ISO 10993-1：2018規格、生体適合性 「医療機器またはアイテムが特定のアプリケーションで適切なホスト応答を使用して実行する能力」 として定義します。. 生体適合性試験を実施する目的は、人間が使用するデバイスの適合性を判断し、デバイスの使用が潜在 ... Dec 16, 2020 · 1 file , 1.6 MB Same As: ISO 10993-1:2018 Product Code(s): 30344602, 30344602, 30344602 Note: This product is unavailable in Ukraine, Russia, Belarus Document History. BS EN ISO 10993-1:2020 currently viewing. December 2020 Biological evaluation of medical devices-Evaluation and testing within a risk management process ISO 18562-1:2017 does not address biological evaluation of the surfaces of medical devices that are in direct contact with the patient. The requirements for direct contact surfaces are found in the ISO 10993 series. The ISO 10993-5 standard. The title of EN ISO 10993-5 is “Biological evaluation of medical devices — Part 5: Tests for in vitro cytotoxicity.”. At 46 pages long, the standard is relatively manageable. Much of the standard (Annexes A-D) is devoted extensively to how to implement specific test setups and is primarily of interest for ... As described in ISO 10993-1:2018, this term is used by the regulated medical device community to also include devices used for less than 30 days as a “medical device which is intended to be ...The purpose of this guidance is to provide further clarification and updated information on the use of International Standard ISO 10993-1, "Biological evaluation of medical devices - Part 1:... Apr 7, 2020 · ISO 10993-1:2018 applies to biological evaluation of active, non-active, implantable, and non-implantable medical devices. The materials this standard evaluates are expected to have direct contact with either the patient’s body during the intended use of the medical device or, if used for protection, the user’s body, (as with surgical ... Direct Contact Method Liquid/Semi-Solid or 1 Extract ISO 10993-5; USP <87> 1 device (72 cm2) 1 device (36 cm2) Neutral Red Uptake (NRU) - Elution or Direct Contact Liquid/Semi-Solid or 1 Extract ISO 10993-5 1 device (72 cm 2) 1 device (36 cm )The ISO 10993 series is applicable when the material or medical device has direct or indirect body contact (see ISO 10993-1 for categorization by nature of body contact). This document is intended for suppliers of materials and manufacturers of medical devices, to support a biological evaluation. Partial recognition.Below the list of harmonized standards for medical device for your reference and search. For latest update check the official page. Title of the standard. EN 285:2006+A2:2009 Sterilization – Steam sterilizers – Large sterilizers. EN 455-1:2000 Medical gloves for single use – Part 1: Requirements and testing for freedom from holes.ANSI/AAMI/ISO 10993-1: 2018 Biological evaluation of medical devices - Part 1: Evaluation and testing within a risk management process. This document specifies: - the general principles governing the biological evaluation of medical devices within a risk management process; - the general categorization of medical devices based on the nature and duration of their contact with the body; - the ...Preview. This document specifies: — the general principles governing the biological evaluation of medical devices within a risk management process; — the general categorization of medical devices based on the nature and duration of their contact with the body; — the evaluation of existing relevant data from all sources; — the ...ISO 10993-1:2018(E) Foreword ISO (the International Organization for Standardization) is a worldwide federation of national standards bodies (ISO member bodies). The work of preparing International Standards is normally carried out through ISO technical committees. Each member body interested in a subject for which a technicalThe purpose of this guidance is to provide further clarification and updated information on the use of International Standard ISO 10993-1, "Biological evaluation of medical devices - Part 1:... 1. ISO 10993-1 (2018) 소개 발표자료. 2. ISO 10993 (생물학적안전성) 국제규격 동향 발표자료 (2019.12) 의료기기산업 미래를 향한 연속 제언 ②인체접촉 의료기기의 안전성 평가 패러다임 변화원재료, 물리·화학적 특성, 위험평가 및 생물학적 안전성 시험 간 상호 연계 ...ISO 10993-1:2018(E) Foreword ISO (the International Organization for Standardization) is a worldwide federation of national standards bodies (ISO member bodies). The work of preparing International Standards is normally carried out through ISO technical committees. Each member body interested in a subject for which a technical ISO 10993-1:2018(E) Foreword ISO (the International Organization for Standardization) is a worldwide federation of national standards bodies (ISO member bodies). The work of preparing International Standards is normally carried out through ISO technical committees. Each member body interested in a subject