BMJ Innovations最新文献

{"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}

{"title":"Disinfectant tunnels: a solution to the problem or a problem on its own?","authors":"Siew Hui Michelle Koh, S. L. Young, H. Z. Chai, A. Chan, Aik Hong Philine Chan, Jun Chun Chia, Frederick Teo, Soh Hui Qing, T. Ong, G. Phua","doi":"10.1136/bmjinnov-2021-000931","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000931","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION The Coronavirus disease 2019 (COVID19) pandemic has impacted the health and socioeconomic status of millions of people worldwide. COVID19– related health policies 2 introduced around the world contain methods to curb the transmission of the virus, and these include border control measures, contact tracing and lockdown. As the world enters the third year of living in the COVID19 pandemic, countries have attempted lifting movement restrictions only to face yet another wave of the virus transmission, resulting in the continuous cycle of transmission, lockdown and reopening. To break this cycle or delay the next wave, Cacciapaglia et al suggested that the key was to limit the number of persons infected during the interwave strolling period. However, aside from the commonly used approach of movement restrictions that has negative impacts on the economy and mental health, 6 another approach that could be considered would be physical devices that can prevent spread of viruses. Novel ideas on automated disinfectant devices have emerged as a means to reduce risks of viral transmission. One such device is a disinfectant booth or tunnel, which has been developed and deployed in as many as 16 countries, including Singapore, China, the middle East and Russia, in an effort to increase sanitisation and minimise transmission of the virus. 9 The type of disinfectant used in these disinfectant tunnels differs, ranging from benzalkonium chloride (BAC) to sodium hypochlorite and even Ayurvedic remedies. 10 BAC is a quaternary ammonium compound, largely used for its properties as an antiseptic and disinfectant. It has reported efficacy against coronaviruses and has been used as one of the main active ingredients in the disinfectant booths or tunnels deployed. However, such disinfectant systems are currently not recommended by WHO. The safety profile of the tunnels is not clear, especially regarding potential pulmonary side effects. In vivo studies suggest pulmonary toxicity associated with BAC. 15 BAC has also been implicated in the development of occupational asthma, as an airway irritant as well WHAT ARE THE NEW FINDINGS ⇒ This is the first pilot study to look at the bronchoconstrictive effects of aerosolised BAC. ⇒ Findings from this pilot study suggest that BAC disinfectant tunnels/booths cause bronchoconstriction even when used with a surgical face mask. With N95 respirators, no conclusive objective evidence of bronchoconstriction was made, but subjective symptoms were reported. ⇒ Hence, conclusion regarding safety cannot be made.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"62 1","pages":"301 - 306"},"PeriodicalIF":2.0,"publicationDate":"2022-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90868451","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":"Cultivating design thinking skills through the biodesign process in Japan","authors":"H. Kiriyama, Takaaki Kakihiana, Yujiro Maeda, Munemasa Sugimoto, Megumi Machida, Tomotaka Inoue, Fumiaki Ikeno, I. Komuro, M. Ono","doi":"10.1136/bmjinnov-2021-000923","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000923","url":null,"abstract":"Background The biodesign process, which originated at Stanford University, has had a significant impact on medical device invention. Design thinking skills are core elements in the biodesign process, but there has been no quantitative evaluation of how design thinking is actually affected by a biodesign course. The purpose of this study was to examine the usefulness of the biodesign process by quantifying design thinking ability. Methods We recruited 17 participants who had studied a systematic biodesign process in Japan and 20 participants who were unfamiliar with the biodesign process. All participants took the design thinking test and we evaluated their design thinking skills using a combination of the creation score and the evaluation score. Results The average age of the participants was 34.4 years and 84% were male. Participants who had taken the biodesign program generated more ideas than other participants (5.3±1.9 ideas vs 3.7±2.3 ideas; p=0.01). They also had significantly higher design thinking score, especially creation score, than those who had not taken the program (design thinking score, 220.1±39.7 vs 194.6±32.1; p=0.02; creation score, 91.3±23.0 vs 70.7±20.2; p=0.03). Conclusion The findings suggest that the biodesign process can cultivate design thinking skills, especially the ability to visualise needs and create solutions. Exposure of more people to the biodesign process may accelerate innovation in the medical technology field.