BMJ Innovations最新文献

{"title":"Systematic literature review of the barriers and facilitators of frugal innovation for surgical care in low-income and middle-income countries","authors":"Cyan Brittany Brown, L. McDermott","doi":"10.1136/bmjinnov-2022-001066","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-001066","url":null,"abstract":"Objective Globally, 5 billion people lack access to safe surgery and annually, only 6% of surgeries occur in low-income countries. Surgical frugal innovations can reduce cost and optimise the function for the context; however, there is limited evidence about what enables success. Design A systematic literature review (SLR) was performed to understand the barriers and facilitators of frugal innovation for surgical care in low-income and middle-income countries (LMICs). Data sources Web of Science, PubMed, Embase at Ovid, Google Scholar and EThOs were searched. Eligibility criteria for selecting studies Inclusion criteria were original research in English containing a frugal surgical innovation. Research must be focused on LMICs. Studies were excluded if the content was not focused on LMICs or did not pertain to barriers and facilitators. 26 studies from 2006 to 2021 were included. The GRADE tool was used to assess overall review quality. Results Results were analysed using the modified consolidated framework for implementation research. The lack of formal evidence regarding frugal innovation in LMICs was the most reported barrier. The adaptability of frugal innovations to the context was the most reported facilitator. The limitations of this study were that most frugal innovations are not included in formal literature and that only English studies were included. Conclusion Frugal surgical innovations that are highly adaptable to the local context hold significant potential to scale and positively affect healthcare access and outcomes. Furthermore, supporting formal research about frugal innovations is important when aiming to innovate for health equity.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"42 1","pages":"226 - 239"},"PeriodicalIF":2.0,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89304948","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":"Feasibility and acceptability of Saheli, a WhatsApp Chatbot, on COVID-19 vaccination among pregnant and breastfeeding women in rural North India","authors":"A. E. El Ayadi, Pushpendra Singh, Mona Duggal, Vijay Kumar, Jasmeet Kaur, Preetika Sharma, K. Vosburg, N. Diamond-Smith","doi":"10.1136/bmjinnov-2022-001012","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-001012","url":null,"abstract":"Introduction Pregnant and breastfeeding women are priority targets for COVID-19 vaccination due to adverse maternal and fetal consequences of perinatal COVID-19 infection and the opportunity for protecting infants through maternal antibodies. Saheli (‘female friend’) is a WhatsApp-deployed chatbot providing evidence-based guidance on COVID-19 for pregnant and breastfeeding women. Objectives To understand the feasibility and acceptability of Saheli and its impact on COVID-19 vaccination. Methods We pilot-tested Saheli among pregnant and breastfeeding participants of pre-existing WhatsApp educational groups led by a community-based non-governmental organisation in Haryana, India from January to March 2022 using a pre/post design. Results 829 unique participants completed precommunity surveys or postcommunity surveys; 238 completed both. 829 individuals used Saheli, including 88% postintervention survey participants. Users reported Saheli was easy to engage with (79%), easy to understand (91%), quick (83%) and met their information needs (97%). 89% indicated it improved their COVID-19 knowledge a lot, 72% recommended it to others and 88% shared chatbot-derived information with others. Most participants received ≥1 COVID-19 vaccine (86% vs 88%, preintervention to postintervention); full vaccination was 55% and 61%, respectively. Vaccination over time increased marginally for ≥1 dose (OR 1.15, 95% CI 0.99 to 1.36) and significantly for 2 doses (OR 1.21, 95% CI 1.09 to 1.34), and increases were significant among pregnant (≥1 dose) and breastfeeding participants (2 doses). Vaccine hesitancy was low. Chatbot use was high, yet individual chatbot engagement did not alter COVID-19 vaccination. Conclusion Chatbots are a promising health education strategy due to high acceptability and deployment potential. Interpreting community chatbot impact must acknowledge the co-occurring constellation of multilevel interventions, community and pandemic factors.