BMJ Innovations最新文献

{"title":"Low-income and middle-income countries leading the way with tobacco control policies","authors":"Joanna E. Cohen, Graziele Grilo, Lauren Czaplicki, Jennifer L Brown, K. Welding, M. Hefler, R. Kennedy, A. Perucic","doi":"10.1136/bmjinnov-2021-000857","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000857","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. GLOBAL TOBACCO USE AND POLICY INTERVENTIONS Tobacco products are the world’s single largest cause of preventable death, accounting for more than 8 million deaths each year and causing suffering from avoidable illnesses among tens of millions more. Tobaccocaused death and disease disproportionately affects people in lowincome and middleincome countries (LMICs). 2 The WHO Framework Convention on Tobacco Control (FCTC), with 182 parties from all regions of the world, was developed in response to the globalisation of the tobacco epidemic and lays out evidencebased demand and supply reduction strategies. These strategies have resulted in measurable progress: global cigarette sales have been declining since 2012 despite overall population growth. It is estimated that tobacco control interventions have saved more than 37 million lives as fewer people start and more people quit, using tobacco products. However, there is much more work needed ahead. Over 1 billion people worldwide still use tobacco products, and the tobacco industry continues to aggressively fight the enactment and effective implementation of proven policy interventions. The demand and supply measures outlined in the FCTC, adopted by the World Health Assembly in 2003, are considered a floor (after all, the Framework Convention was based on the best evidence available through the dawn of the 21st century). However, FCTC Article 2.1 explicitly encourages countries to go beyond the measures outlined, and they have! Early tobacco control policy innovations, with data of their impacts feeding into the development of the FCTC, included smokefree air policies in states and cities in the USA, pictorial health warning labels (HWLs) in Canada, restrictions on tobacco advertising and sponsorship in Canada, and the use of tobacco excise taxes as a measure to reduce smoking in Canada. Since the FCTC came into force, innovations have included a ban on the display of tobacco products at the point of sale in Iceland, and plain and standardised packaging in Australia. However, policy innovations have also occurred across LMICs. This commentary highlights seven diverse examples from across the globe, selected by the authors, of world precedent setting, firstoftheir kind interventions that have originated in LMICs.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83665724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a novel wireless near-infrared spectroscopy (NIRS) device in the detection of tourniquet induced ischaemia","authors":"M. Gimzewska, M. Berthelot, P. Sarai, L. Geoghegan, S. Onida, J. Shalhoub, P. Strutton, A. Davies","doi":"10.1136/bmjinnov-2021-000752","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000752","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Acute limb ischaemia is a vascular emergency threatening both life and limb, with estimated mortality rates of 9%–22%, and 30day extremity amputation rates of 10%–30%. 3 Timely identification of the acutely ischaemic limb is pivotal. Conventional methods of assessing limb ischaemia rely on repeated clinical examination, serial assessment of Doppler signals and imaging technology such as duplex ultrasound, digital subtraction angiography, CT angiography and MR angiography. While able to assess arterial compromise, these technologies are limited as they provide data for only a single time point, and imaging modalities are high in cost and low in portability. The ability to noninvasively and continually monitor for limb ischaemia could enable identification of compromised tissue earlier, prompting faster revascularisation and reducing complications associated with prolonged ischaemia. A growing interest in the role of the microcirculation in tissue perfusion has led to the use of nearinfrared spectroscopy (NIRS) devices in the evaluation of limb ischaemia. 6 NIRS is a noninvasive spectroscopy method of obtaining regional tissue oxygen saturation (StO 2 ), using light wavelengths in the red and nearred range of the spectrogram. NIRSbased devices can reliably identify the ratio of oxygenated haemoglobin (HbO 2 ) and deoxyhaemoglobin (HHb) present in tissue, and as such are able to determine oxygen desaturation associated with limb ischaemia. 8 A number of commercial devices are available for clinical use. Some current limitations around using existing NIRS devices are cost and bulk around the patient bedspace. As such, they are rarely used outside the operating theatre and intensive care unit settings, where patients are relatively immobile and low nurse:patient ratios make the management of multiple wired devices in the bed space feasible for staff. The aims of this prospective study were: 1. To evaluate the feasibility of using a novel, wireless NIRS device in detecting tissue StO 2 in a tourniquetinduced model of limb ischaemia in healthy volunteers. Summary box","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88664554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming the once-a-day pill for HIV prevention from medicine to empowering self-care using human-centred design in Zimbabwe","authors":"E. Harris, K. Shelley, Thenjiwe Sisimayi, Catherine Wandie, Cal Bruns","doi":"10.1136/bmjinnov-2021-000739","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000739","url":null,"abstract":"Objective