for which a technical ISO 10993 and RISK ISO 10993 is intended as a guidance to determine the potential biological risks arising from the use of medical devices. Meaning, what is the risk of my materials and processes to the patient? ISO 10993-1: Biological evaluation of medical devices – Part 1: Evaluation and testing within a risk management processISO 10993-1 Medical devices Biocompatibility evaluation and testing ISO 10993-17 Medical devices Establishment of allowable limits for leachable substances ISO 10993-18 Medical devices Chemical characterization of materials ICH M7 Pharmaceuticals DNA reactive (mutagenic) impurities There are several important uses for chemical characterization, each with a numbered designation. For example, ISO 10993-1 and ISO 10993-14971 are used as part of an assessment for the overall biological safety of a medical device. By contrast, ISO 10993-17 measures the level of a leachable substance.10 hours ago · Persons unable to download an electronic copy of “Use of International Standard ISO 10993–1, `Biological evaluation of medical devices—Part 1: Evaluation and testing within a risk management process' ” may send an email request to [email protected] to receive an electronic copy of the document. Please use the document number ... 10 hours ago · Persons unable to download an electronic copy of “Use of International Standard ISO 10993–1, `Biological evaluation of medical devices—Part 1: Evaluation and testing within a risk management process' ” may send an email request to [email protected] to receive an electronic copy of the document. Please use the document number ... duration of patient contact outlined in ISO 10993-1: "Biological evaluation of medical devices -Part 1: Evaluation and testing within a risk management process." Results of testing demonstrates that the materials used in the construction of the needle and catheter in the proposed Contiplex FX Continuous The first part of the series, ISO 18562-1:2017, covers general principles regarding biocompatibility assessment of medical device materials, which make up the gas pathway as a risk-based approach. The main discussed change in ISO 10993-1:2018 is, however, the revised Annex A, Endpoints to be addressed in a biological risk assessment, which The biological evaluation (or biocompatibility test) of your medical device is a mandatory part of the conformity assessment. Biological evaluations of medical devices are risk-management activities and need to be planned in advance according to ISO 10993-1 and ISO 14971. We guide you through the complete process, including the preparation of ...Introduction. The primary aim of this document is the protection of humans from potential biological risks arising from the use of medical devices. It is compiled from numerous International and national standards and guidelines concerning the biological evaluation of medical devices.A Biological Evaluation Plan (BEP) is an initial risk assessment offered by Nelson Labs is intended to meet the objectives outline in ISO 10993-1, clause 4 “General principles applying to biological evaluation of medical devices.” The first part of this clause states specifically that “The biological evaluation shall be planned, carried ...EN ISO 10993-1:2020. Current. Add to Watchlist. Biological evaluation of medical devices - Part 1: Evaluation and testing within a risk management process (ISO 10993-1:2018, including corrected version 2018-10)Dec 1, 2020 · Other parts of ISO 10993 cover specific aspects of biological assessments and related tests. Devicespecific or product standards address mechanical testing. This document excludes hazards related to bacteria, moulds, yeasts, viruses, transmissible spongiform encephalopathy (TSE) agents and other pathogens. Limitations of ISO 10993-1:2018. The biological safety evaluation should sit within a manufacturer’s risk management process and quality management system, and the recommendations of the ISO 10993 series should be applied. Figure 1 of ISO 10993-1:2018 2 provides a matrix of tests per device categorization. It is important to bear in mind that ...Introduction. The primary aim of this document is the protection of humans from potential biological risks arising from the use of medical devices. It is compiled from numerous International and national standards and guidelines concerning the biological evaluation of medical devices.ISO 10993-1 Corrected 2018-10 Biological evaluation of medical devices — Evaluation and testing within a risk management process Évaluation biologique des dispositifs médicaux — Partie 1: Évaluation et essais au sein d'un processus de gestion du risque ISO Reference 10993-1:2018(E) © ISO 2018 