FrancophonIA/ELRC3.0 huggingface dataset:
English: However, the CHMP considered that few points merit further clarification.
Croatian: No, CHMP je zaključio da nekoliko točaka zahtjeva daljnje pojašnjenje.
English: The matter was then referred to the Committee for Medicinal Products for Human Use (CHMP) for a review under Article 31 of Directive 2001/83/EC.
Croatian: Predmet je zatim upućen Odboru za lijekove za primjenu u ljudi (CHMP-u) na pregled u skladu sa člankom 31 Direktive 2001/83/EZ.
English: If IM delivery is insufficient with one injection, administration of a second injection is recommended.
Croatian: Ako IM isporuka nije dovoljna s jednom injekcijom, preporučuje se primjena druge injekcije.
English: • The CHMP considered the procedure under Article 31 of Directive 2001/83/EC for adrenaline auto-injectors.
Croatian: • je CHMP razmotrio postupak proveden prema članku 31. Direktive 2001/83/EZ za automatske brizgalice adrenalina,
English: Therefore, in accordance with Articles 31 and 32 of Directive 2001/83/EC, the CHMP recommends the variation to the terms of the marketing authorisation for all medicinal products referred to in Annex I and for which the amendments of the relevant sections of the summary of product characteristics and package leaflet are set out in Annex III.
Croatian: Stoga, u skladu sa člancima 31. i 32. Direktive 2001/83/EZ, CHMP preporučuje izmjene uvjeta odobrenja za stavljanje u promet svih lijekova navedenih u Prilogu I. za koje su relevantni dijelovi sažetka opisa svojstava lijeka i uputa o lijeku navedeni u Prilogu III.
English: The barrier of the fascia lata - the fibrous tissue surrounding the muscle - also needs to be considered.
Croatian: Potrebno je uzeti u obzir i barijeru fascia lata - fibroznog tkiva koje okružuje mišić.
English: Annex II Scientific conclusions and grounds for variation to the terms of the marketing authorisations
Croatian: Znanstveni zaključci i razlozi za izmjenu uvjeta odobrenja za stavljanje u promet
English: While these non-clinical models have demonstrated that the adrenaline is projected beyond the tip of the needle to a greater or lesser extent the CHMP was of the view that it remains questionable how representative of the human tissue these models are.
Croatian: Iako su ovi neklinički modeli pokazali da je adrenalin ubrizgan dalje od vrška igle u većem ili manjem omjeru, CHMP je bio mišljenja da ostaje upitno koliko su ovi modeli reprezentativni za ljudsko tkivo.
English: The fact that 15% of mothers were unable to ‘fire' the auto-injector successfully supports that patients' training tools need to be improved and that training needs to be repeated at regular intervals.
Croatian: Činjenica da 15% majki nije bilo u stanju uspješno „pokrenuti” automatsku brizgalicu uspješno potvrđuje da se alati za obuku bolesnika moraju poboljšati te da se trening treba ponoviti u redovitim intervalima.
English: The main clinical data available focus on demonstrating the skin-to-muscle depth (STMD) in adults and children and the CHMP noted that there is inconsistency across the studies with some finding no correlation between STMD and Body Mass Index (BMI) or weight (Song (2005)3, Stecher (2009)4) and others finding a correlation (Bhalla (2013)5, Bewick (2013)6).
Croatian: Glavni dostupni klinički podaci usredotočeni su na dokazivanje dubine kože u odnosu na mišić (STMD) u odraslih osoba i djece, te je CHMP zaključio da postoji nekonzistetnost u ispitivanjima s pojedinim nalazima vezanima uz nepostojanje korelacije između STMD-a i indeksa tjelesne mase (BMI-a) ili tjelesne težine (Song (2005.)3, Stecher (2009.)4) i drugih nalaza vezanih uz korelaciju (Bhalla (2013.)5, Bewick (2013.)6).
English: The CHMP considered also the results of consultations with healthcare professionals, experts and the Pharmacovigilance Risk Assessment Committee (PRAC).