For adolescent girls and young women (AGYW) in sub-Saharan Africa, oral tenofovir‐based pre‐exposure prophylaxis (commonly referred to as PrEP) provides a user-controlled HIV prevention method, critical to addressing their HIV risk and unmet prevention needs. Addressing the gap between clinical and real-world PrEP efficacy requires new approaches, such as ‘V’. ‘V’ reframes PrEP from medicine to self-care that is as easy to use as a young women’s favourite fashion or beauty brand. This article describes how human-centred design (HCD) was used to adapt the ‘V’ brand and service delivery strategy for implementation in Zimbabwe from its development via formative research in South Africa. Methods Following literature review, stakeholder analysis and landscaping, the ‘V’ brand and service delivery strategy were assessed through participatory immersion sessions with 152 participants in four Zimbabwe districts. Insights were synthesised across learning questions: What do AGYW and health workers think about ‘V’?; Which of the ‘V’ materials are most acceptable and relevant for Zimbabwe?; What adaptations are necessary for the selected ‘V’ materials for Zimbabwe?; and How should the selected ‘V’ assets be integrated? Results The ‘V’ innovative design principles—delightfully bold branding, a discreet starter kit and user-friendly materials that put young women in control of educating others—remained resonant. Feasible modifications were identified to adapt the ‘V’ brand and service delivery strategy to suit the local context. Conclusion ‘V’ delivers a ‘delightfully discreet’ approach that puts AGYW in charge of preventing HIV. The resonance of the core ‘V’ design concepts demonstrates how HCD can be applied to reframe PrEP as a product category (ie, from a stigmatising medicine to empowering self-care).","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85798590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blockchain technology for immunisation data storage in India: opportunities for population health innovation","authors":"Somalee Banerjee, Sinchan Banerjee, Anshul Bhagi, Aurobindo Sarkar, Bhrigu Kapuria, S. Desai, Venkatraman Sethuraman, A. Ray, Kara Palanuk, S. Patil","doi":"10.1136/bmjinnov-2021-000725","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000725","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. BACKGROUND Childhood vaccination is a costeffective public health intervention with proven positive outcomes on individual, community and global scales as some of the highest return of investment into healthcare. India’s vaccination programme is one of the largest in the world, covering 27 million live births per year and 100 million children under age 5 alone, but coverage is far from universal. Recent investments and improvements in India’s vaccine programme are working to improve the rates of immunised children, including the recent Mission Indradhanush. However, immunisation data in India is stored in complex fragmented data storage systems that have led to mismatch in resources and systemwide shortfalls. The fragmentation has been due to various innovations being developed in real time in a decentralised manner. With the global need for tracking immunisation data due to the COVID19 pandemic, solutions for improving immunisation data storage are critical. There is a great deal of interest surrounding use cases for blockchain technology in development and healthcare. Blockchain, the technology underlying cryptocurrencies such as bitcoin, can be especially useful in improving decentralised and error prone information storage. There has been limited use of blockchain technology in the field of healthcare data management despite the enthusiasm surrounding it, specifically no prior exploration of the use of blockchain technology in the national storage of healthcare data. In partnership with the Biotechnology and Research Council of India and Gates Grand Challenges India as part of the Immunisation Data: Innovating for Action programme, we explored means for improvement in digitisation of data through the use of blockchain technology.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83439022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the physical and microbiocidal characteristics of an emerging and innovative UV disinfection technology","authors":"G. Messina, D. Amodeo, A. Corazza, N. Nante, G. Cevenini","doi":"10.1136/bmjinnov-2021-000790","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000790","url":null,"abstract":"Introduction Surface disinfection is one of the key points to reduce the risk of transmission both in healthcare and other public spaces. A novel UV-chip disinfection technology is presented. Technological, photonic and microbiocidal characteristics are evaluated taking as reference an ultraviolet-C (UV-C) LED source of equivalent radiant power. Methods The UV chip has a circular radiating surface with a diameter of 1.3 cm, emitting UV cold light at about 5 mW and driven current of about 80 µA. Four bacterial strains were used to conduct the microbiological tests at 4°C and 60°C to evaluate the bactericidal performance of the two technologies under the same operating conditions. Results Spectral differences were found between the UV-C LED and the chip, with an emission curve strictly around 280 nm and a broader band centred around 264 nm, respectively. Between-technology microbiological inactivation levels were comparable, achieving total abatement (99.999%) in 8 min at 7.5 cm. Discussion The UV chip exhibits unique properties that make it applicable in some specific contexts, where UV-C LEDs present the most critical issues. Besides, it is portable and exhibits a broad spectrum of UV wavelengths with a peak where the maximum microbiocidal efficacy occurs. Important issues to be addressed to improve this technology are the high voltage management and the too low energy efficiency. Conclusion This cold emission technology is virtually unaffected by changes in ambient temperature and is particularly useful in short-distance applications. Recent developments in technology are moving towards a progressive increase in the chip’s radiant power.