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"43 1","pages":"195 - 206"},"PeriodicalIF":2.0,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90212357","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":"From feasibility study to randomised control trial: the evolution of a novel neuraxial procedure device","authors":"Ian N Gaston, Alexander G Samworth, Emery H. McCrory, J. Bavaro, Mahesh Vaidyanathan","doi":"10.1136/bmjinnov-2023-001090","DOIUrl":"https://doi.org/10.1136/bmjinnov-2023-001090","url":null,"abstract":"Introduction Neuraxial procedures are performed by many specialties among a wide variety of patients. Palpation is the standard practice to locate a target insertion site. Procedural difficulty may prompt the use of alternative modalities. In a 2020 feasibility study, a neuraxial imaging device called VerTouch was shown to be reliable and easy to learn. In this study, we compared VerTouch to palpation and ultrasound (US). Methods An investigator-initiated prospective, randomised study was conducted on a labour and delivery ward at a large tertiary care hospital. Participants were randomised to either palpation, US or the VerTouch device. The primary endpoint was the total number of redirections. Secondary endpoints included the number of reinsertions and the total procedure time. Results 95 patients were enrolled and 81 completed the study. The VerTouch group required fewer redirections (0.72 vs 2.35 and 2.81, p=0.041) and reinsertions (0.11 vs 0.50 and 0.96, p=0.017) without prolonging the overall procedure time (8.66 mins vs 7.88 and 9.81, p=0.121) when compared to palpation and US, respectively. Conclusion This study supports the potential for VerTouch to improve procedural success for patients who might otherwise require radiology referral and for providers who may lack the resources or training to accommodate US guidance. The results also demonstrate the potential value in clinician involvement in the development of technology from the point of inception through implementation into clinical practice.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"13 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87296846","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":"‘DISSEMINATE’: a roadmap for facilitating adoption of affordable surgical innovations in low and middle-income countries","authors":"D. Sharma, V. Agrawal, N. Sam-Agudu, P. Agarwal, S. Yadav, J. Bajaj","doi":"10.1136/bmjinnov-2022-001077","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-001077","url":null,"abstract":"Importance Affordable surgical innovations (ASIs) provide simple, safe and equitable solutions in resource-limited settings. Effective dissemination is needed for widespread adoption and uptake of ASIs in low and middle-income countries (LMICs). However, surgical systems in these settings face challenges with adoption and uptake of ASIs, which remain unknown and/or unused even after supporting evidence is published. A surgery-specific, implementation science-informed framework can provide a roadmap delineating the actions needed to achieve this goal; however, none exist currently. This prompted the development of a well-defined roadmap for this purpose. Methods The roadmap was developed after several rounds of structured brainstorming discussions among the authors, who are LMIC-based experts in academic surgery, ASIs, global health and implementation science. Results and conclusion The proposed ‘DISSEMINATE’ roadmap presents 18 non-sequential domains to be considered in a comprehensive approach to equitable accessibility for surgical innovations: Design of the innovation; Innovate by combining the IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up) surgical innovation framework with local multidisciplinary expertise; Substantiate available evidence; Scale up application of evidence in surgical practice; Share knowledge on multidisciplinary platforms; Sustainability; Endorsement of the innovation by local catalysts; Media promotion; Identify early adopters; Improve and refine the innovation; Improvise during setbacks; Implementation science methods; Navigate through barriers; Aspirational affordability; Advocacy for the value of ASIs; Tools for scalability and adoption; Evaluate impact of dissemination; and Extend use of the innovation to resource-rich settings. This surgery-specific roadmap provides structure for effective dissemination to help in overcoming know-do gaps in the use of ASIs in LMICs.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"65 1","pages":"207 - 214"},"PeriodicalIF":2.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74597051","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":"COP27 climate change conference: urgent action needed for Africa and the world","authors":"Chris Zielinski","doi":"10.1136/bmjinnov-2022-001051","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-001051","url":null,"abstract":"> Wealthy nations must step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change The 2022 report of the Intergovernmental Panel on Climate Change paints a dark picture of the future of life on earth, characterised by ecosystem collapse, species extinction and climate hazards such as heatwaves and floods.1 These are all linked to physical and mental health problems, with direct and indirect consequences of increased morbidity and mortality. To avoid these catastrophic health effects across all regions of the globe, there is broad agreement—as 231 health journals argued together in 2021—that the rise in global temperature must be limited to <1.5°C compared with pre-industrial levels. While the Paris Agreement of 2015 outlines a global action framework that incorporates providing climate finance to low-income and middle-income countries, this support has yet to materialise.2 COP27 is the fifth Conference of the Parties (COP) to be organised in Africa since its inception in 1995. Ahead of this meeting, we—as health journal editors from across the continent—call for urgent action to