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"31 1","pages":"273 - 277"},"PeriodicalIF":2.0,"publicationDate":"2022-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89347184","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":"Management model of the COVID-19 pandemic in socially vulnerable communities","authors":"G. Marín, Jenny Fonseca, G. Etchegoyen, Lupe Marin, Itziar Kain Aramburu, Rocio Rodriguez, Pablo Vetere, Graciela Mateo, Marcelo Bourgeois, F. Campuzano-Castro, Ignacio Babbini, Gina Marin, Tomás Canevari, H. Bozzano","doi":"10.1136/bmjinnov-2021-000870","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000870","url":null,"abstract":"Introduction Several public policies were proposed to reduce the negative impact of COVID-19 pandemic. This work aimed to determine how a management model is capable of strengthening the community network, providing support, healthcare and channelling public government’s aid during COVID-19 pandemic situation. Methods It is an intervention study that tested the effectiveness of a management model for both healthcare and essential goods access in a socially vulnerable neighbourhood called ‘Puente de Fierro’ in La Plata the capital of Buenos Aires State, Argentina, during the COVID-19 pandemic. Altos de San Lorenzo suburb area was considered as control group. Variables studied were: level of contagion and death due to the SARS-CoV-2 virus; access to food, medicine and other goods; strengthening of community networks; performance of government programmes in territory. Results A new management paradigm was tested by moving essential goods towards the people, instead of making the people move to obtain those benefits. Accessibility to ‘Food Bag’ and ‘Food Bank’ were significantly increased, a reduction of contagion level and mortality rate for COVID-19 was achieved (2.3/100 000 vs 3.6/100 000 inhabitants in control area; and ‘fatality rate’ was 2.8% vs 3.6%, respectively). Support was also provided to installed in local stores virtual payment devices for food cards acceptance. Conclusion The management model based in healthcare and goods and service supplies during COVID-19 pandemic reduced the negative impact of disease and its measures of isolation in socially vulnerable neighbourhoods.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"14 1","pages":"261 - 272"},"PeriodicalIF":2.0,"publicationDate":"2022-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87809508","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":"User-centred innovation to advance safe surgery at the point of need: report on development of the SurgiField system","authors":"D. Teodorescu, Sashidhar Jonnalagedda, A. Rakin, Mike H. M. Teodorescu, Macauley Kenney, Julian Greene, Steven L. Bokshan, H. Mashbari, A. Moten, O. Alser, R. Sinyard, A. Dorken-Gallastegi, Arnav Mahajan, R. Smalley, Daniel Frey, D. R. King, M. Cherian","doi":"10.1136/bmjinnov-2021-000893","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000893","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. Reuse permitted under CC BY. Published by BMJ. INTRODUCTION In conditions ranging from pneumothorax to acute compartment syndrome to fractures to traumatic and degenerative joint disease to appendicitis to obstructed labour to postpartum haemorrhage; safe, timely surgical intervention is the deciding factor among recovery, mortality or longterm disability. Consequently, access to quality surgical care is a global priority across the resource spectrum. Yet despite this, an estimated 18 million people die annually from conditions that safe surgery could address. Even more experience permanent disability from delayed, inaccessible, or unsafe surgery, generating a gross domestic product loss of US$820 billion from lost annual productivity. Far from requiring resourceintensive, sophisticated surgeries, the vast majority of surgical needs globally are captured by the simple, socalled bellwether surgical procedures. Surgical care has traditionally relied on consistent availability of three resource categories: (1) functional equipment and materials, (2) appropriate facility space and (3) medical staff. 4 Given the practical challenges of disseminating these resources consistently in many austere settings, including but not limited to conflict settings, disaster zones, lowtomiddleincome countries and rural regions; surgical care availability is often limited to centralised referral settings. Even higherresource settings regard costcontainment and quality improvement as ongoing challenges to care equity and sustainability. For instance, Californian operating theatres cost an average of US$37 per minute to run. High equipment and facility costs are driven in part by maintaining the sterility WHAT ARE THE NEW FINDINGS","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"14 1","pages":"317 - 322"},"PeriodicalIF":2.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90914076","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}