYPOTHESIS) ................................................ 10 6.1 PRIMARY OBJECTIVES (HYPOTHESIS) ................................................................................................. 10 6.2 SECONDARY OBJECTIVES (HYPOTHESIS) ............................................................................................. 10 7. DESIGN OF THE CLINICAL INVESTIGATION ............................................................................. 10 7.1 POPULATION ................................................................................................................................. 11 7.1.1 SUBJECT POPULATION ..................................................................................................................... 11 7.1.2 INCLUSION CRITERIA ....................................................................................................................... 11 7.1.3 EXCLUSION CRITERIA....................................................................................................................... 11 7.1.4 POINT OF ENROLMENT .............................................................................................................. 11 7.1.5 FEMALES OF CHILDBEARING AGE ....................................................................................................... 11 7.1.6 DURATION OF THE CLINICAL INVESTIGATION ....................................................................................... 11 7.1.7 WITHDRAWAL AND REPLACEMENT OF SUBJECTS .................................................................................. 11 7.1.8 PREMATURE TERMINATION OF THE CLINICAL INVESTIGATION ................................................................. 12 8. METHODOLOGY ................................................................................................................... 12 8.1 TREATMENT DURATION AND MODIFICATION ....................................................................................... 12 8.2 MEDICAL DEVICE ........................................................................................................................... 12 8.2.1 MEDICAL DEVICE AND IT´S CHARACTERISTICS: ..................................................................................... 13 8.2.2 MANUFACTURER (MODEL OR TYPE NUMBER INCLUDING SOFTWARE AND ACCESSORIES): .......................... 13 8.2.3 INSTALLATION AND HANDLING INSTRUCTIONS ..................................................................................... 13 8.2.4 INTENDED USE .............................................................................................................................. 13 8.2.5 IN/DECREASE OF THE TREATMENT FREQUENCY.................................................................................... 13 8.2.6 INTERRUPTION OF THE TREATMENT ................................................................................................... 14 8.2.7 PREMATURE PERMANENT DISCONTINUATION OF THE TREATMENT .......................................................... 14 8.2.8 PROCEDURES FOR SUBJECTS COMPLIANCE .......................................................................................... 14 8.2.9 CONCOMITANT MEDICATION ........................................................................................................... 14 8.2.10 INTERACTIONS, REVERSE REACTIONS AND SIDE EFFECT OF THE MEDICAL DEVICE: ..................................... 14 8.3 RANDOMIZATION AND STRATIFICATION: ...................................................................................... 15 8.4 BLINDING ............................................................................................................................. 15 8.4.1 EMERGENCY PROCEDURE FOR UNBLINDING ........................................................................................ 15 8.4.2 UNBLINDING AT THE END OF THE CLINICAL INVESTIGATION. ................................................................... 15 8.5 BENEFIT AND RISK ASSESSMENT ................................................................................................. 15 8.6 CLINICAL INVESTIGATION PROCEDURES ........................................................................................ 15 8.6.1 GENERAL RULES FOR CLINICAL INVESTIGATION PROCEDURES .................................................................. 15 8.6.2 SCREENING INVESTIGATION.............................................................................................................. 16 8.6.3 TREATMENT .................................................................................................................................. 16 8.6.4 LABORATORY TESTS ........................................................................................................................ 16 8.6.5 END-OF-CLINICAL INVESTIGATION (EOI) EXAMINATION ........................................................................ 16 9. SAFETY DEFINITIONS AND REPORTING REQUIREMENTS ........................................................ 16 9.1 ADVERSE EVENTS (AES)/ADVERSE DEVICE EFFECTS (ADES) ................................................................... 16 9.1.1 SUMMARY OF KNOWN AND POTENTIAL RISKS OF THE MEDICAL DEVICE .................................................... 16 9.1.2 DEFINITION OF ADVERSE EVENT AND ADVERSE DEVICE EFFECT ................................................................ 16 9.2 SERIOUS ADVERSE EVENTS (SAE)/SERIOUS ADVERSE DEVICE EFFECTS (SADES) ........................................ 17 Date Version Page 7 of 29 Study name/Acronym Department 9.2.1 HOSPITALIZATION – PROLONGATION OF EXISTING HOSPITALIZATION ....................................................... 17 9.2.2 SAES /SADE RELATED TO STUDY-MANDATED PROCEDURES .................................................................. 18 9.2.3 PREGNANCY .................................................................................................................................. 18 9.3 SEVERITY OF ADVERSE EVENTS/ADVERSE DEVICE EFFECTS ...................................................................... 18 9.4 RELATIONSHIP TO MEDICAL DEVICE ................................................................................................... 19 9.5 REPORTING PROCEDURES ................................................................................................................ 19 9.5.1 REPORTING PROCEDURES FOR SAES/SADES ...................................................................................... 20 10. FOLLOW-UP ....................................................................................................................... 20 10.1 FOLLOW-UP OF CLINICAL INVESTIGATION PARTICIPANTS INCLUDING FOLLOW-UP OF ADVERSE EVENTS .......... 20 10.2 TREATMENT AFTER END OF CLINICAL INVESTIGATION ............................................................................ 20 11. STATISTICAL METHODOLOGY AND ANALYSIS ...................................................................... 21 11.1 ANALYSIS SETS ............................................................................................................................... 21 11.2 SAMPLE SIZE CONSIDERATIONS ......................................................................................................... 