ensure it is the COP that finally delivers climate justice for Africa and vulnerable countries. This is essential for the health of those countries, and for the health of the whole world. The climate crisis has had an impact on the environmental and social determinants of health across Africa, leading to devastating health effects.3 Impacts on health can result directly from environmental shocks and indirectly through socially mediated effects.4 Climate change-related risks in Africa include flooding, drought, heatwaves, reduced food production and reduced labour productivity.5 Droughts in sub-Saharan Africa …","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"40 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138528789","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":"Adoption of technological innovation in healthcare delivery: a psychological perspective for healthcare decision-makers","authors":"J. H. Wong, Katharina Näswall, Fleur Pawsey, J. Chase, S. Malinen","doi":"10.1136/bmjinnov-2022-001003","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-001003","url":null,"abstract":"Technological advancements are vital for improving the capacity of the health system to deliver health and well-being benefits to individuals. Despite significant financial investments in technological innovations in healthcare, patients reported benefiting from only 30%–60% of new healthcare technologies. We argue that failed adoption can be attributed to the underprioritisation of the human aspect of innovation development and uptake. In this paper, we elaborate on the psychological experience of being introduced to new technology at work through the perspective of a healthcare employee. We then present a psychology-based practical framework called ‘Tech-ISM’ for healthcare decision-makers to encourage more human-centric technology implementation processes, resources and leadership. The framework identifies the key individuals and relationships within a healthcare delivery context that can influence individual attitudes towards adoption, before offering recommendations for how decision-makers can socialise new technology into the workplace (ie, types of organisational resources and processes to provide), and manage these social dynamics over time (ie, types of work cultures to cultivate through leadership). While Tech-ISM is written for a healthcare decision-maker, any individuals involved with healthcare technology implementation can benefit from a holistic understanding of how social and organisational factors of a workplace inter-relate with the human experience of novelty and change.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"9 1","pages":"240 - 252"},"PeriodicalIF":2.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75372617","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 healthcare logistics and evaluating current use cases of UAVs (drones) as a method of transportation in healthcare to generate recommendations for the NHS to use drone technology at scale: a narrative review","authors":"Christopher Tejun Law, Catharina Moenig, Hammad Jeilani, M. Jeilani, Tony Young","doi":"10.1136/bmjinnov-2021-000861","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000861","url":null,"abstract":"Drones have been pioneered and used in the military, however, only recently non-military drones have been introduced. The COVID-19 pandemic has brought into focus the potential value of drones in moving medical supplies. With the onset of social distancing policies and quarantine regulations, the efficiency of traditional logistics systems has been limited. Several companies have recently accelerated their development in this domain, conducting pilot projects at pace, paving the way for the future of the medical logistics supply chain. In this review, we examine both narrative and grey literature for in and out of hospital settings, in order to describe the current state of drone technology in healthcare around the world and some of the most cutting-edge examples of how drones can benefits patients, clinicians and the wider public. We investigate the economic viability and barriers to adopting drones at scale which include regulatory hurdles, public perception and safety of drone technologies, and propose how to overcome these challenges. Further work should look at quantifying the impact and outcomes of how such a service could impact the health outcomes of patients and clinical efficiency. This review aims to equip the National Health Service and more broadly other healthcare systems around the world with the tools to embrace and implement this novel and upcoming technology.