COPYRIGHT PROTECTED DOCUMENT be on reproduced reserved. Limitations of ISO 10993-1:2018. The biological safety evaluation should sit within a manufacturer’s risk management process and quality management system, and the recommendations of the ISO 10993 series should be applied. Figure 1 of ISO 10993-1:2018 2 provides a matrix of tests per device categorization. It is important to bear in mind that ...Jan 14, 2019 · Guidance for Industry and Food and Drug Administration Staff: Use of International Standard ISO 10993-1, "Biological evaluation of medical devices--Part 1: Evaluation and testing within a risk management process", Issued June 2016. Updated September 2020. Apr 1, 1998 · ISO 10993. Required for all types of medical devices, cytotoxicity testing is a key element of the international standards. The international standards compiled as ISO 10993, and the FDA blue book memorandum (#G95-1) that is based on 10993-1, address the critical issue of ensuring device biocompatibility by identifying several types of tests for use in selecting device materials. Direct Contact Method Liquid/Semi-Solid or 1 Extract ISO 10993-5; USP <87> 1 device (72 cm2) 1 device (36 cm2) Neutral Red Uptake (NRU) - Elution or Direct Contact Liquid/Semi-Solid or 1 Extract ISO 10993-5 1 device (72 cm 2) 1 device (36 cm )The ISO 10993 series is applicable when the material or medical device has direct or indirect body contact (see ISO 10993-1 for categorization by nature of body contact). This document is intended for suppliers of materials and manufacturers of medical devices, to support a biological evaluation. ISO 10993 and RISK ISO 10993 is intended as a guidance to determine the potential biological risks arising from the use of medical devices. Meaning, what is the risk of my materials and processes to the patient? ISO 10993-1: Biological evaluation of medical devices – Part 1: Evaluation and testing within a risk management processDec 16, 2020 · 1 file , 1.6 MB Same As: ISO 10993-1:2018 Product Code(s): 30344602, 30344602, 30344602 Note: This product is unavailable in Ukraine, Russia, Belarus Document History. BS EN ISO 10993-1:2020 currently viewing. December 2020 Biological evaluation of medical devices-Evaluation and testing within a risk management process Refer to FDA’s Biocompatibility Guidance on Use of ISO 10993-1, Attachment A for details on which endpoints are included in ISO 10993-1 recommendations and which are additional FDA recommended ...ISO 10993-1:2018 (E) . ISO 10993-3, Biological evaluation of medical devices — Part 3: Tests for genotoxicity, carcinogenicity and. reproductive toxicity. ISO 10993-4, Biological evaluation of medical devices — Part 4: Selection of tests for interactions with blood. ISO/TR 10993-19 1, Biological evaluation of medical devices ? Part 19: Physico-chemical, morphological and topographical characterization of materials : The latest version of a key horizontal Standard used for the biological evaluation of medical devices has been published by NSAI. I.S. EN ISO 1993-1:2020 - "Biological evaluation of medical devices - Part 1: Evaluation and testing within a risk management process" is a fundamental Standard in evaluating the biological testing of medical devices. The horizontal StandaAug 27, 2023 · GB/T 16886.1-2011 / ISO 10993-1. 2009 Replacing GB/T 16886.1-2001 Biological evaluation of medical devices -- Part 1. Evaluation and testing within a risk management process (ISO 10993-1. 2009, IDT) ISSUED ON. JUNE 16, 2011 IMPLEMENTED ON. NOVEMBER 01, 2011 Issued by. General Administration of Quality Supervision, Inspection and Sep 15, 2020 · The guidance specifically addresses ISO 10993-1, “Biological evaluation of medical devices – Part 1: Evaluation and testing within a risk management process.” Key components of the new FDA biocompatibility guidance. Major elements of the updated final guidance on ISO 10993-1 include the following: Dec 2, 2021 · Limitations of ISO 10993-1:2018. The biological safety evaluation should sit within a manufacturer’s risk management process and quality management system, and the recommendations of the ISO 10993 series should be applied. Figure 1 of ISO 10993-1:2018 2 provides a matrix of tests per device categorization. It is important to bear in mind that ... The latest version of a key horizontal Standard used for the biological evaluation of medical devices has been published by NSAI. I.S. EN ISO 1993-1:2020 - "Biological evaluation of medical devices - Part 1: Evaluation and testing within a risk management process" is a fundamental Standard in evaluating the biological testing of medical devices. The horizontal Standa Ref. No. EN ISO 10993-18:2020 E National foreword This British