Croatian: CHMP je također razmotrio rezultate konzultacija s zdravstvenim djelatnicima, stručnjacima i Odborom za ocjenu rizika na području farmakovigilancije (PRAC-om).
English: The CHMP noted the lack of clinical evidence from randomised, controlled trials, due to the logistical and ethical problems involved with conducting such trials in emergency situations, particularly with a placebo control.
Croatian: CHMP je primjetio manjak kliničkih dokaza iz randomiziranih, kontroliranih ispitivanja, uslijed logističkih i etičkih problema uključenih u provođenje takvih ispitivanja u hitnim situacijama, posebice u slučaju placebo kontroliranih ispitivanja.
English: The experts consulted unanimously agreed that a PK study in humans would be useful in order to gain information on the optimum parameters of administration; the group also noted the possibility to collect PD data in this same study.
Croatian: Savjetovani stručnjaci su se jednoglasno složili da bi PK ispitivanja provedena u ljudi bila djelotvorna kako bi se prikupile informacije o optimalnim parametrima za primjenu; grupa je također napomenula mogućnost prikupljanja PD podataka u ovom istom ispitivanju.
English: The safety of adrenaline is also well-established, and it has demonstrated a particularly strong safety profile with intramuscular (IM) administration.
Croatian: Sigurnost adrenalina je također dobro utvrđena, te je dokazan posebno snažan sigurnosni profil s intramišićnim (IM) primjenom.
English: They were originally used for the administration in the field of atropine, the antidote to nerve agents in biological weapons.
Croatian: Izvorno su korišteni za primjenu na području atropina, protulijek za živčana sredstva u biološkom oružju.
English: However, there is insufficient evidence to ensure, even under optimal circumstances, IM delivery of adrenaline to all patients with the currently available auto-injectors authorised in the EU and, even if the medicine is delivered IM, that exposure from a single injection will be sufficient.
Croatian: No, postoji nedovoljno dokaza kako bi se osigurala, čak i u optimalnim okolnostima, IM isporuka adrenalina svim bolesnicima s trenutno dostupnim automatskim brizgalicama odobrenima u EU i, čak ako se lijek isporučuje IM-om, da će izlaganje jednoj injekciji biti dovoljno.
English: The educational materials include but are not limited to a training device, instructional audio-visual material and a checklist for prescribers aiming to facilitate the discussion between the prescriber and the patient and to provide sufficient information on the optimal way of use, administration and storage of the product.
Croatian: Edukacijski materijali uključuju, no nisu ograničeni na uređaje za trening, instrukcijski audio-visualni materijal i kontrolni popis za propisivače kojem je cilj omogućiti raspravu između propisivača i bolesnika kako bi se pružile dovoljne informacije o optimalnom načinu primjene, primjenu i pohranjivanju lijeka.
English: However, there is agreement that in general STMD is greater than the length of the needles of currently available adrenaline auto-injectors in many patients, both adult and child.
Croatian: No, postoji dogovor da je općenito STMD veći od dužine igle trenutno dostupnih automatskih brizgalica za adrenalin u mnogo bolesnika, kako odraslih tako i djece.
English: Published clinical data indicate that the rate of absorption is prolonged if the adrenaline is delivered subcutaneously (SC).
Croatian: Objavljeni klinički podaci indiciraju da je stopa apsorbcije produljena ako se adrenalin isporučuje potkožno (SC).
English: Training and education of both patients/carers and healthcare professionals was considered of paramount importance.
Croatian: Obuka i edukacija bolesnika/pružatelja skrbi i zdravstvenih djelatnika smatrani su od najvećeg značaja.
English: Variability in skin-to-muscle depth (STMD), gender, needle length and the device mechanism itself are important factors which determine whether the route of delivery is IM or SC.
Croatian: Varijabilnost u dubini kože u odnosu na mišić (STMD), spol, dužinu igle i sami mehanizam uređaja su važni faktori koji utvrđuju je li put isporuke IM ili SC.