21 11.3 RELEVANT CIP DEVIATIONS .............................................................................................................. 21 11.4 STATISTICAL ANALYSIS PLAN ............................................................................................................. 22 11.5 MISSING, UNUSED AND SPURIOUS DATA ............................................................................................ 22 11.6 ENDPOINTS ANALYSIS ..................................................................................................................... 22 11.6.1 PRIMARY ENDPOINT ANALYSIS ........................................................................................................ 22 11.6.2 SECONDARY ENDPOINT ANALYSIS .................................................................................................... 22 11.6.3 SAFETY AND TOLERABILITY ENDPOINTS ............................................................................................. 22 11.6.4 BASELINE PARAMETERS AND CONCOMITANT MEDICATIONS ................................................................. 22 11.6.5 EXPLORATORY ANALYSES ............................................................................................................... 22 11.7 INTERIM ANALYSIS .......................................................................................................................... 22 11.8 SOFTWARE PROGRAM(S) ................................................................................................................. 23 12. DOCUMENTATION AND DATA MANAGEMENT .................................................................... 23 12.1 DOCUMENTATION OF STUDY RESULTS ................................................................................................ 23 12.1.1 CASE REPORT FORM (CRF) ............................................................................................................ 23 12.1.2 DATA COLLECTION ....................................................................................................................... 23 12.1.3 IDENTIFICATION DATA TO BE CONSIDERED AS SOURCE DATA ................................................................ 23 12.2 SAFEKEEPING ................................................................................................................................ 24 12.3 QUALITY CONTROL AND QUALITY ASSURANCE .................................................................................. 24 12.3.1 PERIODIC MONITORING .................................................................................................................. 24 12.3.2 AUDITS AND INSPECTIONS ............................................................................................................. 25 12.4 REPORTING AND PUBLICATION ......................................................................................................... 25 12.4.1 FINAL REPORT ............................................................................................................................. 25 12.4.2 PUBLICATION OF STUDY RESULTS .................................................................................................... 25 13. ETHICAL AND LEGAL ASPECTS ............................................................................................. 25 13.1 INFORMED CONSENT OF SUBJECTS .................................................................................................... 25 13.2 ACKNOWLEDGEMENT / APPROVAL OF THE CLINICAL INVESTIGATION ....................................................... 26 13.2.1 CHANGES IN THE CONDUCT OF THE CLINICAL INVESTIGATION PLAN ...................................................... 26 13.3 INSURANCE ................................................................................................................................... 26 13.4 CONFIDENTIALITY ........................................................................................................................... 26 13.5 ETHICS AND LEGAL REQUIREMENTS ................................................................................................... 27 13.5.1 DECLARATION OF HELSINKI ............................................................................................................ 27 13.5.2 GOOD CLINICAL PRACTICE (EN ISO 14155) .................................................................................... 27 14. APPENDICES ...................................................................................................................... 28 15. REFERENCES....................................................................................................................... 29 Date Version Page 8 of 29 Study name/Acronym Department TABLE 1. VISIT AND ASSESSMENT SCHEDULE (example - please adapt to your study; this schedule should be a brief summary of the study design) PERIODS VISITS Name Duration Number Name Time SCREENING 1 Screening Days/Weeks TREATMENT 6 months 2 3 Randomization Control 1 Day 0 Week 2 ( 2 days) 4 Control 2 Week 4 ( 5 days) 5 Control 3 Week 6 ( 2 days) 6 7 Control 4 Month 2 ( 5 days) Control 5 Month 3 ( 5 days) Informed Consent Inclusion / Exclusion Criteria Medical History Concomitant/change in medication Physical Examination Body weight and height Vital Signs (BP, PR) 12-lead ECG Laboratory Tests Device related procedures 1. Device related procedures 2. Device related procedures 3. Pregnancy Test Questionnaires: SF-36 and SHQ Device Application / Return Adverse Events Serious Adverse Events/Serious Device Effects Date Version Page 9 of 29 9 8 Control 6 Month 4 ( 5 days) Control 7 Month 5 ( 5 days) 10 FOLLOW-UP 28 days 11 End of study Month 6 ( 5 days) Follow-up 3 Month 7 ( 5 days) Study name/Acronym Department 5. INTRODUCTION 5.1 Background information Provide a brief summary of the disease and conditions that are the focus of your Investigation. The magnitude, frequency, affected geographical areas, ethnic and gender considerations, etc. of the disease/condition should be followed by a brief description of the most relevant studies published on the subject. 5.2 Rationale of the clinical investigation The Rationale specifies the reasons for conducting the investigation in light of current knowledge. It should include an explicit documented statement of the need/problem is the base of the project, the cause of this problem and its possible solutions. It is the equivalent to the introduction in a clinical investigation plan and it puts the proposal in context. It should answer the question of why and what: why the investigation needs to be done and what will be its relevance. The magnitude, frequency, affected geographical areas, ethnic and gender considerations, etc. of the problem should be followed by a brief description of the most relevant investigations published on the subject as well as preclinical tests that have been performed on the device to be investigated. 