BMJ Innovations最新文献

{"title":"Digital health innovations for non-communicable disease management during the COVID-19 pandemic: a rapid scoping review","authors":"Shruti Murthy, P. Kamath, Myron Anthony Godinho, Nachiket Gudi, A. Jacob, Oommen John","doi":"10.1136/bmjinnov-2021-000903","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000903","url":null,"abstract":"Objective To identify and summarise the digital health interventions (DHIs) implemented for non-communicable disease (NCD) management for COVID-19. Design Rapid scoping review. Three reviewers jointly screened titles–abstracts and full texts. One reviewer screened all excluded records. Data were mapped to WHO DHI Classification and narratively summarised. Data sources PubMed, CENTRAL, CINAHL, EMBASE. Eligibility criteria for selecting studies Peer-reviewed primary research published between 1 November 2019 and 19 September 2021 on DHI for NCD management during the COVID-19 pandemic. Reviews, editorials, letters, commentaries, opinions, conference abstracts and grey literature were excluded. Results Eighty-three studies drawn from 5275 records were included. A majority of the studies were quantitative in design. Forty per cent of the DHIs were implemented in the Americas. Nearly half of these DHIs targeted mental health conditions. A majority of the interventions were delivered remotely and via telephones. Zoom (26.5%), email (17%) and WhatsApp (7.5%) were the top three platforms for care delivery. Telemedicine, targeted client interventions, personal health tracking and on-demand information services for clients were the most frequently implemented interventions. Details regarding associated costs, sustainability, scalability and data governance of the DHI implementations were not described in the majority of the studies. Conclusion While DHIs supported NCD management during the COVID-19 pandemic, their implementation has not been equitable across geographies or NCDs. While offering promise towards supporting the continuum of care during care delivery disruptions, DHIs need to be embedded into healthcare delivery settings towards strengthening health systems rather than standalone parallel efforts to overcome system level challenges.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"18 1","pages":"3 - 18"},"PeriodicalIF":2.0,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82498107","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":"Innovations that harm: tobacco product and packaging in low-income and middle-income countries","authors":"Jennifer L Brown, K. Clegg Smith, K. Welding, J. Barnoya, Joanna E. Cohen","doi":"10.1136/bmjinnov-2021-000865","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000865","url":null,"abstract":"Brown JL, et al. BMJ Innov 2022;0:1–4. doi:10.1136/bmjinnov-2021-000865 Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Departamento de Investigacion, Unidad de Cirugia Cardiovascular, Guatemala City, Guatemala Integra Cancer Institute, Guatemala City, Guatemala","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"110 1","pages":"23 - 26"},"PeriodicalIF":2.0,"publicationDate":"2022-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76046242","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":"Flash glucose monitoring: the story so far and the journey ahead","authors":"T. Crabtree, P. Choudhary, P. Kar, E. Wilmot","doi":"10.1136/bmjinnov-2021-000862","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000862","url":null,"abstract":"Just a few years ago FreeStyle Libre (FSL) was a rarely encountered device, used only by a select few people with type 1 diabetes who could afford to self-fund it. This small disc has a small cannula under the skin which allows for interstitial glucose measurements and remains in situ for 14 days. Over the last 4 years the number of people with access to this life-changing technology on the National Health Service (NHS) has increased rapidly. Although there were barriers to implementing access and encouraging uptake of this technology, including systems, healthcare professionals and the users themselves, innovative interventions from NHS England and diabetes organisations ensured those who stood to gain the most benefit were not impeded in their access, with a particular emphasis on enabling FSL use in those who are often the hardest to reach. This article reviews the impact of FSL on type 1 diabetes care in England, the key events to date and the lessons learnt that can be applied in the future for newer diabetes technologies.