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"183 1","pages":"150 - 164"},"PeriodicalIF":2.0,"publicationDate":"2023-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73733981","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":"Barriers and facilitators for the adoption of telemedicine services in low-income and middle-income countries: a rapid overview of reviews","authors":"V. Dhyani, Jisha B. Krishnan, E. Mathias, M. Hossain, Carrie Price, Nachiket Gudi, S. Pattanshetty, S. Zodpey","doi":"10.1136/bmjinnov-2022-001062","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-001062","url":null,"abstract":"Objective To identify the barriers and facilitators for uptake of telemedicine services in low-income and middle-income countries (LMICs). Design The rapid review approach to identify the barriers and facilitators for the uptake/delivery of telemedicine in health system from both the provider and the patient’s perspective. A two-stage sequential screening process was adopted. Data extraction was done using a piloted data extraction form. Data sources A search on PubMed (NCBI), Embase (Ovid), the Cochrane Library (Wiley), Scopus (Elsevier) and the WHO Global Index Medicus was conducted. Eligibility criteria for selecting studies Studies published between 1 January 2012 and 1 July 2022 on barriers and facilitators for uptake of telemedicine services in LMICs were included. Results Database search identified a total of 2829 citations. After removing 1069 duplicates, 1760 were taken forward for title and abstract screening. A total of 43 articles were included at full text stage and 8 articles were included in this overview for narrative synthesis. Barriers and facilitators to telemedicine adoption and use were categorised under four subheadings, namely organisational and environmental, individual and cultural barriers, financial barriers and technological barriers. Providers, patient and health policy-makers perspectives were captured. Conclusion Any development of telemedicine services should engage the primary users such as patients and their family caregivers to design people-centred digital health systems and services. Usability studies must be commissioned by the governments and host agencies to enhance the interaction experience pending which investments would remain futile. Future research should employ mixed methods or multi methods approaches to understand the interaction between patients and providers.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"76 1","pages":"215 - 225"},"PeriodicalIF":2.0,"publicationDate":"2023-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86566265","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":"Design thinking to improve rational use of oral rehydration salts: lessons from an innovative co-packaged diarrhoea treatment kit","authors":"R. Ramchandani, Simon Berry, Jane Berry, Beth A. Pratt, Albert Saka, R. Black","doi":"10.1136/bmjinnov-2023-001081","DOIUrl":"https://doi.org/10.1136/bmjinnov-2023-001081","url":null,"abstract":"Introduction We explored whether greater consideration of product design, informed by end users’ opinions, led to improved utilisation (ie, rational use) of oral rehydration salts (ORS) in home settings. We tested whether a ‘design thinking’ approach, focusing on product acceptability, functionality and ease of use, contributed to an increased likelihood of appropriate ORS use, specifically dosing and preparation of ORS in the correct concentration. Methods Intervention design decisions were used to develop a co-packaged diarrhoea treatment kit containing ORS and zinc, branded as ‘Kit Yamoyo’. In addition to co-packaging, key product design features were the inclusion of 200 mL ORS sachets and a water measurement function incorporated in the packaging design. Cross-sectional data from household surveys of caregivers in rural Zambia were then used to compare ORS preparation and use for diarrhoea patients aged <5 years, who used either the novel co-pack or standard 1 L sachets of ORS. Design benefits were demonstrated to caregivers from two rural areas by trained community health workers (CHWs). Results Odds of correct ORS preparation were 10.93 times greater (p<0.001; 95% CI 5.74 to 20.78) among Kit Yamoyo users versus individuals who used 1 L sachets. Co-pack users prepared ORS to the correct concentration 93% (95% CI 0.89% to 0.96%) of the time, while non-users prepared it in the correct concentration just 60% (95% CI 0.54% to 0.66%) of the time. Conclusion Application of design thinking to the development of a co-packaged ORS and zinc diarrhoea treatment kit, coupled with demonstrations by CHWs, can improve rational use of ORS.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"112 1","pages":"132 - 143"},"PeriodicalIF":2.0,"publicationDate":"2023-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79218235","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":"Feasibility of morphometric analysis of conjunctival blood vessel as an additional diagnostic indicator of health and vascular disease status","authors":"Shobhana Sugirthamuthu, S. Sundaram, Radha Annamalai, S. Prabhakar, Neha Arora, Arthi Mohanendran, Parikumar Periasamy","doi":"10.1136/bmjinnov-2022-001017","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-001017","url":null,"abstract":"Sugirthamuthu S, et al. BMJ Innov 2023;0:1–4. doi:10.1136/bmjinnov-2022-001017 Department of Ophthalmology, The Light Eye Hospital, Dharmapuri, Tamil Nadu, India Department of Pathology, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India Department of Ophthalmology, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India Consultant Ophthalmologist, The Light Eye Hospital, Dharmapuri, Tamil Nadu, India","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"61 1","pages":"253 - 256"},"PeriodicalIF":2.0,"publicationDate":"2023-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86416123","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}