6. OBJECTIVES OF THE CLINICAL INVESTIGATION (HYPOTHESIS) 6.1 Primary Objectives (Hypothesis) 6.2 Secondary Objectives (Hypothesis) Goals are broad statements of what the proposal hopes to accomplish. They create a setting for the proposal. Specific objectives are statements of the research question(s). Objectives should be simple (not complex), specific (not vague), and stated in advance (not after the research is done). After statement of the primary objective, secondary objectives may be mentioned. Hypotheses are very clear-cut statements (Null and Alternative Hypothesis) that can be verified/rejected by a statistical test. Objectives may include claims implicit in the intended purpose of the device as well as those made explicit in labeling, instructions for use or promotional material. It should be clearly stated whether or not the determinations of long term effects are part of the objectives of the current clinical investigation. 7. DESIGN OF THE CLINICAL INVESTIGATION The design of the study should include information on the type of study, the research population or the sampling frame, and who can take part (e.g. inclusion and exclusion criteria, withdrawal criteria etc.), and the expected duration of the study. Date Version Page 10 of 29 Study name/Acronym Department Please provide a schematic diagram. 7.1 Population 7.1.1 Subject population 7.1.2 Inclusion criteria 7.1.3 Exclusion criteria 7.1.4 POINT OF ENROLMENT 7.1.5 Females of childbearing age 7.1.6 Duration of the clinical investigation For the individual clinical investigation participant 7.1.7 Withdrawal and replacement of subjects Criteria for withdrawal Subjects may prematurely discontinue from the clinical investigation at any time. Premature discontinuation from the study is to be understood when the subject did not undergo EOS examination and / or all pivotal assessments during the clinical investigation, i.e. three complete dosage-time profiles. Subjects must be withdrawn under the following circumstances: at their own request if the investigator feels it would not be in the best interest of the subject to continue if the subject violates conditions laid out in the consent form / information sheet or disregards instructions by the clinical investigation personal or please indicated other reasons (e.g. regarding medical device) In all cases, the reason why subjects are withdrawn must be recorded in detail in the CRF and in the subject’s medical records. Should the clinical investigation be discontinued prematurely, all clinical investigation materials (complete, partially completed and empty CRFs) will be retained. Follow-up of patients withdrawn from the clinical investigation In case of premature discontinuation after treatment with the medical device , the investigations scheduled for the EOS visit will be performed X days after discontinuation. The subjects will be advised that participation in these investigations is voluntary. Furthermore, they may request that from the time point of withdrawal no more data will be recorded and that all biological samples collected in the course of the clinical investigation will be destroyed. Replacement policy Please describe procedure of replacement. Date Version Page 11 of 29 Study name/Acronym Department For example: Will patients be replaced (please indicate process e.g. next free subject number will be allocated...) and/or will drop-outs be included in the sample size… 7.1.8 Premature termination of the clinical investigation The sponsor has the right to close this clinical investigation at any time. The IEC and the competent regulatory authority must be informed. The clinical investigation or single dose steps will be terminated prematurely in the following cases: If adverse event/adverse devise effect occur which are so serious that the risk-benefit ratio is not acceptable If the number of dropouts is so high that proper completion of the clinical investigation cannot realistically be expected. Or please indicate other reasons 8. METHODOLOGY The methodology section is the most important part of the CIP. It should include detailed information on the interventions to be made, procedures to be used, measurements to be taken, observations to be made, laboratory investigations to be done etc. If multiple sites are engaged in a specified CIP, methodology should be standardized and clearly defined. Interventions should be described in detail, including a description of the device that is being tested. The test equipment to be used for the assessment of clinical investigation variables and the arrangements for monitoring the maintenance and calibrations should be described. Interventions could also be in the realm of social sciences for example providing training or information to groups of individuals. Procedures could be biomedical (collection of blood or sputum samples to develop a diagnostic test), or in the realm of social sciences (doing a questionnaire survey, carrying out a focus group discussion as part of formative research, observation of the participant's environment, etc.). Standardized and/or documented procedures/techniques should be described and bibliographic references, if not provided earlier should be provided. Instruments which are to be used to collect information (questionnaires, FGD guides, observation recording form, case report forms etc.) must also be provided. A list of any other device or medication to be used either during the application of the device or during the follow up period has to be described. The measures to be taken to minimize or avoid bias should be explained. In the case of randomized controlled clinical investigation additional information on the process of randomization and blinding, description of stopping rules for individuals, for part of the clinical investigation or entire clinical investigation, the procedures and conditions for breaking the codes etc. should also be described. A graphic outline of the clinical investigation design and procedures using a flow diagram must be provided. This should include the timing of assessments. 8.1 Treatment duration and modification (point of enrolment, to be specified) 8.2 Date Medical Device Version Page 12 of 29 Study name/Acronym Department please adapt for your own clinical investigation/your medical device; information due to your medical device could be used from Investigator`s Brochure/Manual for Medical Device In these sections, following issues should be described: 8.2.1 Medical device and it´s characteristics: 8.2.2 Manufacturer (Model or Type Number including software and accessories): Storage Instructions: 8.2.3 Installation and handling instructions Including a preparation for use and any intended re-use, maintainance, pre-use checks, precautions to be taken after use A summary of necessary training and experience needed for the use of the device. Delivery & storage conditions of the medical device If required, please adapt to your clinical investigation! Packaging and labeling of the medical devise Packaging shall indicate that the investigational device is exclusively for use in a clinical investigation according to applicable regulations. Please describe delivery procedures (e.g. shipment of device to site…). The labeling should be done according to local legal requirements. Labels should be written in the local language if required according to local legal regulations Please indicate a sample label. Accountability of medical devices Please indicate handling procedures regarding accountability of the medical device (e.g. Accountability will be recorded at on-going basis in paper form/source data, treatment/administration have to be entered in the eCRF too. Furthermore the correct administration of the device or any variations concerning that will be recorded in the eCRF at each visit during treatment period.) 