English: On the other hand, other investigators express an opinion that compression may preferentially involve muscle rather than subcutaneous tissue and therefore the needle deficit is not overcome by compression.
Croatian: S druge strane, drugi istražitelji izrazili su mišljenje da kompresija može ovisno o preferenci uključivati mišić a ne potkožno tkivo i stoga se nedostatak igle ne prevladava kompresijom.
English: The PRAC considered that there were no identified data sources that would permit a formal epidemiological approach for assessing actual usage or device failure of adrenaline auto-injectors in the EU.
Croatian: PRAC je zaključio da nema identificiranih izvora podataka koji bi dozvolili formalni epidemiološki pristup za ocjenu stvarne primjene ili kvara uređaja automatskih brizgalica adrenalina u EU.
English: Other factors such as the mechanism of action (spring loaded or not) and method of administration (swing and jab or place and press) of the device, the angle of placement on the skin and the force used to activate the device also play a part.
Croatian: Drugi čimbenici, poput mehanizma djelovanja (punjeno oprugom ili ne) i metoda primjene (zamah i ubod ili postavljanje i pritisak) uređajem, kut postavljanja na kožu i sila koja se primjenjuje za aktiviranje uređaja također igraju ulogu.
English: Most of the evidence for penetration of adrenaline into the tissue relies on non-clinical data using a gelatin model or a porcine model.
Croatian: Većina dokaza za prodiranje adrenalina u tkivo oslanja se na nekliničke podatke uz primjenu želatinastog modela ili svinjskog modela.
English: The STMD is only one factor affecting whether or not the adrenaline reaches the muscle layer.
Croatian: STMD je jedini faktor koji utječe na to hoće li adrenalin dosegnuti mišićni sloj.
English: The CHMP acknowledged that patient/carer compliance with the use of the auto-injectors is also very important as evidenced by the study by Brown J et al (2015)7.
Croatian: CHMP potvrdio je važnost sukladnosti bolesnika/skrbnika s primjenom automatskih brizgalica, što je dokazano ispitivanjem Brown J et al (2015.)7.
English: Clinical Communication 7 Brown J, Tuthill D, Alfaham M et al. (2013) A randomised maternal evaluation of epinephrine autoinjection devices.
Croatian: J Allergy Clin Immunol Pract Month 2013. Clinical Communication 7 Brown J, Tuthill D, Alfaham M et al. (2013) A randomised maternal evaluation of epinephrine autoinjection devices.
English: Results from PK studies (Simons, 19981, 20012) support the guidelines recommendation (e.g. UK Resuscitation Guideline) that an intramuscular injection is the preferred route of administration in the treatment of anaphylaxis as a rapid response is important in ensuring a non-fatal outcome.
Croatian: Rezultati PK ispitivanja (Simons, 1998.1, 2001.2) podupiru preporuku sadržanu u smjernicama (primjerice Smjernice za oživljavanje Ujedinjenog Kraljevstva) prema kojoj je intramišićna injekcija preferirani put primjene u terapiji anafilakse kao brzi odgovor u osiguravanju nesmrtonosnog ishoda.
English: Some investigators are of the opinion that even when the needle length is shorter than the STMD, IM injection is still possible as the physical compression of subcutaneous tissue by the force of the device can help to overcome the deficit in needle length.
Croatian: Pojedini istraživači bili su mišljenja da čak i ako se dužina igle skrati u odnosu na STMD, IM injekcija je još uvijek moguća budući da se fizička kompresija potkožnoga tkiva silom uređaja može pomoći u prevladavanju nedostatka dužine igle.
English: The efficacy of adrenaline in the treatment of anaphylaxis is well-supported by anecdotal and retrospective evidence.
Croatian: Djelotvornost adrenalina u terapiji anafilakse je dobro podržana anekdotalnim i retrospektivnim dokazom.
