BMJ Innovations最新文献

{"title":"Development and testing of an intact cord resuscitation trolley","authors":"Jaspreet Singh Raina, Deepak Chawla, Suksham Jain, S. Khurana","doi":"10.1136/bmjinnov-2022-000950","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-000950","url":null,"abstract":"Objective To develop a mobile resuscitation platform—intact cord resuscitation (ICR) trolley and to assess the safety, feasibility and acceptability of its use during delayed cord clamping (DCC). Study design Bench-side product development and single-arm experimental study. Participants and methods We first developed a theoretical framework of the specifications required for the platform which can provide resuscitation close to the delivery/operating table. The theoretical framework was then translated into a working model in a series of iterations. After testing and training of healthcare workers in a simulated environment, the trolley was tested to perform DCC in neonates who were born at ≥34 weeks of gestation and were breathing spontaneously at birth. Outcomes measured Primary outcome was the feasibility of DCC using the ICR trolley defined as the proportion of babies successfully completing 180 s of DCC on the trolley. Secondary outcomes included the proportion of babies with 1 min heart rate (HR) and oxygen saturation (SpO2) recorded, neonatal and maternal safety outcomes, and acceptability among care providers. Results Among 50 neonates (gestation: 36.9±1.9 weeks and birth weight: 2544±649 g) enrolled in the study, DCC for ≥180 s was successfully done in 42 (84%) neonates. The mean duration of DCC was 170±27 s. HR and SpO2 at 1 min were recorded successfully in 92% of the babies. The majority of the maternal and neonatal care provider strongly supported the use of ICR trolley. Conclusion We developed an ICR trolley and successfully tested the feasibility and acceptability of its use in healthy neonates undergoing DCC.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"1 1","pages":"323 - 328"},"PeriodicalIF":2.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83235940","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 and development of a clinical decision support system for community health workers to support early detection and management of non-communicable disease","authors":"S. Zaman, Nisal De Silva, Tian Yu Goh, R. Evans, Rajkumari Singh, Rajesh Singh, Ashutosh Kumar Singh, P. Singh, A. Thrift","doi":"10.1136/bmjinnov-2022-000952","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-000952","url":null,"abstract":"Background Numerous groups have developed software applications (apps) for use by community health workers (CHWs) in hard-to-reach settings. However, these have either not been based on clinical guidelines or are not freely available. Our objectives were to (1) design and develop an app for use by CHWs; and (2) conduct preliminary testing of the app to identify potential obstacles. Methods We used the principle of human-centred design to develop an app programmed to an Android operating system. We used a mixed-methods approach which included site observations, meetings with stakeholders and the app development team, and laboratory simulation to fine tune the design. The ‘Mobile Application Rating Scale’ (MARS) was used for testing reliability and quality. We also assessed the validity of the app by matching the uploaded data with ‘gold standard’ preset answers. Results Depending on human–computer interactions, the app has reminder, advisor, critic and guide functions which can facilitate CHWs to make clinical decisions. We found the app is usable based on the final score of the MARS tool, and that the entered data were accurate. We present the simple procedures that were followed to develop this Android app. The app, including all of its code, is freely available. Conclusion The app shows promise as a tool for the management of non-communicable disease in a rural setting in India. The next step will be to refine the app in a field setting and then to evaluate its efficacy in a large-scale clinical trial.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"6 1","pages":"49 - 56"},"PeriodicalIF":2.0,"publicationDate":"2022-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81701306","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":"National Institutes of Health Stroke Scale scores obtained using a mobile application compared to the conventional paper form: a randomised controlled validation study","authors":"H. Bugge, M. Guterud, J. Røislien, K. Larsen, H. Ihle-Hansen, M. Toft, M. R. Hov, E. Sandset","doi":"10.1136/bmjinnov-2022-000968","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-000968","url":null,"abstract":"Background Prehospital delay contributes to treatment delay in acute stroke. Numerous prehospital stroke scales exist for stroke identification, but they lack the diagnostic accuracy of the in-hospital National Institutes of Health Stroke Scale (NIHSS). We have developed a mobile application to aid paramedics assessing prehospital NIHSS. This study explores agreement between NIHSS scores obtained using the Paramedic Norwegian Acute Stroke Prehospital Project (ParaNASPP) application compared with conventional assessment. Methods 25 physicians working with stroke were randomised to an application group or control. 20 unique videos portraying acute stroke symptoms were scored by both groups. 95% limits of agreement (LoA) were calculated using Bland-Altman’s method, comparing the groups to predefined scores, and each other. LoAs within ±3 NIHSS points were considered acceptable. Cohen’s kappa was calculated on dichotomised NIHSS scores. Results The ParaNASPP application group had 95% LoA of −2.33 to 2.71. The control group had LoA of −2.60 to 2.55. Direct comparison between the groups gave LoA of −3.12 to 3.55. When compared with the dichotomised predefined scores kappa was 0.93 in the application group and 0.89 in the control group. Kappa was 0.84 for direct comparison between the groups. Discussion There was very good agreement between the application and both the predefined score and the control group. Scores from the ParaNASPP application differ slightly more than our predefined goal when compared with the control group, but is well within when compared with the predefined NIHSS scores. We consider this acceptable and the ParaNASPP application validated for further clinical studies.