8.2.4 Intended Use please describe in detail! Initial treatment: maintenance treatment: Administration: Patient diary: specific safety monitoring 8.2.5 In/Decrease of the treatment frequency If feasible Date Version Page 13 of 29 Study name/Acronym Department 8.2.6 Interruption of the treatment If required, please adapt to your clinical investigation and define the reasons for interruption of the treatment with the medical device and the following procedures. 8.2.7 Premature permanent discontinuation of the treatment If required, please adapt to your clinical investigation and define the reasons for premature permanent discontinuation of the treatment with medical device and the following procedures (End of Clinical investigation ……..) Premature permanent discontinuation due to an adverse event If the reason for premature permanent discontinuation of clinical investigation is an AE, the patient should have a “Premature EOS” visit with all the assessments performed before the discontinuation of the treatment with the medical device, whenever possible. Premature permanent discontinuation due to another reason than adverse event If the reason for premature permanent discontinuation of clinical investigation is not an AE, the patient should be withdrawn (withdrawal of consent) and have the EOS visit with all the assessments performed before the medical device discontinuation, whenever possible. 8.2.8 Procedures for subjects compliance Please indicate procedures for monitoring subject compliance (e.g. a patient diary will be used) 8.2.9 Concomitant medication Please adapt details to your own clinical investigation! e.g.: The well-being of the patient has the first priority, and modifications of concomitant treatment during the clinical investigation are allowed as necessary. They should be documented in the patient’s records. In this clinical investigation, all concomitant medications are allowed, with the exception of: Allowed: Not allowed: Special precautions: 8.2.10 Interactions, reverse reactions and side effect of the medical device: Please adapt to your device! Information from Investigator`s Brochure/Manual for Medical device may be used. Date Version Page 14 of 29 Study name/Acronym Department 8.3 Randomization and stratification: If required; please adapt to your own clinical investigation and describe the process of randomization and the selected system to randomize. Also provide details on the individual randomization process for clinical investigation participants e.g.: On day 0 patients are randomized to one of the two groups and the first medical devices are provided. Please also indicate which randomization procedure will be used Subjects who replace discontinuing subjects before they had a medical device use on day 1 of the first investigation period, the substitute subject will receive the same randomization number as the subject he replaces. 8.4 Blinding If required; please adapt to your own clinical investigation if required! Please set a responsible person and describe the procedure of blinding (codes, envelopes …). 8.4.1 Emergency procedure for unblinding If required; please adapt to your own clinical investigation and define “Emergency” for that unblinding procedure as well as procedure of unblinding (“Code–breaking-procedure”,” EmergencyEnvelope”.…) 8.4.2 Unblinding -procedure at the end of the clinical investigation. If required; please adapt to your own clinical investigation and describe procedure of unblinding (“Code–breaking-procedure”,” Emergency-Envelope”.…). 8.5 Benefit and risk assessment This point shall include the results of a risk analysis and assessment. This shall describe the balance of anticipated clinical benefit against the risk associated with the device itself and the procedures involved in its use This shall include an analysis of adverse device effects and any history of modification or recall in relation to safety and clinical performance in relation to both the device under investigation and devices described. 8.6 Clinical investigation procedures 8.6.1 General rules for clinical investigation procedures Date All clinical investigation measures like blood sampling and measurements (vital parameters, ECG, etc.) have to be documented with date (dd:mm:yyyy). In case several clinical investigation procedures are scheduled at the same time point, there is no specific sequence that should be followed. The dates of all procedures should be according to the CIP. The time margins mentioned in the clinical investigation flow chart are admissible. If for any reason, a clinical investigation procedure is not performed within scheduled margins a CIP deviation should be noted, and the procedure should be performed as soon as possible or as adequate. If it is necessary for organizational reasons, it is admissible to perform procedures which are scheduled for one visit at two different time points. Allowed time margins should thereby not be exceeded. Version Page 15 of 29 Study name/Acronym Department 8.6.2 Screening investigation Please provide Information on the procedures taking place at the screening investigation 8.6.3 Treatment 8.6.4 Laboratory Tests Provide detailed information on the different tests and procedures performed during the clinical investigation. E.g. Laboratory tests, ECGs, Physical examination, etc. 8.6.5 End-of-clinical investigation (EOI) examination e.g.: After treatment period (X month) patients undergo the end-of-clinical investigation examination that entails … 9. SAFETY DEFINITIONS AND REPORTING REQUIREMENTS 9.1 Adverse events (AEs)/Adverse device effects (ADEs) 9.1.1 Summary of known and potential risks of the medical device Provide a summary of all known adverse events and risks of the medical device and other interventions (preferably in a table). Use the Investigator`s Brochure. In addition to adverse event reporting, non-medical complaints such as malfunction, misuse, use error not leading to an adverse event, shall be documented throughout the clinical investigation and shall be reported as specified by local law. All complaints of a non-medical nature shall be handled under the sponsor's quality management system. 