BMJ Innovations最新文献

{"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}

{"title":"The Essential Network (TEN): rapid development and implementation of a digital-first mental health solution for Australian healthcare workers during COVID-19","authors":"P. Baldwin, Melissa J Black, J. Newby, Lyndsay Brown, N. Scott, Tanya Shrestha, N. Cockayne, J. Tennant, S. Harvey, H. Christensen","doi":"10.1136/bmjinnov-2021-000807","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000807","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION The COVID19 pandemic has presented healthcare workers (HCWs) with extraordinary, unabating stress. International data suggest that frontline HCWs are at increased risk of poor mental health, with posttraumatic stress disorder (PTSD) a significant concern. Early mental health treatment can lower the risk of HCWs developing more chronic and potentially disabling difficulties; however, many HCWs avoid seeking help due to concerns about stigma, 6 confidentiality and negative impacts on their employment. 8 HCWs urgently need accessible and effective mental health services that sidestep these systemic barriers. HCWspecific services must address the unique challenges of healthcare. During a pandemic, HCWs encounter unique stressors, such as fear of infecting their families or watching colleagues die, 10 and differ greatly in how they react to stress. Therefore, HCWs need a responsive, tailored mental health service that can address a range of concerns, from acute distress to moral injury and psychiatric disorders like PTSD. 4 Another challenge is delivering such personalised services at the required scale in the context of an ongoing pandemic. With tens of millions of HCWs across the globe, researchers have called for selfguided mental health tools for HCWs than can be rapidly scaled. Existing national healthcarefocused services have recommended streamlined triage for HCWs with fasttracking into persontoperson treatments. Only technologydriven solutions can service these needs while rapidly adapting and scaling during a crisis. A diverse anthology of patientfocused digital mental health interventions 17 have paved the way for multichannel digital hubs, such as Learn, Assess, Manage, Prevent, that can both personalise and centralise scalable care across states and even international borders. Yet despite these global innovations, few such services for HCWs exist Summary box","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72828730","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":"Rapid phase I evaluation of a novel automated hand hygiene monitoring system in response to COVID-19","authors":"Katie-Rose Cawthorne, D. Powell, R. Cooke","doi":"10.1136/bmjinnov-2021-000859","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000859","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Direct observation (DO) of hand hygiene (HH) behaviour remains the gold standard tool for measuring staff compliance during the COVID19 pandemic. However, gathering HH data in the current environment may be challenging for many healthcare facilities due to resources being diverted to COVID19 containment measures. Hence, audit on HH compliance may be severely compromised due to lack of labour force to perform DO. This is problematic as hospital transmission of COVID19 is high. Automated hand hygiene monitoring systems (AHHMS) have been developed in recent years to enable healthcare organisations to gather robust HH data with minimal investment of labour. Group monitoring systems and badgebased systems are the two most common types of AHHMS available in the marketplace. Group monitoring systems track usage of HH dispensers to give an idea of HH frequency by staff groups. Badgebased systems typically require healthcare workers (HCWs) to wear an additional tracking device that communicates with dispenserbased sensors. Hospitals with AHHMS already in place prior to the COVID19 pandemic are in an advantageous position. An AHHMS was used to capture 35 million HH opportunities between January and May 2020 at the height of the pandemic. Capturing a similar number of HH opportunities via DO would not be feasible. Makhni et al used the same AHHMS to demonstrate that in the early days of the pandemic, HH compliance reached 100%, although unfortunately it did decline to 51.8% within a few months. AHHMS which purport to measure HH compliance rates are typically USbased and are reliant on healthcare institutions having a high proportion of singlepatient rooms. These AHHMS focus on single room entries and exits as surrogates for WHO HH moments 1 and 4, that is, washing hands before and after patient contact. Such an approach contributes to a limited picture of true HH behaviour. After an extensive consultation exercise with NHS HCWs, the concept of a novel AHHMS, ‘Hygenie’, has evolved. The end result of any HH initiative is to prevent healthcareassociated infections (HCAIs) and improve patient safety. Simply encouraging HCWs to perform HH more often could be a simpler improvement initiative for HCWs to work Summary