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"6 1","pages":"27 - 31"},"PeriodicalIF":2.0,"publicationDate":"2022-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77006658","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":"Future developments and new technologies in the field of faecal incontinence: scanning the horizon using late-stage clinical trial registrations","authors":"K. Thomson, K. Dangova, D. Bliss, S. Wallace, Nicole O’Connor, H. Richter, F. Pearson","doi":"10.1136/bmjinnov-2021-000860","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000860","url":null,"abstract":"Aim The aim of this study was to examine how new technologies in late-stage clinical trials might address unmet patient, practitioner or caregiver need for faecal incontinence (FI) over the next 5 years. Methods Horizon scanning techniques were used to provide insights into the current landscape of emerging health technologies. A search was performed across clinical trial registries using the National Institute for Health Research Innovation Observatory’s ScanMedicine database (scanmedicine.com) to identify new, emerging interventions or health technologies (drugs, medical devices or diagnostics) that were addressing or investigating FI. Trials were then screened for relevance to FI in a non-blinded duplicate manner. Results 1163 records were identified through searching ScanMedicine, and 136 trials were included in the final data extraction and mapping process. The most frequently investigated FI intervention topics were complementary therapies (n=17, 12.4%); electrical stimulation (n=13, 9.5%); pelvic floor muscle training/biofeedback/sphincter exercises (n=13, 9.5%) and implanted sacral nerve stimulation (n=12, 8.7%). There was little evidence of new pharmaceutical technologies in development. Existing drugs are, however, being repurposed and trialled for the treatment of FI (eg, linaclotide, colesevelam). Such repurposed drugs often have lower development costs, shorter timelines and report lower failure rates compared with new pharmaceutical products. Conclusion Overall, the innovation space as indicated by late-stage clinical trials related to FI, is relatively stagnant. Patients, carers and healthcare professionals are demanding more effective treatment and containment options; however, these are unlikely to come to market in the immediate future.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"1 1","pages":"278 - 284"},"PeriodicalIF":2.0,"publicationDate":"2022-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86457214","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":"’Padayon’: a new digital health model for diabetes and hypertension in rural Philippines","authors":"John Paluyo, Anne Stake, Richard L. Bryson","doi":"10.1136/bmjinnov-2021-000900","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000900","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Noncommunicable diseases (NCDs) account for 41 million global deaths every year, equating to 71% of global deaths overall. Of the 41 million deaths, 29 million occur in lowincome and middleincome countries (LMICs). However, health system services for prevention, education, screening and treatment of NCDs remain inaccessible to billions of people living in rural regions in LMICs. The WHO has reported that over half the world’s population lack access to the basic health services they need. Digital health has the potential to address the gaps and weaknesses of traditional health systems. Unfortunately, many digital health services do not work in regions with low internet connectivity and low digital literacy. Approximately 3 billion people lack internet connectivity at all. The growth in virtual healthcare during the COVID19 pandemic has been primarily in affluent, metropolitan areas. Digital health needs to better serve the lowincome, rural populations at risk of NCDs. A new digital health model, Padayon, for diabetes and hypertension was designed to address this challenge across LMICs. The focus was the municipality of Pototan, Western Visayas, in rural Philippines. The prevalence of type 2 diabetes among adults in the Philippines is estimated at 7%, comprising almost 4 million cases and accounting for 6.5% of mortality across total deaths in 2020. Cardiovascular disease is the single largest cause of mortality in the Philippines, accounting for 33% of total deaths. There are significant health system weaknesses in Pototan, where residents live on an average income of $3–7 per day and over an hour from healthcare providers. There is a lack of access to basic screening such as random blood sugar (RBS) testing, with a comprehensive panel for diabetes at a private clinic costing 10 times the residents’ daily wage. Residents must travel over an hour Summary box","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"12 1","pages":"43 - 48"},"PeriodicalIF":2.0,"publicationDate":"2022-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80593072","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":"Road to success: lessons from the Qatar Foundation Ability Friendly Program","authors":"Maha El Akoum, Neil Moors, Diedre Thompson, Ryan Moignard, Kathleen Bates","doi":"10.1136/bmjinnov-2021-000928","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000928","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION: QATAR FOUNDATION’S ABILITY FRIENDLY (AF) PROGRAM History and evolution of the programme