English: Until these uncertainties can be resolved, there is a need for more definitive evidence in humans of the speed and extent of delivery of adrenaline into the circulation following use of different adrenaline auto-injectors, from which it may be possible to infer site of delivery.
Croatian: Sve dok se ove nesigurnosti ne uklone postoji potreba za čvršćim dokazima u ljudi vezano uz brzinu i razmjer isporuke adrenalina u cirkulaciju nakon primjene različitih automatskih brizgalica za adrenalin, od kojih može biti moguća interferencija mjesta isporuke.
English: The CHMP agreed that proper training of both patients/carers and healthcare professionals and comprehensive educational materials are of paramount importance.
Croatian: CHMP je suglasan da su ispravni trening kako bolesnika/pružatelja skrbi tako i zdravstvenih profesionalaca i opsežni edukacijski materijali od iznimne važnosti.
English: • The CHMP concluded that there was a need for further risk minimisation measures such as educational materials to be submitted and agreed via risk management plans.
Croatian: • CHMP je zaključio da postoji potreba za daljnjim mjerama za smanjivanje rizika poput edukacijskih materijala koje je potrebno dostaviti i suglasiti putem planova za upravljanje rizikom.
English: Adrenaline auto-injectors are indicated in the emergency treatment of severe allergic reactions (anaphylaxis) to e.g. insect stings or bites, foods, drugs and other allergens as well as idiopathic or exercise-induced anaphylaxis.
Croatian: Automatske brizgalice za adrenalin indicirane su za primjenu u hitnim terapijama ozbiljnih alergijskih reakcija (anafilakse), primjerice uboda insekata ili ugrize, hranu, lijekove ili druge alergene kao i na idiopatsku ili vježbanjem uzrokovanu anafilaksu.
English: It is widely accepted that IM delivery is superior to SC delivery in achieving the rate of rise and levels of plasma adrenaline that are most effective to treat anaphylaxis.
Croatian: Široko je prihvaćeno da IM isporuka je superiorna u odnosu na SC isporuku u postizanju stope povišenja i koncentracije adrenalina u plazmi koja je najdjelotvornija za liječenje anafilakse.
English: The use of adrenaline to treat anaphylaxis is established as the recommended first-line treatment.
Croatian: Uporaba adrenalina za liječenje anafilakse utvrđena je kao preporučena prva linija terapije.
English: A key finding of the review was that there is no robust evidence that the administration devices deliver adrenaline intramuscularly in all patients.
Croatian: Ključni nalaz pregleda bio je da nije postojao robusni dokaz za proizvodi za primjenu isporučuju adrenalin intramišićno u svih bolesnika.
English: The needle length is another factor and the UK Resuscitation Council Guidelines do suggest a 25mm needle is optimal for intramuscular injection; however the CHMP noted that these guidelines are written for use in the hospital setting where healthcare professionals will generally inject the adrenaline using a manual needle and syringe, not an auto-injector.
Croatian: Dužina igle je drugi faktor te Smjernice za oživljavanje Ujedinjene Kraljevine preporučaju iglu od 25 mm kao optimalnu iglu za intramišićnu injekciju; no CHMP je napomenuo da su ove smjernice pisane za primjenu u bolničkom okruženju gdje zdravstveni djelatnici načelno ubrizgavaju adrenalin uz primjenu ručne igle i štrcaljke, a ne automatsku brizgalicu.
English: The CHMP sought the advice of experts on the feasibility of conducting imaging or PK studies or any other trials or tests that could be performed as well as the advice of the PRAC on potential databases or other data sources that might hold information on actual device usage.
Croatian: CHMP je zatražio savjet o provedivosti provođenja oslikavanja ili PK ispitivanja ili bilo kojih drugih ispitivanja ili testova koji bi se mogli provesti kao i savjeta PRAC-a o potencijalnim bazama podataka ili drugim izvorima podataka koji mogu sadržati informacije o stvarnoj primjeni uređaja.
English: The CHMP also recommended further risk minimisation measures, including educational materials, to be submitted and agreed via risk management plans.