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2021-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87765120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel digitally enabled care pathway to support postintensive care recovery and goal attainment following critical illness","authors":"L. Rose, C. Apps, Kate Brooks, E. Terblanche, N. Hart, Joel Meyer","doi":"10.1136/bmjinnov-2021-000842","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000842","url":null,"abstract":"© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Intensive care unit (ICU) survivors, particularly with a protracted length of stay such as those mechanically ventilated for COVID19 pneumonitis, experience lasting physical, cognitive and psychological challenges that impede their recovery and functional capability. Survivors also experience substantial symptom burden including breathlessness, extreme fatigue and pain. Together, the healthcare issues faced by ICU survivors are frequently referred to as postintensive care syndrome (PICS). Family members acting as informal caregivers experience substantial psychosocial burden and in some cases loss of employment and financial difficulties due to their informal caregiver commitments. Unfortunately, fragmentation in healthcare delivery following transfer from the ICU to an inpatient ward location, and following hospital discharge, is all too common. This fragmentation results in mismatches in the healthcare services needed and those received, information loss, treatment omissions, hospital readmission, and poor patient and family experience, all of which may interfere with recovery. Despite the wellestablished recovery challenges faced by ICU survivors and their family members, development of a recovery plan and provision of followup recovery services are highly variable, and in some jurisdictions extremely limited. Individualised recovery goal setting, although the standard of care across many areas of rehabilitation is not routine for ICU survivors. Virtual care and telemedicine may provide a solution to bridge the fragmentation prevalent across arbitrary healthcare system boundaries and thus enable individualised patient and familycentred recovery for ICU survivors. Although telemedicine is commonly used in the management of chronic diseases such as Chronic Obstructive Pulmonary Disease (COPD) and congestive heart failure, only a few examples exist that facilitate rehabilitation and recovery of ICU survivors such as the virtual Sepsis Transition and Recovery (STAR) programme for sepsis survivors in the USA. Therefore, as a clinical service innovation, we aimed to create a digital recovery pathway delivered via an ehealth platform (aTouchAway, Aetonix, Canada) Summary box","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82226178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healing at Home: applying innovation principles to redesign and optimise postpartum care","authors":"J. Gaulton, Kirstin Leitner, Lauren Hahn, Ryan Schumacher, L. Christ, Laura F. Scalise, Deborah S Driscoll, R. Rosin, R. Merchant","doi":"10.1136/bmjinnov-2021-000791","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000791","url":null,"abstract":"Gaulton JS, et al. BMJ Innov 2021;0:1–5. doi:10.1136/bmjinnov-2021-000791 Neonatology, Jefferson Health–Abington, Abington, Pennsylvania, USA HUP Obstetrics and Gynecology, Penn Medicine, Philadelphia, Pennsylvania, USA Center for Health Care Innovation, Penn Medicine, Philadelphia, Pennsylvania, USA Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA Office of the Dean of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA Emergency Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2021-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84002651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why is Kangaroo Mother Care not yet scaled in the UK? A systematic review and realist synthesis of a frugal innovation for newborn care","authors":"Giulietta Stefani, Mark Skopec, C. Battersby, M. Harris","doi":"10.1136/bmjinnov-2021-000828","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000828","url":null,"abstract":"Objective Kangaroo Mother Care (KMC) is a frugal innovation improving newborn health at a reduced cost compared with incubator use. KMC is widely recommended; however, in the UK, poor evidence exists on KMC, and its implementation remains inconsistent. Design This Systematic Review and Realist Synthesis explores the barriers and facilitators in the implementation of KMC in the UK. Data source OVID databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and Google Scholar were searched. Eligibility criteria Studies were UK based, in maternity/neonatal units, for full-term/preterm children. First screening included studies on (1) KMC, Kangaroo Care (KC) or skin-to-skin contact (SSC) or (2) Baby Friendly Initiative, Small Wonders Change Program or family-centred care if in relation to KMC/KC/SSC. Full texts were reviewed for evidence regarding KMC/KC/SSC implementation. Results The paucity of KMC research