9.1.2 Definition of adverse event and adverse device effect An AE/ADE is any adverse change from the subject's baseline condition, i.e. any unfavorable and unintended sign including an abnormal laboratory finding, symptom or disease which is considered to be clinically relevant be the physician that occurs during the course of the, whether or not considered related to the medical device. Adverse event /ADE include: Exacerbation of a pre-existing disease. Increase in frequency or intensity of a pre-existing episodic disease or medical condition. Disease or medical condition detected or diagnosed after treatment with the medical device even though it may have been present prior to the start of the clinical investigation. Continuous persistent disease or symptoms present at baseline that worsen following the start of the clinical investigation. Date Version Page 16 of 29 Study name/Acronym Department Lack of efficacy in the acute treatment of a life-threatening disease. Events considered by the investigator to be related to clinical investigation-mandated procedures. Abnormal assessments, e.g., ECG and physical examination findings, must be reported as AEs/ADEs if they represent a clinically significant finding that was not present at baseline or worsened during the course of the clinical investigation. Laboratory test abnormalities must be reported as AEs/ADEs if they represent a clinically significant finding, symptomatic or not, which was not present at baseline or worsened during the course of the clinical investigation lead to interruption or permanent discontinuation of medical device. Adverse events do not include: Pre-planned interventions or occurrence of endpoints specified in the CIP are not considered AEs/ADEs, if not defined otherwise. Medical or surgical procedure, e.g. surgery, endoscopy, tooth extraction, transfusion. However, the event leading to the procedure is an AE. If this event is serious, the procedure must be described in the SAE/SADE narrative. Pre-existing disease or medical condition that does not worsen. Situations in which an adverse change did not occur, e.g., hospitalizations for cosmetic elective surgery or for social and/or convenience reasons. Misuse of either medical device or concomitant medication without any signs or symptoms. However, misuse must be mentioned in the Medical Device Inventory/ Treamtment Log. 9.2 Serious adverse events (SAE)/Serious adverse device effects (SADEs) A Serious Adverse Event (SAE)/Serious adverse device effect is defined as any AE/ADE fulfilling at least one of the following criteria: lead s to a death, lead s to a serious deterioration in the health of the subject that 1) resulted in a life-threatening illness or injury, 2) resulted in a permanent impairment of a body structure or a body function, 3) required in-patient hospitalization or prolongation of existing hospitalization, 4) resulted in medical or surgical intervention to prevent permanent impairment to body structure or a body function. leads to foetal distress, foetal death or a congenital abnormality or birth defect. is an important medical event that may not immediately result in death, be life-threatening, or require hospitalization but may be considered as SAEs/SADEs when, based upon appropriate medical judgment, it may jeopardize the subject and may require medical or surgical intervention to prevent one of the outcomes listed in the definitions above. shows the occurance of a malignant tumor (§3 (16) MPG). Life-threatening refers to an event in which the subject was at risk of death at the time of the event. It does not refer to an event that hypothetically might have caused death if it were more severe. 9.2.1 Hospitalization – Prolongation of existing hospitalization Hospitalization is defined as an overnight stay in a hospital unit and/or emergency room. An additional overnight stay defines a prolongation of existing hospitalization. The following is not considered an SAE/SADE and should be reported as an AE/ADE only: Date Version Page 17 of 29 Study name/Acronym Department Treatment on an emergency or out subject basis for an event not fulfilling the definition of seriousness given above and not resulting in hospitalization. The following reasons for hospitalizations are not considered AEs, and therefore not SAEs: Hospitalizations for cosmetic elective surgery, social and/or convenience reasons. Standard monitoring of a pre-existing disease or medical condition that did not worsen, e.g., hospitalization for coronary angiography in a subject with stable angina pectoris. Elective treatment of a pre-existing disease or medical condition that did not worsen, e.g., hospitalization for chemotherapy for cancer, elective hip replacement for arthritis. 9.2.2 SAEs /sADE related to study-mandated procedures Such SAEs /SADEs are defined as SAEs/SADEs that appear to have a reasonable possibility of causal relationship (i.e., a relationship cannot be ruled out) to study-mandated procedures (excluding administration of medical device) such as discontinuation of subject's previous treatment or complication of a mandated invasive procedure (e.g., blood sampling, heart catheterization), or car accident on the way to the hospital for a study visit, etc. 9.2.3 Pregnancy Any pregnancy that occurs during study participation must be reported to the principal investigator/sponsor. To ensure subject safety, each pregnancy must be reported to the principal investigator/sponsor immediately. A pregnancy must be followed up to determine outcome (including premature termination) and status of mother and child. Pregnancy complications and elective terminations for medical reasons must be reported as an AE/ADE or SAE. Spontaneous abortions must be reported as an SAE. Any SAE occurring in association with a pregnancy,brought to the investigator’s attention after the subject has completed the study and considered by the investigator as possibly related to the investigational product, must be promptly reported to the principal investigator/sponsor. In addition, the investigator must attempt to collect pregnancy information on any female partners of male study subjects who become pregnant while the subject is enrolled in the study. Pregnancy information must be reported to the principal investigator/sponsor as described above. Please enter the address of Investigator/Sponsor! 9.3 Severity of adverse events/adverse device effects The severity of clinical AEs /ADEs is graded on a three-point scale: mild, moderate, severe, and reported on specific AE pages of the CRF. If the severity of an AE/ADE worsens during medical device administration, only the worst intensity should be reported on the AE page. If the AE lessens in intensity, no change in the severity is required. Mild Event may be noticeable to subject; does not influence daily activities; the AE /ADE resolves spontaneously or may require minimal therapeutic intervention; Moderate Event may make subject uncomfortable; performance of daily activities may be influenced; intervention may be needed; the AE/ADE produces no sequelae. Date Version Page 18 of 29 Study name/Acronym Department Severe Event may cause noticeable discomfort; usually interferes with daily activities; subject may not be able to continue in the study; the AE/ADE produces sequelae, which require prolonged therapeutic intervention. A mild, moderate or severe AE/ADE may or may not be serious. These terms are used to describe the intensity of a specific event (as in mild, moderate, or severe myocardial infarction). However, a severe event may be of relatively minor medical significance (such as severe headache) and is not necessarily serious. For example, nausea lasting several hours may be rated as severe, but may not be clinically serious. Fever of 39°C that is not considered severe may become serious if it prolongs hospital discharge by a day. Seriousness rather than severity serves as a guide for defining regulatory reporting obligations. 