Standard is the UK implementation of EN ISO 10993‑18:2020. It is identical to ISO 10993‑18:2020. It supersedes BS EN ISO 10993‑18:2009, which is withdrawn. The UK participation in its preparation was entrusted to Technical Committee CH/194, Biological evaluation of medical ... ISO 10993-1, Biological Evaluation of Medical Devices - Part 1: Evaluation and Testing within a Risk Management Process, is the most widely used standard for assessing the biocompatibility of medical devices and materials, and provides a framework for determining the appropriate biocompatibility steps for planning a biological evaluation.ISO 10993 การประเมินทางชีวภาพของเครื่องมือแพทย์—ส่วนที่ 1: การประเมินและการทดสอบภายในกระบวนการจัดการความเสี่ยง เป็นกรอบการทำงานสำหรับกำหนดการ ... Based on ISO 10993-1, the BRA is the process of evaluating the device and the related manufacturing from biological risks point of view. It can be considered a part of the risk management process. Biological evaluation of medical devices shall begin with the so-called Biological Risk Assessment (BRA). This basically shall include an assessment ...Jun 2, 2021 · Therefore, ISO 10993-12:2021 now clearly states that it defines requirements and gives guidance on the procedures in the preparation of samples and the selection of reference materials for medical device testing primarily in biological test systems in accordance with one or more parts of the ISO 10993 series. The recommended sample preparation ... relevant to other biocompatibility standards (e.g., other parts of the ISO. 3 . 3. 10993 series of standards, ASTM, 4. ICH, 5. OECD, 6. USP. 7). This document discusses the following topics: · use of risk assessments for biocompatibility evaluations for a proposed medical device; · use of ISO 10993-1 and the FDA-modified matrix (Attachment A ...The biological evaluation (or biocompatibility test) of your medical device is a mandatory part of the conformity assessment. Biological evaluations of medical devices are risk-management activities and need to be planned in advance according to ISO 10993-1 and ISO 14971. We guide you through the complete process, including the preparation of ... In January 2021, the long-awaited new member in the family – ISO 10993-23:2021, Biological evaluation of medical devices-Part 23: Tests for irritation – was released. This standard specifies the procedure for the assessment of the irritating potential of medical devices, materials, or their extracts. It is relevant to all directly or ...It is not intended to replace any policies specified in Use of International Standard ISO 10993-1, "Biological evaluation of medical devices - Part 1: Evaluation and testing within a risk ...Not includedin MDD or ISO 10993‐ 1:2018 ‐ Not withinscope of biological evaluation ISO 10993‐1: final product, subjected to all manufacturing processes, must be evaluated. (Includes all constituents, processing aids, packaging, sterilization, etc.) ISO 10993‐1When MOS > 1 : the toxicological risk can be assessed to be tolerable. When MOS ≤1 : additional toxicological risk factors that reduce/limit exposure or benefit/risk assessment (according to ISO 10993-1:2018) : Appropriate tests (biocompatibility tests) Clinical experience Other relevant informations .. When MOS > 1 : the toxicological risk can be assessed to be tolerable. When MOS ≤1 : additional toxicological risk factors that reduce/limit exposure or benefit/risk assessment (according to ISO 10993-1:2018) : Appropriate tests (biocompatibility tests) Clinical experience Other relevant informations .. ASTM F2100 / ISO 374-5 / ISO 13688 / ISO 10993-1 - Medical Personal Protective Equipment Package; BS EN 62366 / BS EN ISO 14971 / BS EN ISO 20417 / ISO 10993-1 - Medical Devices PackageThe medical devices tests in this package are for system toxicity, hypersensitivity, local effects after implantation, genotoxicity, carcinogenicity, reproductive toxicity and interactions with blood. This package is 45% off the individual list price and includes the following standards: ISO 10993-1:2018. ISO 10993-2:2022. ISO 10993-1:2018(E) Foreword ISO (the International Organization for Standardization) is a worldwide federation of national standards bodies (ISO member bodies). The work of preparing International Standards is normally carried out through ISO technical committees. Each member body interested in a subject for which a technicalISO/TR 10993-19 1, Biological evaluation of medical devices ? Part 19: Physico-chemical, morphological and topographical characterization of materials : ISO 10993-1-2018 is the 5th edition of the biocompatibility standard for the evaluation of medical devices. The new version, released in August, replaces the 2009 version of the standard. I was unable to find a European version of this standard, but you can expect one to be made available very soon–probably before you read this article.