BMJ Innovations最新文献

{"title":"Effectiveness of an anti-fog polymer coating in protective eyewear: a blinded, randomised controlled cross-over trial with healthcare providers in an emergency department setting","authors":"Yonatan G. Keschner, A. Raja, J. Margolin, Hui Zheng, K. Olson","doi":"10.1136/bmjinnov-2022-000962","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-000962","url":null,"abstract":"Background Eye protection is a mandatory component of the personal protective equipment in healthcare settings, especially for suspected or confirmed cases of COVID-19 and during aerosolising procedures. Fogging of protective eyewear is a frequent problem experienced by providers. The hydrophilic property of a sulfonated polymer, BiaXam, may be able to decrease fogging through wicking moisture from the lens. In this study, we tested the anti-fogging properties of this polymer when applied to protective eyewear. Methods An investigator-initiated prospective, randomised, single-blinded cross-over study was conducted in an emergency department in a large, tertiary care hospital. Participants were blinded and randomised first to either a pair of anti-fog coated or uncoated eyewear, and then to the alternative pair after 2 hours. Study participants completed an identical survey at the end of each 2-hour period. Results 50 emergency medicine healthcare providers were enrolled and 48 completed the study. Results demonstrated a significant difference in fogging between the coated and uncoated eyewear, as 81% of the participants reported fogging of the uncoated lenses and only 55% of the participants reported fogging in the coated pair (p=0.0029). Participants reported that the uncoated lenses fogged two times as frequently on a 10-point Likert scale (4.5±3.3 vs 2.1±2.5; p<0.0001). Subgroup analysis of participants who wore only a surgical mask demonstrated even more efficacious results with coated eyewear. Conclusion Overall, sulfonated polymer-coated eyewear improved provider visualisation, user experience and perceived mitigation of potential medical errors.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"149 12","pages":"144 - 149"},"PeriodicalIF":2.0,"publicationDate":"2022-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72576042","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 ‘half-and-half’ design of staining jars for comparative assessment of stains","authors":"S. Sachdev, T. Chettiankandy","doi":"10.1136/bmjinnov-2022-000983","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-000983","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION At present, Coplin jars are used universally for histological staining. They are grooved glass jars which allow microscopic slides to stand separated while staining procedure. They were invented by William Coplin in 1897 and remain in use to date. Except for a few modifications such as use of plastic materials, or screwcapping to avoid evaporation or contamination, the design of Coplin jars has remained mostly unchanged. Many times, situations arise in histopathological laboratories wherein multiple special stains are to be applied on the tissue sections for histochemical confirmation of the nature of cells or material. The scenario is fairly common in researches that compare two or more histological stains. Certain study designs also revolve around comparing the effect of fixation or embedding on staining characteristics. Demonstrating suitability of histological stains in detecting microbes, pigments, or tissue elements such as muscle, cartilage, etc aids in making the diagnostic pathological procedures more accurate and efficient. In such scenarios, the extent of materials such as microscopic slides, cover slips, staining dyes and other chemicals required for the procedures correspond to the number of samples to be stained. The need may not seem significant in routine cases, but the financial toll is amplified exponentially when a large number of samples are involved in studies. Many laboratories, particularly in lowincome and middleincome countries, are not able to afford such exuberant expenditure and are ultimately unable to conduct such largescale comparative studies due to nonfeasibility. They either refrain from conducting the study or select a smaller sample size. A smaller sample size ultimately makes the finals results of their study less valid. The chemicals and materials required for research may also be difficult to procure at times. The problem is fairly common in rural areas of lowincome and middleincome countries, such as India. The problem was even further amplified in COVID19 pandemic, wherein much of the funds were focused on countering the pandemic. There was a decrease Summary box","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"60 1","pages":"192 - 194"},"PeriodicalIF":2.