9.4 Relationship to medical device For alls, the investigator will assess the causal relationship between the medical device and the AE/ADE using his/her clinical expertise and judgment according to the following algorithm that best fits the circumstances of the AE/ADE: Unrelated May or may not follow a reasonable temporal sequence from administration of the study product Is biologically implausible and does not follow known response pattern to the suspect medical device (if response pattern is previously known) Can be explained by the known characteristics of the subject’s clinical state or other modes of therapy administered to the subject. Possible related Follows a reasonable temporal sequence form administration of the medical device. May follow a known response pattern to the medical device (if response pattern is previously known). Could not be reasonable not be reasonably explained by the known characteristics of the subject’s clinical state or other modes of therapy administered to the subject, if applicable. Definitely related Follows a reasonable temporal sequence form administration of the medical device . Follows a known response pattern to the medical device (if response pattern is previously known). No other reasonable cause is present. 9.5 Reporting procedures A special section is designated to adverse events/ADEs in the case report form. The following details must thereby be entered: Type of adverse event/ADE Start (date and time) End (date and time) Severity (mild, moderate, severe) Serious (no / yes) Unexpected (no / yes) Date Version Page 19 of 29 Study name/Acronym Department Outcome (resolved, ongoing, ongoing – improved, ongoing – worsening) Relation to medical device (unrelated, possibly related, definitely related) Device related adverse events are to be documented in the case report form in accordance with the above mentioned criteria and reported to the Sponsor. 9.5.1 Reporting procedures for SAEs/SADEs In the event of serious, the investigator has to use all supportive measures for best patient treatment. A written report is also to be prepared and made available to the clinical investigator immediately.The following details should be at least available: Patient initials and number Patient: date of birth, sex, ethical origin The suspected medical device The adverse event assessed as serious Short description of the event and outcome Device related or non-device related The written report is divided into two parts: Initial report: Informs about what has happened (AE/ADE assessed as serious), if there is a relationship to the medical device … and which action was set. Follow up-Report: informs about the outcome The Sponsor is responsible for the classification of adverse events and ongoing safety evaluation of the clinical investigation and shall: review the investigators assessment of all adverse events and determine and document in writing their seriousness and relationship to the investigational device; in case of disagreement between the sponsor and principal investigator(s) review all devices deficiencies and determine and document in writing whether they could have led to a serious adverse device effect; in case of disagreement between the sponsor an the principal investigator(s) report or ensure the reporting , to the EC and regulatory authorities (AGES) of all serious adverse events and devices. 10. FOLLOW-UP 10.1 Follow-up of clinical investigation participants including follow-up of adverse events The clinical investigation plan must give a clear indication of what follow up will be provided to the research participants and for how long. This may include a follow up, especially for adverse events, even after data collection for the clinical investigation is completed. 10.2 Treatment after end of clinical investigation Please adapt to your clinical investigation! Describe whether there is a treatment after end of clinical investigation or not, and describe their treatment in the event of expiry Date Version Page 20 of 29 Study name/Acronym Department 11. STATISTICAL METHODOLOGY AND ANALYSIS The clinical investigation plan should provide information on how the data will be managed, including data handling and coding for computer analysis, monitoring and verification. The statistical methods proposed to be used for the analysis of data should be clearly outlined, including reasons for the sample size selected, power of the study, level of significance to be used, procedures for accounting for any missing or spurious data etc. For projects involving qualitative approaches, specify in sufficient detail how the data will be analyzed. Please also indicate criteria for termination of the clinical investigation. 11.1 Analysis sets Define the analysis sets used in detail e.g. Two different analysis sets are defined: Intention to treat set This analysis set includes subjects who were randomized and received at least one dose medical device This analysis set should preferably be chosen for efficacy and safety assessment Per-protocol set This analysis set comprises all subjects who were treated with the medical device (at least one dose) and did not violate the CIP in a way that might affect the evaluation of the effect of the medical device on the primary objective, i.e., without major CIP violations. Define allowed CIP violations as comprehensive as possible (for instances specify the percentage of treatment with medical device necessary etc.) In certain circumstances this set can be employed in the analysis of efficacy variables. 11.2 Sample size considerations Provide information about the sample size you have chosen for your study. A formal sample size calculation employing established biometric methods should preferably be presented. The statistical test used as well as the alpha-error and the power of this calculation should be presented. The underlying data for the calculation (i.e. expected difference, variation of the primary outcome) should be supported by a literature reference. The sample size calculation should be based on the primary outcome (justification is needed if another endpoint is chosen). If no formal sample size calculation is performed, the sample size should at least be strongly justified in detail with supporting literature. 11.3 Date Relevant CIP deviations Version Page 21 of 29 Study name/Acronym Department Please describe, how potential CIP deviations will be assessed and classified into minor and major deviations and how to deal with these deviations (e.g. major deviations regarding to subjects safety will lead to withdrawal). Major and minor CIP deviations will be identified by medically trained staff before the study closure. All CIP deviations will be listed in the study report. No deviations from the CIP and of any type will be made without complying with all IRB/EC established procedures in accordance with applicable regulations. 11.4 Statistical analysis plan Please adapt to your study. A statistical analysis plan (SAP) will provide full details of the analyses, the data displays and the algorithms to be used for data derivations. The SAP furthermore will include definitions of major and minor CIP deviations and the link of deviations to the analysis set, which also will be covered in the final study report. Procedures of reporting any deviations from the original statistical plan (any deviations from the original statistical plan should be described and justified in the CIP and/or in the final report, as appropriate. 