(ISO 10993‐1:2018 Clause 4.1) ISO 14971 is a normative reference of ISO 10993‐1 and therefore specifies the required risk management process A biological evaluation must therefore only be conducted in line with a clearly specified risk management process [SOURCE: ISO 10993-1:2018, B.3.1.2; see also Attachment F of the FDA’s Biocompatibility Guidance on Use of ISO 10993-1 for the Component and Device Documentation Examples Test Method]Ref. No. EN ISO 10993-18:2020 E National foreword This British Standard is the UK implementation of EN ISO 10993‑18:2020. It is identical to ISO 10993‑18:2020. It supersedes BS EN ISO 10993‑18:2009, which is withdrawn. The UK participation in its preparation was entrusted to Technical Committee CH/194, Biological evaluation of medical ...1. ISO 10993-1 (2018) 소개 발표자료. 2. ISO 10993 (생물학적안전성) 국제규격 동향 발표자료 (2019.12) 의료기기산업 미래를 향한 연속 제언 ②인체접촉 의료기기의 안전성 평가 패러다임 변화원재료, 물리·화학적 특성, 위험평가 및 생물학적 안전성 시험 간 상호 연계 ...You can delve into EKG case studies here. The ISO 10993 parts EKG Labs distinctly assesses are: ISO 10993-1: Evaluation and testing in the risk management process. ISO 10993-7: Ethylene oxide sterilization residuals. ISO 10993-9: Framework for identification and quantification of potential degradation products. ISO 10993-4* Complement Activation using a U.S. marketed ELISA kit ISO 10993-4 and ASTM F756 Direct and Indirect Hemolysis ISO 10993-5 MEM Elution Cytotoxicity ISO 10993-10. 6.ISO 10993-1 was prepared by Technical Committee ISO/TC 194, Biological evaluation of medical devices. This fourth edition cancels and replaces the third edition (ISO 10993-1:2003), which has been technically revised. ISO 10993 consists of the following parts, under the general title Biological evaluation of medical devices:Dec 1, 2020 · Other parts of ISO 10993 cover specific aspects of biological assessments and related tests. Devicespecific or product standards address mechanical testing. This document excludes hazards related to bacteria, moulds, yeasts, viruses, transmissible spongiform encephalopathy (TSE) agents and other pathogens. FDA-Modified ISO 10993-1 and USP Class VI tests, and meets the requirements specified for up to 30 days contact with human tissue. Abbreviation to DIN EN ISO 1043-1: PC Designation to DIN EN ISO 7391-1: Thermoplastics ISO 7391-PC,M,(,,)-18-9 Delivery form Granules, packed in 25-kg polyethylene sacks, FIBC You can delve into EKG case studies here. The ISO 10993 parts EKG Labs distinctly assesses are: ISO 10993-1: Evaluation and testing in the risk management process. ISO 10993-7: Ethylene oxide sterilization residuals. ISO 10993-9: Framework for identification and quantification of potential degradation products. ISO 10993-1 Medical devices Biocompatibility evaluation and testing ISO 10993-17 Medical devices Establishment of allowable limits for leachable substances ISO 10993-18 Medical devices Chemical characterization of materials ICH M7 Pharmaceuticals DNA reactive (mutagenic) impurities ISO 10993 and RISK ISO 10993 is intended as a guidance to determine the potential biological risks arising from the use of medical devices. Meaning, what is the risk of my materials and processes to the patient? ISO 10993-1: Biological evaluation of medical devices – Part 1: Evaluation and testing within a risk management process Based on ISO 10993-1, the BRA is the process of evaluating the device and the related manufacturing from biological risks point of view. It can be considered a part of the risk management process. Biological evaluation of medical devices shall begin with the so-called Biological Risk Assessment (BRA). This basically shall include an assessment ...Furthermore, ISO 10993-1:2018, 6.1 states that gathering physical and chemical information on the medical device or component is a crucial first step in the biological evaluation process and its associated process of material characterization. Lastly, ISO 10993-1:2018, and by reference ISO 14971, points out that a biological risk analysis depends Introduction. The primary aim of this document is the protection of humans from potential biological risks arising from the use of medical devices. It is compiled from numerous International and national standards and guidelines concerning the biological evaluation of medical devices.Direct Contact Method Liquid/Semi-Solid or 1 Extract ISO 10993-5; USP <87> 1 device (72 cm2) 1 device (36 cm2) Neutral Red Uptake (NRU) - Elution or Direct Contact Liquid/Semi-Solid or 1 Extract ISO 10993-5 1 device (72 cm 