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"41 1","pages":"57 - 63"},"PeriodicalIF":2.0,"publicationDate":"2022-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86903358","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":"Social innovation in health, community engagement, financing and outcomes: qualitative analysis from the social innovation in health initiative","authors":"Patricia Moscibrodzki, Emmanuel Ahumuza, Jingjing Li, Xiaoming Sun, Yusha Tao, L. van Niekerk, U. Amazigo, B. Halpaap, P. Awor, Joseph D. Tucker","doi":"10.1136/bmjinnov-2021-000902","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000902","url":null,"abstract":"Background Social innovation in health is a community-engaged process that links social change and health improvement, drawing on the diverse strengths of local individuals and institutions. However, there are few studies that examine community engagement, financing and outcomes. The purpose of this study is to use a qualitative descriptive analysis to assess 40 social innovations in health identified through a global open call. Methods This qualitative analysis examined social innovation case studies from low- and middle-income countries identified by a global social innovation network. A crowdsourcing open call identified projects and key components of each social innovation were evaluated by an independent panel. We used a US Centers for Disease Control and Prevention framework to measure community engagement as shared leadership, collaboration, involvement, consultation or informing. We used descriptive statistics to examine key aspects of community engagement, financing, health outcomes and non-health outcomes. Results Data from 40 social innovations were examined. Social innovations were from Africa (21/40), Asia (11/40), and Latin America and the Caribbean (8/40). Community engagement was diverse and robust across the cases and 60% (24/40) had either shared leadership or collaboration. Financing for social innovation came from research grants (23), national or provincial government support (15), revenues from sales (13), donations (13) and local government support (10). Social innovations reported health and non-health outcomes. Conclusion Our data demonstrate social innovations had robust community engagement. Innovative financing mechanisms provide mechanisms for sustaining social innovations. Further research on health and non-health outcomes of social innovation is needed.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"125 1","pages":"216 - 223"},"PeriodicalIF":2.0,"publicationDate":"2022-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80435752","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":"Structured digital care pathway for systemic acne treatment using isotretinoin","authors":"Amandip Sangha, M. Rizvi","doi":"10.1136/bmjinnov-2021-000917","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000917","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Acne is a condition that affects a large portion of the population, especially younger people. The condition is well documented as being a formidable burden on the patient, psychologically and socially. Moreover, the severe forms of acne can leave permanent scars on the skin, if not properly treated. Treatments of acne consist of a range of various topical treatments sometimes combined with antibiotics administered orally. Among the most potent systemic treatment options, there is isotretinoin, which is a vitamin Aderivative. In treating acne, isotretinoin works by ► Reducing sebum production. ► Shrinking the sebaceous glands. ► Reducing follicular occlusion. ► Inhibiting the growth of bacteria. ► Having antiinflammatory effects. Isotretinoin is administered orally in the form of capsules that are ingested daily over a longer period of time, typically over a course of 6–12 months. In most cases, the effect of the treatment is prolonged and sometimes permanent. The treatment of acne using isotretinoin includes regular followups and blood tests. Female patients need to be strongly advised against pregnancy due to the severe teratogenic effect. Among other known side effects are liver toxicity and elevated blood lipids. (Depression and other psychological problems are possible, although much debated side effects). 4 Hence, liver enzymes and lipid panels should be monitored. A safe treatment plan will include checkups with the doctor for blood work, patient– doctor conversation and guidance during the treatment. Though the frequency of blood tests need not be monthly for standard doses. In our service design research phase, we identified some key challenges that acne patients meet, when being considered for isotretinoin treatment. ► General practitioners (GPs) sometimes lack the knowledge of isotretinoin for acne treatment. It is a specialised task better left WHAT ARE THE NEW FINDINGS ⇒ Digital care pathway for treatment of acne using isotretinoin aims to streamline both patient and dermatologist user experience. ⇒ The digital service is built with care for medical soundness and treatment safety. ⇒ Communication between patient and doctor is facilitated through frequent message exchanges. ⇒ Knowledge transfer to patient is addressed. ⇒ The digital care pathway aims to make the treatment more accessible, and the digital experience more user friendly and efficient. ⇒ Provides a working example of a modern, teledermatological, digital care pathway for systemic treatment of acne using isotretinoin.