11.5 Missing, unused and spurious data Please describe and justify, how to deal with missing, unused and spurious data. Please describe the statistical methods in place for missing or unused data (e.g. last observation carried forward) as comprehensive as possible. 11.6 Endpoints analysis Provide details about the primary and secondary endpoint analyses, including the statistical tests that will be used 11.6.1 Primary endpoint analysis 11.6.2 Secondary endpoint analysis 11.6.3 Safety and tolerability endpoints 11.6.4 Baseline parameters and concomitant medications 11.6.5 Exploratory analyses 11.7 Interim analysis Specify if an interim analysis is performed and give alpha and power for this analysis. State if this analysis is done for futility only or also for efficacy. Criteria for the termination of the clinical invetigation: Date Version Page 22 of 29 Study name/Acronym Department Please provide statistical reasoning (e.g. thresholds for the interim analysis) for study termination. If applicable. 11.8 Software program(s) 12. DOCUMENTATION AND DATA MANAGEMENT 12.1 Documentation of study results A subject screening and enrollment Log will be completed for all eligible or non-eligible subjects with the reasons for exclusion. 12.1.1 Case report form (CRF) Please indicate whether a “Paper-CRF*” or an”e-CRF” will be used and adapt section below to your study. For each subject enrolled, regardless of medical device initiation, a CRF must be completed and signed by the principal investigator or co-investigator. This also applies to those subjects who fail to complete the study. If a subject withdraws from the study, the reason must be noted on the CRF. Case report forms are to be completed on an ongoing basis. CRF entries and corrections will only be performed by study site staff, authorized by the investigator. In a “Paper-CRF” all forms should be completed using a black pen and must be legible*. Errors should be crossed out but not obliterated, the correction inserted, and the change initialed and dated by the investigator, co-investigator or study nurse. The entries will be checked by trained personnel (Monitor) and any errors or inconsistencies will be checked immediately. The monitor will collect original completed and signed CRFs at the end of the study. A copy of the completed and signed CRFs will remain on site. Please indicate a responsible person, to whom original CRF´s would be passed. f.e.: Data Manager… Special provisions may apply for electronic CRFs 12.1.2 Data Collection Data collected at all visits are entered into an interactive form. The CRFs will be source documents verified following guidelines established before study onset as detailed in the Monitoring Plan. Maintenance of the study database will be performed by …… Please adapt for your own study 12.1.3 Identification data to be considered as source data Please indicate if any data to be considered to be source data and therefore to be directly entered on the CRF. Date Version Page 23 of 29 Study name/Acronym Department 12.2 Safekeeping The investigator will maintain adequate and accurate records to enable the conduct of the study to be fully documented and the study data to be subsequently verified. These documents will be classified into two different categories: investigator's file, and subject clinical source documents. The investigator's file will contain the CIP/amendments, IB/Manual for Medical Device, CRFs (eCRF printout), standard operation procedures (SOPs), data clarification and query forms, EC/IRB and Health Authority approval with correspondence, informed consent, drug records, staff curriculum vitae and authorization forms, screening and enrollment logs, and other appropriate documents/correspondence as per EUROPENAN Standard of EN ISO 14155 (incl. GCP) and local regulations. Subject clinical source documents include, but are not limited to subject hospital/clinic records, physician’s and nurse’s notes, appointment book, original laboratory reports, ECG, X-ray, pathology and special assessment reports, consultant letters, etc. These two categories of documents must be kept on file by the investigator for as long as needed to comply with national and international regulations (in Austria 15 years after discontinuing clinical development or after the last marketing approval). If source documents are not durable as long as needed (e.g. ECG printouts) they must be preserved as a copy. No study document should be destroyed without prior written approval from the Department of …… When source documents are required for the continued care of the subject, appropriate copies should be made for storing outside of the site. 12.3 Quality Control and Quality Assurance Please adapt to your own study 12.3.1 Periodic Monitoring The monitor will contact and visit the investigator regularly and will be allowed, on request, to have access to all source documents needed to verify the entries in the CRFs and other CIP-related documents provided that subject confidentiality is maintained in agreement with local regulations. It will be the monitor's responsibility to inspect the CRFs at regular intervals throughout the study, to verify the adherence to the CIP and the completeness, consistency and accuracy of the data being entered on them. The monitoring standards require full verification for the presence of informed consent, adherence to the inclusion/exclusion criteria, documentation of SAEs/SADEs and the recording of the main efficacy, safety, and tolerability endpoints. To be ISO 14155 compliant at least 3 monitoring visits are scheduled. An initiation visit, one routine visit and a final visit after the last patient had finished the study. The monitor will be working according to SOPs and will provide an ISO 14155-compliant monitoring report after each visit for the sponsor and the investigator. Depending on the quality of the data, additional monitoring visits will be necessary according to the sponsor’s discretion. Monitoring will be performed by………… Please adapt for your own studyPlease indicate the number and frequency of planned monitoring visits as well as the planned percentage of “Source Data Verification” (SDV). e.g: 6 monitoring visits are planned ; monitoring visits will be performed every 6 weeks, 100% of source data will be checked by the monitor (which means 100% SDV). Date Version Page 24 of 29 Study name/Acronym Department 12.3.2 Audits and Inspections Upon request, the investigator will make all study-related source data and records available to a qualified quality assurance auditor mandated by the sponsor or to regulatory authority inspectors. The main purpose of an audit or inspection is to confirm that the rights and welfare of the subjects have been adequately protected, and that all data relevant for assessment of safety and efficacy of the investigational product have appropriately been reported to the sponsor. 12.4 Reporting and Publication Please adapt to your own study. 