2) 1 device (36 cm )Dec 2, 2021 · Limitations of ISO 10993-1:2018. The biological safety evaluation should sit within a manufacturer’s risk management process and quality management system, and the recommendations of the ISO 10993 series should be applied. Figure 1 of ISO 10993-1:2018 2 provides a matrix of tests per device categorization. It is important to bear in mind that ... ISO 10993-1:2018 applies to biological evaluation of active, non-active, implantable, and non-implantable medical devices. The materials this standard evaluates are expected to have direct contact with either the patient’s body during the intended use of the medical device or, if used for protection, the user’s body, (as with surgical ...The biological evaluation of medical devices is currently governed by the set of standards developed by the International Organization for Standardization (ISO) and known as ISO 10993 or, in the United States, by FDA blue book memorandum #G95-1, which is a modification of ISO 10993-1, "Guidance on Selection of Tests." ISO 10993-1 states that ...
As described in ISO 10993-1:2018, this term is used by the regulated medical device community to also include devices used for less than 30 days as a “medical device which is intended to be .... Joe tahan
The medical devices tests in this package are for system toxicity, hypersensitivity, local effects after implantation, genotoxicity, carcinogenicity, reproductive toxicity and interactions with blood. This package is 45% off the individual list price and includes the following standards: ISO 10993-1:2018. ISO 10993-2:2022. The purpose of this guidance is to provide further clarification and updated information on the use of International Standard ISO 10993-1, "Biological evaluation of medical devices - Part 1:... ISO 10993-1:2018(E) Foreword ISO (the International Organization for Standardization) is a worldwide federation of national standards bodies (ISO member bodies). The work of preparing International Standards is normally carried out through ISO technical committees. Each member body interested in a subject for which a technical Jan 14, 2019 · Guidance for Industry and Food and Drug Administration Staff: Use of International Standard ISO 10993-1, "Biological evaluation of medical devices--Part 1: Evaluation and testing within a risk management process", Issued June 2016. Updated September 2020. ISO 10993-1:2018(E) Foreword ISO (the International Organization for Standardization) is a worldwide federation of national standards bodies (ISO member bodies). The work of preparing International Standards is normally carried out through ISO technical committees. Each member body interested in a subject for which a technicalAs described in ISO 10993-1:2018, this term is used by the regulated medical device community to also include devices used for less than 30 days as a “medical device which is intended to be ...What does BS EN ISO 10993-1:2020 do? It aims to protect people from the biological risks that can arise from using medical devices by describing the biological evaluation of medical devices within a risk management process. It combines the review and evaluation of existing data from all sources with, as necessary, the selection and application ...ISO 10993-1, Biological Evaluation of Medical Devices - Part 1: Evaluation and Testing within a Risk Management Process, is the most widely used standard for assessing the biocompatibility of medical devices and materials, and provides a framework for determining the appropriate biocompatibility steps for planning a biological evaluation.ISO Standard. ISO2859-1 Sampling Plans for Inspection by Attributes; ISO 10993-1 Biological Evaluation of Medical Devices—Part 1: Evaluation and Testing Within a Risk Management Process; ISO 10993-5 Biological Evaluation of Medical Devices—Part 5: Tests for in vitro CytotoxicityJan 27, 2023 · ISO Standard. ISO2859-1 Sampling Plans for Inspection by Attributes; ISO 10993-1 Biological Evaluation of Medical Devices—Part 1: Evaluation and Testing Within a Risk Management Process; ISO 10993-5 Biological Evaluation of Medical Devices—Part 5: Tests for in vitro Cytotoxicity As described in ISO 10993-1:2018, this term is used by the regulated medical device community to also include devices used for less than 30 days as a “medical device which is intended to be ...Ref. No. EN ISO 10993-18:2020 E National foreword This British Standard is the UK implementation of EN ISO 10993‑18:2020. It is identical to ISO 10993‑18:2020. It supersedes BS EN ISO 10993‑18:2009, which is withdrawn. The UK participation in its preparation was entrusted to Technical Committee CH/194, Biological evaluation of medical ....