BMJ Innovations最新文献

{"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":"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":"Real-time continuous measurement of lactate through a minimally invasive microneedle patch: a phase I clinical study","authors":"D. Ming, Saylee Jangam, S. Gowers, Richard C. Wilson, D. M. Freeman, M. Boutelle, A. Cass, D. O’Hare, A. Holmes","doi":"10.1136/bmjinnov-2021-000864","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000864","url":null,"abstract":"Introduction 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. Methods 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. Results 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. Conclusion 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. Trial registration number NCT04238611.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"13 1","pages":"87 - 94"},"PeriodicalIF":2.0,"publicationDate":"2022-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82494732","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}

{"title":"Measuring the learning outcomes of datathons","authors":"M. Lyndon, Atipong Pathanasethpong, M. Henning, Yan Chen, L. Celi","doi":"10.1136/bmjinnov-2021-000747","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000747","url":null,"abstract":"Purpose Healthcare datathons are events in which cross-disciplinary teams leverage data science methodologies to address clinical questions using large datasets. The aim of this research was to evaluate participant satisfaction and learning outcomes of datathons. Methods A multicentre cross-sectional study was performed using survey data from datathons conducted in Sydney, Australia (April 2018) n=98, Singapore (July 2018) n=169 and Beijing, China (December 2018) n=200. Participants (n=467) completed an online confidential survey at the end of the datathons which contained the Affective Learning Scale, and measures of event satisfaction, perceived knowledge gain, as well as free text responses, and participants’ demographic background. Data analysis used descriptive statistics and multivariate analysis of variance (MANOVA). Thematic analysis was performed on the text responses. Results The overall response rate was 64% (301/467). Participants were mostly male (70%); 50.2% were health professionals and 49.8% were data scientists. Based on the Affective Learning Scale (7-point Likert type scale), participants reported a positive learning experience (M = 5.93, SD = 1.21), satisfaction for content and subject matter of the datathon (M = 5.81, SD = 1.17), applying behaviours (M = 4.71, SD =2.02), instruction from mentors (M = 6.01, SD = 1.18), and intention to participate in future datathons (M = 6.03, SD = 1.23). The MANOVA showed significant differences between health professionals and data scientists in perceived knowledge gain from the datathons. Themes from text responses emerged: (1) cross-disciplinary collaboration; (2) improving healthcare using data science and (3) preparations for big data analytics. Conclusions Datathons provide a satisfying learning experience for participants and promote affective learning, cross-disciplinary collaboration and knowledge gain in health data science.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"35 1","pages":"72 - 77"},"PeriodicalIF":2.0,"publicationDate":"2022-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87399257","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":"Barriers and facilitators to adopting horizon scanning to identify novel integrated care models: a qualitative interview study","authors":"Malin Nuth Waggestad-Stoa, Gloria Traina, Eli Feiring","doi":"10.1136/bmjinnov-2021-000804","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000804","url":null,"abstract":"Objectives Horizon scanning methodologies are employed in healthcare to identify and prioritise innovations at the early stages of development processes. To date, horizon scanning has been predominantly applied to early awareness systems of health technologies to facilitate healthcare planning. Still, horizon scanning methodologies may also be relevant for identifying novel healthcare delivery models and interventions. This study aimed to examine perceptions of determinants for adopting horizon scanning in the context of the development of integrated care models. Methods Qualitative semistructured interviews were conducted between March and May 2021. The interviewees (n=10) were participants in innovation projects in the South-Eastern Norway Regional Health Authority. Data were analysed thematically with the aid of a predefined framework adapted from behavioural change theory. Results Determinants of adopting horizon scanning were reported at the individual, organisational and wider institutional levels. Seven domains were perceived to enable or hinder stakeholders’ potential use of horizon scanning: knowledge of structured reviews, skills to perform horizon scanning, beliefs about consequences (validity and reliability of information, outcomes of filtering and priority setting, stakeholder involvement), beliefs about capabilities (technical skills, knowledge of roles and professional identities, organisational regulations), emotions (positivity, engagement, change fatigue), organisational resources (professional library, time, management support), context (complexity of ‘integrated care’, professional hierarchies, legal and political regulations). Conclusions This study provides novel insights into potential determinants for adopting horizon scanning to identify, assess and prioritise innovative integrated care models. The findings may assist organisations considering using horizon scanning and inform strategies to mitigate barriers and promote facilitators.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"42 1","pages":"65 - 71"},"PeriodicalIF":2.0,"publicationDate":"2022-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83710790","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":"Virtual reality experience for in utero fetal surgery: a new era of patient counselling and medical education","authors":"Y. Blumenfeld, David M. Axelrod, David Sarno, S. Hintz, K. Sylvester, Gerald A Grant, M. Belfort, A. Shamshirsaz, Y. El‐Sayed","doi":"10.1136/bmjinnov-2021-000799","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000799","url":null,"abstract":"Blumenfeld YJ, et al. BMJ Innov 2022;0:1–3. doi:10.1136/bmjinnov-2021-000799 Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California, USA Cardiology, Stanford University School of Medicine, Stanford, California, USA Lighthaus, Inc, San Francisco, California, USA Pediatrics, Stanford University School of Medicine, Stanford, California, USA Surgery, Stanford University School of Medicine, Stanford, California, USA Neurosurgery, Stanford University School of Medicine, Stanford, California, USA Obstetrics & Gynecology, Baylor College of Medicine, Houston, Texas, USA","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"17 1","pages":"95 - 97"},"PeriodicalIF":2.0,"publicationDate":"2022-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83872357","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":"Comparison of safety and usability between peristaltic and pneumatic large-volume intravenous smart pumps during actual clinical use","authors":"D. Penoyer, K. Giuliano, Aurea Middleton","doi":"10.1136/bmjinnov-2021-000851","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000851","url":null,"abstract":"Objective To describe and compare safety and usability between a peristaltic large-volume intravenous smart pump (IVSP) and a novel pneumatic large-volume IVSP during clinical use. Methods A prospective, comparative study was conducted in a large, tertiary hospital in the southeastern USA. Safety and usability were measured by observation during medication administration (medication administration error, interruptions, programming time), dose error reduction system (DERS) compliance, end-user surveys and compliance with manufacturer setup requirements. Study implementation began on a small pilot unit for 1 month, followed by data collection on the study unit over 2 months. Results For the observed medication administrations (N=158): 79 peristaltic (36 primary; 43 secondary) and 79 pneumatic (42 primary; 37 secondary), use of the peristaltic IVSP was associated with significantly (p<0.05) higher medication administration errors and programming time (11.9 s) and a significantly higher number of interruptions during programming. DERS compliance was significantly less (p<0.001) with the peristaltic (75.9%) as compared with the pneumatic IVSP (99.8%). Programming workload (National Aeronautics and Space Administration Task Load Index) was significantly (p=0.004) higher with peristaltic versus pneumatic IVSP, and the usability (System Usability Scale) was significantly (p=0.007) lower with peristaltic versus pneumatic IVSP. There was a 0% compliance with peristaltic secondary setup requirements in 43 observed infusions. Conclusions Though nurses had a high level of experience with the peristaltic IVSP, results of this study support that the pneumatic IVSP was easier to use and associated with fewer errors and deviations from safe practices as compared with the peristaltic IVSP.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"148 1","pages":"78 - 86"},"PeriodicalIF":2.0,"publicationDate":"2022-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77881563","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}