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"2 1","pages":"312 - 316"},"PeriodicalIF":2.0,"publicationDate":"2022-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83561494","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 of a real time ultrasound guided lumbar puncture device","authors":"B. Fan, Chuang Kiat Desmond Soh, Hee Chuan Darryl Heng, Lee Long Eddie Woo, W. H. Bin","doi":"10.1136/bmjinnov-2021-000921","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000921","url":null,"abstract":"Department of Haematology, Tan Tock Seng Hospital, Singapore Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore Yong Loo Lin School of Medicine, National University of Singapore, Singapore Medulla Pro Technology Pte Ltd, Trendlines Medical Singapore, Singapore Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"21 1","pages":"307 - 311"},"PeriodicalIF":2.0,"publicationDate":"2022-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89267513","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":"Building the social innovation for health ecosystem in Latin America: experiences and learning from SIHI-LAC","authors":"L. van Niekerk, M. I. Echavarria, J. Alger, D. Castro-Arroyave, Martha Milena Bautista-Gómez, Claudia Ivette Nieto Anderson, B. Beltran, L. Cuervo","doi":"10.1136/bmjinnov-2021-000898","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000898","url":null,"abstract":"Social innovation for health has grown in relevance and momentum across Latin America.1-5 Yet, the potential of social innovation for health appears mostly untapped, with one reason for this being the limited investment to build strong ecosystems that can support social innovation initiatives.6-8","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"268 1","pages":"224 - 233"},"PeriodicalIF":2.0,"publicationDate":"2022-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77168910","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":"Social innovation in health: concepts and practice","authors":"Joseph D. Tucker, L. Manderson, U. Amazigo, J. Alger, Elizabeth Chen, M. Labarda, E. Kpokiri, P. Dako-Gyeke, R. Peeling, L. Cuervo, B. Halpaap","doi":"10.1136/bmjinnov-2022-000982","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-000982","url":null,"abstract":"","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"21 1","pages":"133 - 136"},"PeriodicalIF":2.0,"publicationDate":"2022-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87526556","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":"Technological innovation in vascular access surgery: a reflection on two recent developments","authors":"A. Williamson","doi":"10.1136/bmjinnov-2021-000854","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000854","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION The discipline of vascular access surgery can be defined as the facilitation of dialysis through rapid and easy access to a patient’s bloodstream. 2 This is one of the most fundamental diagnostic and therapeutic principles in the care of renal failure patients; however, instruments to achieve this in a controlled manner were only developed midway through the 17th century. By the early 20th century, the earliest dialysis machines had been created; however, haemodialysis could not continue beyond a couple of dozen treatments per patient—there was an exhaustion of access as the blood vessels would be ligated (‘tiedoff ’) after each treatment to prevent excessive bleeding. Modern vascular access methods were born in the 1950s when the first central venous catheters (CVCs—catheter entering a central vein), arteriovenous grafts (AVG—a synthetic tube connecting an artery and a vein) and native arteriovenous fistulas (AVF—a surgically created communication between an artery and a vein) were used. Technological advancement in these early stages focused on vascular anastomosis techniques and arteriovenous shunting (directing arterial blood through the venous system) materials to overcome access failure and thrombosis, respectively. The need for innovation to overcome the shortcomings of previous technologies or practices is an ongoing process—this report describes the driving forces behind two recent developments in the field of vascular access and evaluates their advantages and disadvantages against alternate technologies and their current use in clinical practice: ► The Hemodialysis Reliable Outflow (HeRO) graft—a twocomponent graft aiming to overcome the problem of central venous stenosis (luminal narrowing of the central veins). ► Percutaneous endovascular fistula creation—imageguided fistula creation aiming to avoid complications associated with open surgically created AVFs.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"84 1","pages":"291 - 295"},"PeriodicalIF":2.0,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75107336","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":"Youth researchers academy: a report on an innovative research training programme for young people in Zimbabwe","authors":"M. Tembo, C. Mackworth-Young, K. Kranzer, Chido Dziva-Chikwari, C. Mavodza, E. Dauya, Mufaro Makuni, Dakarai Chipare, Blessing Munyavi-Dehwe, Daniel Raradza, S. Bernays, R. Chingono, N. Dzavakwa, Rudo Nyamwanza, S. Francis, V. Simms, R. Ferrand","doi":"10.1136/bmjinnov-2021-000885","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000885","url":null,"abstract":"Introduction Youth engagement has the potential to enhance the design, implementation and relevance of research. Without strategies to capacitate young people with research skills, youth engagement in research is often tokenistic and ineffective. In this paper, we detail the implementation and evaluation of an innovative research training programme for youth (aged 18–24 years) in Zimbabwe called the Youth Researchers Academy (YRA). Methods Quantitative programme data and qualitative interviews and focus group discussions assessed acceptability of the YRA, youth researcher and mentor experiences, and impact of the YRA over time. Results We received 60 applications in 2019 and 89 applications in 2021. Ongoing feedback led to changes in the second programme (including longer training and certification). Youth researcher experiences included being motivated by learning new skills and valuing the relationship with mentors and peer networks. Many described long-term impact, including facilitation of higher education, setting up of new businesses through the stipends received, and, for some, opportunities to work in research. Discussion Overall, the programme was acceptable, facilitated meaningful youth-led research and trained a cohort of empowered youth researchers. Young people were eager to learn and capable of both learning and implementing critical research skills in a professional working environment. Implementation challenges included limited freedom in the co-design of research projects and the additional burden of work for YRA mentors. Conclusion The YRA provides a template for other academics to support similar training to facilitate capacity building and meaningful youth engagement for research with and for youth.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"22 1","pages":"183 - 189"},"PeriodicalIF":2.0,"publicationDate":"2022-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91006762","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}