box","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87595338","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":"Use of telemedicine in managing deep brain stimulation for movement disorders","authors":"M. Paranathala, U. Brechany, Russell Mills, C. Nicholson, Alistair J. Jenkins, M. Hussain","doi":"10.1136/bmjinnov-2021-000735","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000735","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION During the global COVID19 pandemic, there has been a move towards ‘remote’ healthcare and minimising nonessential traffic through primary and secondary care to minimise the spread of the virus. Studies have shown that patients with deep brain stimulators (DBSs) have a high requirement for input regarding programming and maintenance of their systems. 2 Patients with neuromodulators for movement disorders are usually seen by specialist nurses for followup. One component of assessment is checking the implantable pulse generators (IPGs) which are the batteries for the stimulation, and planning surgery for replacement in a timely manner. If this is not done, it can lead to clinical crises for the patient, emergency admission and longer stays in hospital while they wait for emergency surgery and recover from the episode leading to significant mental and physical impact. Monitoring of recharging patterns, where the IPG is rechargeable, is valuable in highlighting any problems. To maintain clinical care during the pandemic, there was a move towards video and audio conferencing of outpatient appointments for new and followup patients within neurosurgery. 4 Studies suggest that this method of clinical followup is acceptable to patients with DBS. 5 Other options for telemedicine are secure interactive software for communication with the patient via their own devices such as laptop, tablets and mobile telephones. Reminders and notifications can be sent securely via this medium between clinicians and patients. Such telemedicine allows management of IPGs to be done remotely. Use of telemedicine can be technically and logistically challenging due to cost and hardware required, so it is important to understand its utility, as well as patient experience, tolerability and impact on clinical resources. Studies during COVID19 suggest its use in managing DBS for Parkinson’s disease (PD) was effective. If valuable then its use may be continued beyond the COVID19 pandemic to reduce the workload on clinical staff and enable contemporaneous monitoring of patients. We reviewed our experience with telemedicine in managing our cohort of patients with DBS for movement disorder.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85755528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a novel digital diagnostic tool to support the assessment of respiratory disease in a COVID-19 fever clinic","authors":"A. Ladhams, Shrawan Patel, Mathew Çetin","doi":"10.1136/bmjinnov-2021-000673","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000673","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 Following its first detection in Wuhan, China, in December 2019, the speed at which SARSCoV2 spread around the globe took many countries and their health systems by surprise. The coronavirus pandemic presented three major difficulties, namely a surge in SARSCoV2 infections, high mortality associated with COVID19 disease and large patient numbers overwhelming emergency departments and intensive care units. In March 2020, the Australian government responded by establishing standalone fever clinics to assess patients experiencing symptoms possibly related to COVID19. At a macro level, these clinics helped Australia manage many aspects of the pandemic; however, at a micro level, the clinics encountered various challenges. First, SARSCoV2 spread through the population alongside other winterassociated respiratory illnesses causing a surge in the volume of individuals experiencing COVID19like symptoms, and thus presenting to the clinics. Second, the precautionary requirement for clinicians to don and doff personal protective equipment between patient encounters reduced patient assessment speed and efficiency. Finally, given that the symptoms of respiratory illnesses—including fever, cough, sore throat and shortness of breath—can be related to a number of different diseases such as COVID19, chronic obstructive pulmonary disease (COPD), asthma, pneumonia and upper respiratory tract infections, there is diagnostic complexity in distinguishing patients with a particular respiratory disease and even more so for those with concurrent infections. This final challenge is exaggerated in highthroughput clinical environments, such as COVID19 fever clinics. A single Federal Government funded COVID19 fever clinic in Queensland, Australia, looked to virtual health technologies as a potential way to alleviate these problems. One technology in particular—ResAppDx (‘the device’)—offered noticeable value to the COVID19 fever clinic due to its ability to rapidly identify Summary box","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83268768","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}