Croatian: CHMP je također preporučio daljnje mjere za smanjivanje rizika, uključujući edukacijske materijale, koji će se dostaviti i usuglasiti putem planova za upravljanje rizicima.
English: The United Kingdom's Medicines and Healthcare products Regulatory Agency (MHRA) undertook a review of all authorised adrenaline auto-injectors to evaluate the most effective site for injection, the clarity of instructions for use as well as the most appropriate auto-injector needle length for ensuring intramuscular (IM) delivery of the adrenaline injection.
Croatian: Regulatorna agencija za lijekove i zdravstvene proizvode Ujedinjene Kraljevine (MHRA) provela je pregled svih odobrenih automatskih brizgalica za adrenalin kako bi ocijenila najdjelotvorniju lokaciju za ubrizgavanje, jasnoću uputa za primjenu kao i najprimjereniju dužinu igle za automatsku brizgalicu sa ciljem intramišićne (IM) isporuke adrenalinske injekcije.
English: • The CHMP considered the totality of the available non-clinical and clinical data to inform whether adrenaline administered via an auto-injector is delivered intramuscularly or subcutaneously, including submissions by marketing authorisation holders, consultations with healthcare professionals, experts and the Pharmacovigilance Risk Assessment Committee (PRAC).
Croatian: • je CHMP razmotrio ukupnost dostupnih nekliničkih i kliničkih podataka kako bi izvijestio isporučuje li se primjena adrenalina putem automatske brizgalice intramišićno ili potkožno, uključujući podneske dostavljene od strane nositelja odobrenja za stavljanje lijeka u promet, konzultacije s zdravstvenim djelatnicima, stručnjacima i Odborom za ocjenu rizika na području farmakovigilancije (PRAC-a).
English: The CHMP has considered the totality of the available non-clinical and clinical evidence on the delivery of adrenaline from adrenaline auto-injectors and on whether the product information contains clear and detailed instructions for appropriate use.
Croatian: CHMP razmotrio je ukupnost dostupnih nekliničkih i kliničkih dokaza za isporuku adrenalina iz automatskih brizgalica za adrenalin te sadrže li informacije o proizvodu jasne i detaljne upute za primjerenu uporabu.
English: The preferred route of administration in an emergency situation has been established as IM, although intravenous administration may be indicated in severe cases.
Croatian: IM je utvrđen kao preferirani put primjene u hitnim situacijama, iako intravenozna primjena može biti indicirana u ozbiljnim slučajevima.
English: The CHMP noted that generally there is a large degree of consistency between the product information for the different auto-injectors in particular as regards main messages such as to seek emergency medical assistance immediately after a single administration, the use with caution in certain patient populations and that adrenaline should be administered intramuscularly in order to maximise the possibility of a positive outcome in the treatment of anaphylaxis.
Croatian: CHMP je zaključio da općenito postoji visoki stupanj konzistencije između informacija o proizvodu za različite automatske brizgalice posebice u vezi s glavnim porukama poput traženja hitne medicinske pomoći odmah nakon jedne primjene, primjena opreza u određene populacije bolesnika i da se adrenalin treba primijeniti intramišićno kako bi se maksimizirala mogućnost pozitivnog ishoda za liječenje anafilakse.
English: • The CHMP considered that the efficacy of adrenaline in the treatment of anaphylaxis is wellsupported by anecdotal and retrospective evidence and that the safety of adrenaline is also well-established, and it has demonstrated a strong safety profile particularly with IM administration.
Croatian: • je zaključio da je djelotvornost andrenalina u terapiji anafilakse dobro podržana od strane anekdotalnih i retrospektivnih dokaza, te da je sigurnost adrenalina dobro utvrđena, i da je dokazan snažan profil sigurne primjene posebice s IM primjenom.
English: • The CHMP considered that the preferred route of administration of adrenaline in an emergency situation has been established as IM, although intravenous administration may be indicated in severe cases.