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91237916","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":"SAFER framework for moving forward on the medical device right to repair","authors":"Shuhan He, D. Lai, Grace Jin, Jarone Lee","doi":"10.1136/bmjinnov-2022-000936","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-000936","url":null,"abstract":"Across various industries, the right to repair (RTR) movement has gained momentum as more than 20 states have proposed RTR laws to expand access to repair of consumer products. Medical device equipment shortages during the COVID-19 pandemic demonstrated that stronger repair mechanisms are necessary for the US health system to become more efficient, affordable and sustainable. We propose a 5-point SAFER framework including safety and security, adaptability, fiscal, environmental and regulatory factors for consideration in implementing medical device RTR. The healthcare community can help advance RTR legislation in a manner that serves our patients and healthcare system best.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"75 1","pages":"97 - 102"},"PeriodicalIF":2.0,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82291560","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":"Implementation of a community-based referral project to improve access to emergency obstetric and newborn care in Rohingya population during COVID-19 pandemic in Bangladesh.","authors":"Mrittika Barua,&nbsp;Avijit Saha,&nbsp;Srizan Chowdhury,&nbsp;Sayantan Chowdhury,&nbsp;Stenly Hely Sajow,&nbsp;Malabika Sarker","doi":"10.1136/bmjinnov-2021-000831","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000831","url":null,"abstract":"<p><strong>Introduction: </strong>The delay in seeking emergency obstetric care leads to significant maternal morbidity and mortality and can worsen during pandemics, especially in humanitarian conflict settings with low uptake of obstetric services. To mitigate the challenges related to the second delay caused by lack of transport in the COVID-19 pandemic, the organisation United Nations Population Fund implements a community-based referral project called Referral Hub in the Rohingya refugee population in Bangladesh. The objective of the paper is to describe the implementation process of the Referral hub and present clients' utilisation and perception of the service.</p><p><strong>Methods: </strong>Findings from part of a larger mixed-method study, the analysis of the standard operating protocol of the intervention, secondary data of routine utilisation of the 12 referral hubs between January and August 2020, 21 key informant interviews and a community survey among 100 pregnant women are presented in this paper.</p><p><strong>Results: </strong>The findings show an increasing trend in the referral hub utilisation and a strong recommendation of the service.</p><p><strong>Conclusion: </strong>Due to a robust referral mechanism by collaborating with the community and engaging accessible and free of cost transport service, the intervention has high potential to improve access to facility care in low-resource and humanitarian contexts, especially during pandemics.</p>","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"8 4","pages":"247-254"},"PeriodicalIF":2.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10156895","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":"Innovative technology to eliminate the racial bias in non-invasive, point-of-care (POC) haemoglobin and pulse oximetry measurements","authors":"Sanjay G Gokhale, V. Daggubati, G. Alexandrakis","doi":"10.1136/bmjinnov-2022-001018","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-001018","url":null,"abstract":"There is a significant unmet clinical need for a reliable point-of-care (POC) estimation of the blood haemoglobin (Hb) method. Current available methods, notably pulse oximetry, have certain limitations related to design and methodology of devices. These have low sensitivity for detecting serial change in the Hb values, especially at the lower range and are inaccurate in people with darker skin. Objective This study aimed at developing a novel, non-invasive technology for the measurement of Hb and oxygen saturation. Design This was an observational study. Recruitment This was approved by the Institutional Review Board at the University of Texas at Arlington and 16 healthy adult volunteers (age 20–40 years) were recruited in this study. The investigational device (Shani) probe (United States Patent 11191460B1) consists of light emitting diodes with wavelengths ranging 520–580 nm, and a photosensor component. The probe is gently placed on the back of the subject’s wrist and reflected light is measured as an electrical signal, with digital recordings. Skin tone (or skin colour) was assessed by Von Luschan Chromatic Scale (VLS). Using a specific algorithm accounting for melanin (as determined from VLS Scale) and employing a software, the results can be displayed on screen as Hb values and ratio of tissue oxygen saturation. Results The results of the investigational non-invasive (Shani) device were comparable with the invasive, point of care (POC) method (iSTAT, Abbott Inc.).","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"226 1","pages":"73 - 