Although the AF sports programme was not officially launched in Qatar until 2019, the planning process for the development and inauguration of the programme was set in motion much earlier. Three years earlier, in 2016, the World Innovation Summit for Health (WISH), an initiative of the Qatar Foundation for Education, Science, and Community Development (QF), published a global research report on autism titled ‘Autism: a Global Framework for Action’. This report formed one of a series of reports published during the WISH 2016 summit, and 1 of 50 WISH has produced since its inception in 2013. Publication of the autism report also coincided with a powerful grassroots campaign from a group of mothers in Qatar who were collectively calling for greater inclusion opportunities for their children. The idea for a programme that would provide a unique opportunity for inclusive sports, leisure and social opportunities for children and young adults with autism came directly from the recommendations of the WISH report. For the vast majority of WISH research reports, it falls to national and regional governments, along with other care providers, to implement and take forward report recommendations. While the Qatari government set about creating an overarching national autism strategy at the national level—taking many of the recommendations from the 2016 report—the WISH team saw an opportunity to use its parent organisation, QF, as a platform to lead the introduction of abilityfriendly programmes within the community. Physical activity (PA) and participation in recreational and competitive sports in general have long been considered a positive Summary box","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"80 1","pages":"109 - 115"},"PeriodicalIF":2.0,"publicationDate":"2022-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87094431","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":"Real-time continuous measurement of lactate through a minimally invasive microneedle patch: a phase I clinical study.","authors":"Damien K Ming, Saylee Jangam, Sally An Gowers, Richard Wilson, David Me Freeman, Martyn G Boutelle, Anthony Eg Cass, Danny O'Hare, Alison H Holmes","doi":"10.1136/bmjinnov-2021-000864","DOIUrl":"10.1136/bmjinnov-2021-000864","url":null,"abstract":"<p><strong>Introduction: </strong>Determination of blood lactate levels supports decision-making in a range of medical conditions. Invasive blood-sampling and laboratory access are often required, and measurements provide a static profile at each instance. We conducted a phase I clinical study validating performance of a microneedle patch for minimally invasive, continuous lactate measurement in healthy volunteers.</p><p><strong>Methods: </strong>Five healthy adult participants wore a solid microneedle biosensor patch on their forearms and undertook aerobic exercise for 30 min. The microneedle biosensor quantifies lactate concentrations in interstitial fluid within the dermis continuously and in real-time. Outputs were captured as sensor current and compared with lactate concentrations from venous blood and microdialysis.</p><p><strong>Results: </strong>The biosensor was well-tolerated. Participants generated a median peak venous lactate of 9.25 mmol/L (IQR 6.73-10.71).Microdialysate concentrations of lactate closely correlated with blood. Microneedle biosensor current followed venous lactate concentrations and dynamics, with good agreement seen in all participants. There was an estimated lag-time of 5 min (IQR -4 to 11 min) between microneedle and blood lactate measurements.</p><p><strong>Conclusion: </strong>This study provides first-in-human data on use of a minimally invasive microneedle patch for continuous lactate measurement, providing dynamic monitoring. This low-cost platform offers distinct advantages to frequent blood sampling in a wide range of clinical settings, especially where access to laboratory services is limited or blood sampling is infeasible. Implementation of this technology in healthcare settings could support personalised decision-making in a variety of hospital and community settings.</p><p><strong>Trial registration number: </strong>NCT04238611.</p>","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"13 1","pages":"87-94"},"PeriodicalIF":1.8,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7618145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82494732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare’s new frontier: the digital front door","authors":"Namrata Rastogi","doi":"10.1136/bmjinnov-2021-000874","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000874","url":null,"abstract":"Primary care has faced long-standing access challenges in the UK National Health Service (NHS) due to an increased demand on services caused by an ageing population, inadequate funding, a shortage of General Practitioners (GPs) and GP trainees and inefficient administrative processes. The pandemic accelerated digital adoption in primary care as