Croatian: • je CHMP zaključio kako je IM utvrđen kao preferirani put primjene adrenalina u hitnim situacijama, iako se intravenozna primjena može indicirati u teškim slučajevima.
English: The CHMP agreed that there are many factors that may affect whether the adrenaline is delivered to the muscle or the subcutaneous tissue when an adrenaline auto-injector is used.
Croatian: CHMP je suglasan da mnogi čimbenici mogu utjecati na to isporučuje li se adrenalin mišićima ili potkožnom tkivu prilikom korištenja automatskog ubrizgivača adrenalina.
English: • The CHMP considered that there are multiple factors that may affect whether adrenaline is delivered to the muscle or the subcutaneous tissue when an adrenaline auto-injector is used such as the needle length, the mechanism of action of the device, the angle of placement on the skin, the force used to activate the device and the patient/carer compliance.
Croatian: • je CHMP zaključio da su prisutni višestruki čimbenici koji mogu utjecati na to hoće li se adrenalin isporučivati u mišić ili potkožno tkivo kada se koristi automatska brizgalica za adrenalin; i to dužina igle, mehanizam djelovanja uređaja, kut postavljanja na kožu, sila koja se koristi za aktiviranje proizvoda i sukladnost bolesnika/pružatelja skrbi.
English: The CHMP noted the inconsistency amongst studies as to the part played by compression of the tissue.
Croatian: CHMP je istaknuo nekonzistetnost u ispitivanjima s obzirom na ulogu koju igra kompresija tkiva.
English: However, the CHMP was of the view that PK and PD studies in healthy volunteers representing the broad range of phenotypes, or imaging studies in healthy volunteers to understand the influence of different factors on distribution, exposure and activity of adrenaline when administered via an adrenaline auto-injector device could be considered.
Croatian: No, CHMP je bio mišljenja da treba uzeti u obzir PK i PD ispitivanja u zdravih dobrovoljaca koji predstavljaju široki spektar fenotipova, ili ispitivanja oslikavanja u zdravih dobrovoljaca kako bi razumjeli utjecaj različitih čimbenika na distribuciju, izlaganje i aktivnost adrenalina prilikom primjene putem automatske brizgalica adrenalina.
English: Furthermore, the CHMP imposed a PK/PD study in order to understand the influence of different factors on distribution, exposure and activity of adrenaline when administered via an adrenaline auto-injector device and encouraged the possibility for a study to assess the effectiveness of the proposed risk minimisation measures and the conduct of an observational study to assess usage and incidence of lack of efficacy and device failure.
Croatian: Nadalje, CHMP je nametnuo PK/PD ispitivanje kako bi se razumio utjecaj različitih čimbenika na distribuciju, izlaganje i aktivnost adrenalina kada se primjenjuje putem automatske brizgalice adrenalina i potiče mogućnost da ispitivanje ocijeni djelotvornost predloženih mjera za smanjivanje rizika i da se provede observacijsko ispitivanje kako bi se ocijenila primjena i incidencija nedostatka djelotvornosti i kvara uređaja.
English: Frey, M.R. Reichenbach, and S.T. Wilber, Predictors of epinephrine autoinjector needle length inadequacy.
Croatian: Wilber, Predictors of epinephrine autoinjector needle length inadequacy.
English: The CHMP therefore recommended amendments to the product information, in order to reflect the uncertainties in whether a single administration would suffice for any given episode and advise that patients are prescribed two pens which they should carry at all times, to include a recommendation for immediate associates of patients to be trained to use the AAI and to include information on the needle length.
Croatian: CHMP je stoga preporučio dopunu informacija o proizvodu, kako bi se prikazale određene nesigurnosti vezane uz to da li bi jedna primjena bila dostatna za bilo koju danu epizodu i savjet da se bolesnicima propisuju dvije brizgalice koje trebaju nositi u svakom trenutku, kako bi se uključila preporuka da se neposredne osobe u kontaktu s bolesnicima također obuče za primjenu AAI i da se uključe informacije o dužini igle.