77"},"PeriodicalIF":2.0,"publicationDate":"2022-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80125230","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":"‘It all stems from relationship’: effectiveness of a crowdsourcing contest to elicit community ideas on how to build trust between healthcare providers and community about COVID-19","authors":"A. Mathews, Miranda Wenhold, Allison Caban-Holt, T. Starks, Alan N. Richmond, A. Vines, G. Byrd","doi":"10.1136/bmjinnov-2021-000896","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000896","url":null,"abstract":"Objective The COVID-19 pandemic requires a nimble approach to building trust between healthcare providers and community. Crowdsourcing is one community-engaged approach that may be effective at engaging marginalised communities to identify ways to build trust. This early-stage innovation report assesses the effectiveness of using a crowdsourcing contest to elicit community ideas on how to build trust between healthcare providers and community about COVID-19 and promote community engagement about vaccines. Methods This mixed-methods study conducted a qualitative assessment of crowdsourcing contest entries and evaluated online community engagement via social media analytics (reach, video views, engagement). Themes from contest entries informed the development of community leader video interviews. Qualitative data from contest entries were digitally transcribed and analysed using axial coding. Results Contest participants (n=19) were European Americans (n=10), African Americans (n=8, 87%) and American Indians (n=1), the majority of whom identified as women (n=18) and were 18–80 years old. Contest entry recommendations included: (1) partner with community stakeholders and providers, (2) improve access to credible information from trusted sources, (3) use multiple channels of communication, and (4) use clear and plain language. Conclusion Crowdsourcing contests coupled with public education are beneficial community engagement tools to identify new ways to promote trust between medical professionals and diverse community members about COVID-19. Crowdsourcing contests also provide opportunity for partnership and critical dialogue between healthcare professionals and community leaders.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"9 1","pages":"116 - 123"},"PeriodicalIF":2.0,"publicationDate":"2022-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87484148","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":"Pressure sensing and pressure redistribution mattress for prevention and management of pressure injuries","authors":"H. Tey, Crystal Zhen Yu Phuan, Joey Sok Theng Tan, Sufang Yang, Nwe Oo Hnin, S. Y. Hoi","doi":"10.1136/bmjinnov-2022-000958","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-000958","url":null,"abstract":"","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"1 1","pages":"124 - 127"},"PeriodicalIF":2.0,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78582932","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":"Cleaning up plastics in healthcare waste: the transformative potential of leadership","authors":"Fawzia N Rasheed, G. Walraven","doi":"10.1136/bmjinnov-2022-000986","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-000986","url":null,"abstract":"This article argues that plastics ought to be included under the category of ‘hazardous’ healthcare waste and suggests that health professionals should strive for alternatives as part of their mission to improve health. The focus of this paper is on replacing, rather than recycling, plastics. The rationale for this stance stems from the unbridled escalation of plastics use, the fact that few countries have significant recycling capacity, and because the process of recycling as well as the end products of recycled plastics remain hazardous to health and the environment. Issues related to incinerated plastic, plastics in single-use items, plastic blister packs and containers for medicines, as well as plastics which are unrelated to healthcare but which nevertheless make up a substantial part of general healthcare waste are discussed. Suggestions are put forward to dramatically reduce plastics in all such cases. To support needed reforms and to guide best practice for single-use plastics in particular, a call for a reliable reference source is made—similar to the Essential Medicines Lists, which would share updated information on the most problematic items in use and environmentally friendly alternatives in each case. It is argued that concerted action by health professionals to improve healthcare waste, beginning with plastics, would send much needed market signals to industry to produce environmentally-friendly products for healthcare and would likely lead to solutions for domestic waste, too.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"557 1","pages":"103 - 108"},"PeriodicalIF":2.