policy and reimbursement changes led to new ways of working including telephone triage, video consultations, remote monitoring, online consultations, and text and email communication between clinicians and patients. The agenda has moved to how innovation teams lead digital transformation to drive long term and sustainable benefits in primary care. The digital front door is defined as the channels and framework through which patients access network-wide services in a digitally enabled system. Pillars to this front door include navigation, triage, increased electronic health record (EHR) functionality, shared care records with interoperability, a skilled workforce, key stakeholder engagement and digital inclusion. Out of hospital care has become an integrated community of health, wellness and social care providers. Primary care organisations are presented with a unique opportunity to redesign their access points, to re-evaluate how to navigate and triage users most effectively through their systems, to leverage health data and analytics to derive more insights from the EHR than ever before, and to build a skilled workforce that meets the evolving needs of the community as we move towards a more equitable health system.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"54 1","pages":"129 - 132"},"PeriodicalIF":2.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85228974","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":"Ambulatory monitoring of patients with COVID-19: initial experiences and next steps","authors":"S. Connolly, H. Wa Katolo, C. Cronin, Alison Dingle, M. Creed, C. Edwards, K. O'Reilly, Brendan O'Kelly, J. Lambert, E. Muldoon, G. Sheehan, H. Coetzee, Alan Sharp, S. Dempsey, E. O'Connor, J. Farrell, A. Cotter, T. McGinty","doi":"10.1136/bmjinnov-2021-000875","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000875","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Since cases were first described in December 2019, SARSCoV2 has posed a distinct challenge to healthcare delivery, and Ireland has been no exception. Hospital bed numbers per capita in Ireland are at 2.9 per 1000 inhabitants, bed occupancy is the highest in the European Union, care is predominantly delivered in 4 to 6bedded wards, and singleroom isolation facilities are in short supply, risking being overwhelmed by high caseloads. Droplet spread within environments increasingly appears to travel further than the initially predicted 2 m 3 and one Irish hospital has reported as many as 49% of their COVID19 cases occurring via nosocomial transmission, and higher (32%) mortality in this group. We therefore identified a need to manage patients safely at home to minimise spread to susceptible patients and staff. As SARSCoV2 infection’s natural history includes a rapid deterioration, characteristically in the second week of the illness in those who develop severe disease, 6 the challenge of safely caring for such patients in the community was raised. Given that COVID19 causes pneumonitis and impaired oxygenation, it is advised that patients with mildmoderate COVID19 are monitored for progression. Finger probe oxygen saturation (SpO 2 ) monitoring is therefore a feasible method of home monitoring. Within months of the pandemic being declared a number of centres internationally (including those within Australia, Canada, China, The Netherlands and the UK) began to implement COVID19 virtual monitoring programmes, taking a variety of forms, ranging from telephone support alone to remote assessments of patients’ symptoms in combination with collecting biometric data. Ireland’s national Health Service Executive (HSE) developed an early partnership with the digital health firm patientMpower in February 2020, with rollout of a new Summary box","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"21 1","pages":"123 - 128"},"PeriodicalIF":2.0,"publicationDate":"2022-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86284462","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":"Collaborative, patient-centred care model that provides tech-enabled treatment of opioid use disorder via telehealth","authors":"R. Rollston, Winifred Gallogly, Liza Hoffman, Eshan Tewari, Sarah Powers, Brian Clear","doi":"10.1136/bmjinnov-2021-000816","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000816","url":null,"abstract":"Rollston R, et al. BMJ Innov 2022;0:1–6. doi:10.1136/bmjinnov-2021-000816 Research & Development, Bicycle Health Inc, Boston, Massachusetts, USA Patient Services, Bicycle Health Inc, Boston, Massachusetts, USA User Experience Research, Bicycle Health Inc, Boston, Massachusetts, USA Product, Bicycle Health Inc, Boston, Massachusetts, USA Clinical Medicine, Bicycle Health Inc, Boston, Massachusetts, USA","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"28 1","pages":"117 - 122"},"PeriodicalIF":2.0,"publicationDate":"2022-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84615845","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}