12.4.1 Final report Within one year after the final completion of the study, a full Final Report will be written by……………………….. (please indicate the responsible person for this issue) The Principal Investigator will be asked to review and sign the Final Report. 12.4.2 Publication of study results (Example; please adapt to your own study): The findings of this study will be published by the sponsor (investigators) in a scientific journal and presented at scientific meetings. The manuscript will be circulated to all co-investigators before submission. Confidentiality of subjects in reports/publications will be guaranteed. You can also mention here who will be first author or corresponding author and determine who qualifies for authorship. Timelines (e.g.: writing of the full article within 6 months after finishing the study) can also be given. 13. ETHICAL AND LEGAL ASPECTS 13.1 Informed consent of subjects Following comprehensive instruction regarding the nature, significance, impact and risks of this clinical investigation, the patient must give written consent to participation in the study. During the instruction the patients are to be made aware of the fact that they can with-draw their consent – without giving reasons – at any time without their further medical care being influenced in any way. In addition to the comprehensive instructions given to the patients by the investigator, the patients also receive a written patient information sheet in comprehensible language, explaining the nature and purpose of the study and its progress. The patients must agree to the possibility of study-related data being passed on to relevant authorities. The patients must be informed in detail of their obligations in relation to the proband insurance in order not to jeopardize insurance cover. Date Version Page 25 of 29 Study name/Acronym Department 13.2 Acknowledgement / approval of the clinical investigation The investigator (or a designated CRO) will submit this CIP and any related document provided to the subject (such as subject information used to obtain informed consent) to an Ethics Committee (EC) or Institutional Review Board (IRB). Approval from the committee must be obtained before starting the clinical investigation, and should be documented in a dated letter to the investigator. Serious Adverse Events /Serious Adverse Device Effects have to be reported to the ethics committee and to the Austrian Agency for health and Food Safety (AGES). Adverse events / Adverse device effects- whether serious and/or unexpected, and possibly endangering the safety of the study participants are likewise to be reported to the ethics committee. The clinical investigation shall be performed in full compliance with the valid legal regulations according to the Medical Device Law (MPG Medizinproduktegesetz as actual amendet) of the Republic of Austria and the ISO 14155 (as actual amended) The study must be notified to the Austrian Agency for Health and Food Safety (AGES) and Ethics Committee. 13.2.1 Changes in the Conduct of the Clinical Investigation Plan Amendments of the clinical investigation plan Proposed amendments must be submitted to the appropriate CA and ECs. Substantial amendments may be implemented only after CA/EC approval has been obtained. Amendments that are intended to eliminate an apparent immediate hazard to subjects may be implemented prior to receiving CA/EC approval. However, in this case, approval must be obtained as soon as possible after implementation. Termination of the clinical investigation If the sponsor or the investigator decides to terminate the clinical investigation before it is completed, they will notify each other in writing stating the reasons of early termination. In terminating the study, the sponsor and the investigator will ensure the adequate consideration is given to the protection of the subject interests. The investigator, sponsor or designated CRO will notify the relevant regulatory authorities and EC. Documentation will be filed in the Trial Master (Clinical Investigation) clinical investigationand Investigator Files. 13.3 Insurance During their participation in the clinical investigation the patients will be insured as defined by legal requirements. The principal investigator of the clinical investigation will receive a copy of the insurance conditions of the 'patients insurance'. The sponsor is providing insurance in order to indemnify (legal and financial coverage) the investigator/center against claims arising from the clinical investigation, except for claims that arise from malpractice and/or negligence. The compensation of the subject in the event of clinical investigation-related injuries will comply with the applicable regulations. Details on the existing patients insurance are given in the patient information sheet. Please indicate insurance details 13.4 Confidentiality Please adapt to your own study. Date Version Page 26 of 29 Study name/Acronym Department The information contained in this document, especially unpublished data, is the property of the……... It is therefore provided to you in confidence as an investigator, potential investigator, or consultant, for review by you, your staff, and an Ethics Committee or Institutional Review Board. It is understood that this information will not be disclosed to others without written authorization from…………., except to the extent necessary to obtain informed consent from those persons to whom the medical device may be treated with. 13.5 Ethics and legal requirements 13.5.1 Declaration of Helsinki The investigator will ensure that this study is conducted in full conformance with the principles of the "Declaration of Helsinki" (as amended at the 56th WMA General Assembly, Tokyo, Japan, 2008). 13.5.2 Good Clinical Practice (EN ISO 14155) ISO 14155 addresses good clinical practices for the design, conduct, recording and reporting of clinical investigations carried out in human subjects to assess the safety and performance of medical devices for regulatory purposes . It specifies general requirements intended to: protect the rights, safety and well-being of human subjects, ensure the scientific conduct of the clinical investigation and the credibility of the clinical investigation results, assist sponsors, monitors, investigators, ethics committees, regulatory authorities and other bodies involved in the conformity assessment of medical devices. The principal investigator of the clinical investigation shall guarantee that only appropriately trained personnel will be involved in this. All clinical investigations must follow the EUROPENAN Standard of EN ISO 14155 and, if applicable, the Code of Federal Regulations (USA). In other countries in which EN ISO Guidelines exist, the investigators will strictly ensure adherence to the stated provisions. Therefore this study follows the EN ISO Guidelines embedded in the Austrian medical device act. Date Version Page 27 of 29 Study name/Acronym Department 14. APPENDICES Date e. g. Informed Consent Form ( Version; Date ), Manual of medical Device, IB etc. Version Page 28 of 29 Study name/Acronym Department 15. REFERENCES Provide References in Vancouver Style (http://www.icmje.org/) Date Version Page 29 of 29