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73434862","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":"Reverse innovation in western healthcare: a randomised crossover trial comparing the ReMotion prosthetic knee with the current standard of care","authors":"W. van Oorschot, N. Keijsers, R. V. Van Ee, M. van Houdenhoven","doi":"10.1136/bmjinnov-2021-000908","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000908","url":null,"abstract":"Introduction Healthcare expenses are reaching unaffordable levels worldwide and reverse innovation could play a role in decreasing these expenses and improving healthcare accessibility. The ReMotion Knee, a prosthetic knee primarily developed for low-income countries, could serve as a reverse innovation for people with a lower limb amputation. This study aimed to evaluate the ReMotion Knee as a potential reverse innovation in high-income countries, specifically in terms of functional mobility. Methods Nine participants with a transfemoral amputation or knee exarticulation were included in this randomised crossover trial. The ReMotion Knee was compared with the participants’ current prosthetic knee in terms of functional mobility and subjective experiences. The primary outcome in this study was the L test for functional mobility. Secondary outcomes were additional clinical performance tests and subjective experiences (balance confidence, walking comfort, test performance and fatigue). Results Participants scored significantly better using their current prosthetic knee than using the ReMotion Knee on primary outcome, the L test (p<0.01, median difference 7.5 s, IQR 6.1–10.6) and all secondary outcomes except experienced test performance and fatigue. All participants were able to safely perform all clinical tests with the ReMotion Knee, even after a short familiarisation period. Conclusions The ReMotion Knee has the potential to become a reverse innovation after modifications improving velocity, walking comfort and weight limit. Collaboration between high-income and low-income countries can facilitate further development of the ReMotion Knee and could result in alternative products and treatments that could reduce healthcare costs while still providing a good quality of care. Trial registration number NCT04700085.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"1 1","pages":"65 - 72"},"PeriodicalIF":2.0,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90016686","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":"Machine-learning algorithm to non-invasively detect diabetes and pre-diabetes from electrocardiogram","authors":"A. Kulkarni, Ashwini A Patel, Kanchan V Pipal, Sujeet G Jaiswal, Manisha T Jaisinghani, Vidya Thulkar, Lumbini Gajbhiye, Preeti Gondane, Archana B Patel, M. Mamtani, H. Kulkarni","doi":"10.1136/bmjinnov-2021-000759","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000759","url":null,"abstract":"Objectives Early detection is of crucial importance for prevention of type 2 diabetes and pre-diabetes. Diagnosis of these conditions relies on the oral glucose tolerance test and haemoglobin A1c estimation which are invasive and challenging for large-scale screening. We aimed to combine the non-invasive nature of ECG with the power of machine learning to detect diabetes and pre-diabetes. Methods Data for this study come from Diabetes in Sindhi Families in Nagpur study of ethnically endogenous Sindhi population from central India. Final dataset included clinical data from 1262 individuals and 10 461 time-aligned heartbeats recorded digitally. The dataset was split into a training set, a validation set and independent test set (8892, 523 and 1046 beats, respectively). The ECG recordings were processed with median filtering, band-pass filtering and standard scaling. Minority oversampling was undertaken to balance the training dataset before initiation of training. Extreme gradient boosting (XGBoost) was used to train the classifier that used the signal-processed ECG as input and predicted the membership to ‘no diabetes’, pre-diabetes or type 2 diabetes classes (defined according to American Diabetes Association criteria). Results Prevalence of type 2 diabetes and pre-diabetes was ~30% and ~14%, respectively. Training was smooth and quick (convergence achieved within 40 epochs). In the independent test set, the DiaBeats algorithm predicted the classes with 97.1% precision, 96.2% recall, 96.8% accuracy and 96.6% F1 score. The calibrated model had a low calibration error (0.06). The feature importance maps indicated that leads III, augmented Vector Left (aVL), V4, V5 and V6 were most contributory to the classification performance. The predictions matched the clinical expectations based on the biological mechanisms of cardiac involvement in diabetes. Conclusions Machine-learning-based DiaBeats algorithm using ECG signal data accurately predicted diabetes-related classes. This algorithm can help in early detection of diabetes and pre-diabetes after robust validation in external datasets.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"59 1","pages":"32 - 42"},"PeriodicalIF":2.0,"publicationDate":"2022-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84757610","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}