in the UK did not permit a realist review. However, expanded review of available published studies on KC and SSC, used as a proxy to understand KMC implementation, demonstrated that the main barriers are the lack of training, knowledge, confidence and clear guidelines. Conclusion The lack of KMC implementation research in the UK stands in contrast to the already well-proven benefits of KMC for stable babies in low-income contexts and highlights the need for further research, especially in sick and small newborn population. Implementation of, and research into, KC/SSC is inconsistent and of low quality. Improvements are needed to enhance staff training and parental support, and to develop guidelines to properly implement KC/SSC. It should be used as an opportunity to emphasise the focus on KMC as a potential cost-effective alternative to reduce the need for incubator use in the UK.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2021-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86563077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone conduction hearing kit for children with glue ear","authors":"Tamsin Mary Holland Brown, I. Fitzgerald O’Connor, J. Bewick, Colin Morley","doi":"10.1136/bmjinnov-2021-000676","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000676","url":null,"abstract":"© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Background Hearing loss is one of the most common disabilities in childhood. One in 10 children starting school in UK or Europe have hearing loss secondary to glue ear (Otitis Media with Effusion (OME)). 2 This is much higher in lower income countries. Eighty per cent of children have at least one episode of glue ear, where fluid builds up behind their eardrum after a cough, cold or ear infection. OME often selfresolves or children can be offered grommets (also known as ‘tympanostomy tubes’) if persistent. Grommets ‘only offer short term hearing improvement’ of ~12 dB, diminishing to ~4 dB 6–9 months later, therefore grommets improve a child’s symptoms for about 6 months while ‘natural resolution continues’. Grommet insertion is common, requiring a general anaesthetic, and risks include opening the middle ear to infection (requiring treatment in approximately a third of patients), perforation (1% of cases) and variable scarring the eardrum (tympanosclerosis). Hearing aids are not an easy solution, since glue ear fluctuates and multiple audiology appointments are needed to avoid overamplification or underamplification. Children need to hear to learn. Poor hearing can affect speech, language, social skills, listening, attention and learning. While some children catch up learning after an episode of glue ear, others do not. Glue ear mostly affects those under 8 years old, which is a critical time for development, speech acquisition, learning, writing, spelling and phonics. Deafness at this time interferes with speech development, language, communication, auditory processing, selfesteem, socialisation, listening and learning. Operational aims and objectives Bone conduction hearing aids work well in OME because they send sound as a vibration through the bones of the skull directly to the cochlea (bypassing the eardrum and middle ear bones where the fluid, mucus or ‘glue’ accumulates) but they are often prohibitively expensive, costing up to £3000. Bone conduction headphones are marketed at cyclists, allowing sound from mobile phones to be directed straight to the cochlea while sound from traffic noises still accessible through the ear canals. These headphones cost ~£100 commercially (figure 1) . An initial study in 2016–2018 trialled these simple bone conduction headphones paired to a microphone for the first time in children with OME. The Hear Glue Ear app was trialled in 2019. It was codesigned with a patient Summary box","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74621905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining frugal innovation: a critical review","authors":"C. Hindocha, Grazia Antonacci, J. Barlow, M. Harris","doi":"10.1136/bmjinnov-2021-000830","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000830","url":null,"abstract":"Frugal innovation (FI), which has gained traction in various sectors, is loosely defined as developing quality solutions in a resource-constrained environment that are affordable to low-income consumers. However, with its popularity, multiple and diverse definitions have emerged that often lack a theoretical foundation. This has led to a convoluted conceptualisation that hinders research and adoption in practice. Despite this plethora of perspectives and definitions, scholars do agree that there is a need for a unified definition. This critical review across the management, entrepreneurship, business and organisation studies literatures explores the multiple definitions of FI that have appeared in the last two decades and seeks to examine the commonalities and differences. One definition is supported by a theoretical underpinning, and main themes include affordability, adaptability, resource scarcity, accessibility and sustainability, however, there remains significant ambiguity around what constitutes an FI. Defining FI as a concept should not deter from focusing on its core aim and identifying an FI may be best achieved by comparing it to an incumbent alternative, rather than against an ill-defined concept. There is merit in developing a common understanding of FI to support strategies for its successful acceptance and diffusion globally.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79012811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}