BMJ Innovations最新文献

{"title":"Conversational AI facilitates mental health assessments and is associated with improved recovery rates","authors":"Max Rollwage, Johanna Habicht, Keno Juchems, Ben Carrington, Tobias U Hauser, Ross Harper","doi":"10.1136/bmjinnov-2023-001110","DOIUrl":"https://doi.org/10.1136/bmjinnov-2023-001110","url":null,"abstract":"Mental health services across the globe are overburdened due to increased patient need for psychological therapies and a shortage of qualified mental health practitioners. This is unlikely to change in the short-to-medium term. Digital support is urgently needed to facilitate access to mental healthcare while creating efficiencies in service delivery. In this paper, we evaluate the use of a conversational artificial intelligence (AI) solution ( Limbic Access ) to assist both patients and mental health practitioners with referral, triage, and clinical assessment of mild-to-moderate adult mental illness. Assessing this solution in the context of England’s National Health Service (NHS) Talking Therapies services, we demonstrate in a cohort study design that deploying such an AI solution is associated with improved recovery rates. We find that those NHS Talking Therapies services that introduced the conversational AI solution improved their recovery rates, while comparable NHS Talking Therapies services across the country reported deteriorating recovery rates during the same time period. Further, we provide an economic analysis indicating that the usage of this AI solution can be highly cost-effective relative to other methods of improving recovery rates. Together, these results highlight the potential of AI solutions to support mental health services in the delivery of quality care in the context of worsening workforce supply and system overburdening. For transparency, the authors of this paper declare our conflict of interest as employees and shareholders of Limbic Access, the AI solution referred to in this paper. Data available at a dedicated GitHub repository. Code and data supporting this study are available at a dedicated GitHub repository.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140018774","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":"What is the impact of healthcare innovation on measurable outcomes of healthcare organisation performance? A systematic review","authors":"Caoimhe Madden, Róisín O'Malley, Emily O'Dowd, Paul O'Connor, Sinéad Lydon, Jared Gormly, Dara Byrne","doi":"10.1136/bmjinnov-2023-001097","DOIUrl":"https://doi.org/10.1136/bmjinnov-2023-001097","url":null,"abstract":"Objective The lack of quantitative evidence of effectiveness has been cited as a notable shortcoming of initiation and diffusion of innovations in healthcare. Therefore, this review aimed to synthesise research assessing the impact of healthcare innovations on measurable outcomes of healthcare organisation performance. Design A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources Systematic searches were conducted across three electronic databases, namely MEDLINE, CINAHL and PsycINFO. Eligibility criteria for selecting studies Articles were required to: (a) be published in an English-language, peer-reviewed journal since 2000; (b) describe the application of a specific innovation within a secondary healthcare setting; (c) report data on the summative evaluation of the impact of the innovation on healthcare outcomes, using an outcome measure in line with Level Four of Kirkpatrick’s Evaluation Hierarchy (ie, a measure of organisation performance) and (d) consist of a research design that allowed for evaluation of innovation impact on outcome measures by means of a comparator. Results Innovations targeting organisational change were most commonly implemented. Innovations generally had a positive impact, evident in almost two-thirds of the outcome measures assessed across the included articles. Innovation impact was predominantly measured via health utilisation metrics and medical-clinical indicators, with safety outcomes and patient/family perceptions less frequently assessed. Conclusion There is evidence to show that innovations result in discernible change in organisational importance, including on important metrics such as finance and healthcare utilisation. Bundling outcome measures are recommended to provide a more complete picture of the true impact of innovation on healthcare organisation performance. Data are available on reasonable request.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139420807","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":"Exploratory study to assess the functional capacity, safety and ability to isolate novel COVID-19 of a novel self-administrative nasopharyngeal wash specimen collecting device","authors":"S K Mohanasundari, Sivam Thanigainathan, R Gadapalli, Pankaj Rawat, S Vandana, K Deepak, N Gupta","doi":"10.1136/bmjinnov-2023-001122","DOIUrl":"https://doi.org/10.1136/bmjinnov-2023-001122","url":null,"abstract":"Introduction Although nasopharyngeal/oropharyngeal swabs are considered the gold standard for SARS-CoV-2 diagnosis, these procedures are distressing, require trained personnel and may pose a risk of transmission. Aim This study aims to assess the functional capacity, safety, ability to isolate the novel COVID-19 and end-users’ acceptance of a novel self-collection device for obtaining nasopharyngeal wash samples. Methods Initially, the novel device’s functional capacity (amount of nasopharyngeal wash specimen collected by participants themselves using the novel device) and safety (procedure-related complications such as bleeding, aspiration or syncope) were assessed in 15 healthy volunteers. Then, its ability to isolate the novel COVID-19 in symptomatic patients, procedure-related discomfort and end-users’ acceptance were compared with the conventional nasopharyngeal/oropharyngeal swab technique. Results All 15 volunteers obtained more than 1 mL of nasopharyngeal wash sample using the novel device, with no reported medical complications. Out of 14 COVID-19-suspected patients, 9 tested positive using the novel method compared with 8 with the conventional method (p=0.09). The novel method demonstrated significantly less discomfort (median score 1 vs 5, p<0.001) and significantly higher acceptability (median score 9 vs 2, p<0.001) compared with the conventional method. Conclusion The novel self-administrative nasopharyngeal wash specimen-collecting device allowed patients to collect samples safely. The procedure could isolate the novel COVID-19 from the nasopharynx, similar to the conventional nasopharyngeal swab technique. The novel method was less discomforting and more acceptable for end-users compared with the conventional method and is suitable for mass screening.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139423537","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":"Development and introduction of a mixed realities playkit: decreasing the incidence of general anaesthesia for paediatric MRI","authors":"Jill Thompson, Dylan Yamada-Rice, Sean Thompson, Louise Murray, Matthew Taylor","doi":"10.1136/bmjinnov-2023-001083","DOIUrl":"https://doi.org/10.1136/bmjinnov-2023-001083","url":null,"abstract":"","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539924","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":"Time to treat the climate and nature crisis as one indivisible global health emergency","authors":"Chris Zielinski","doi":"10.1136/bmjinnov-2023-001188","DOIUrl":"https://doi.org/10.1136/bmjinnov-2023-001188","url":null,"abstract":"","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135217163","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":"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}