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Biomechanical analysis of delivering chest compressions in virtual reality simulation: preliminary insights into fidelity and validity of virtual reality as a means of delivering life support training 在虚拟现实模拟中进行胸外按压的生物力学分析:对虚拟现实作为生命支持培训手段的逼真性和有效性的初步认识
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-07 DOI: 10.1136/bmjinnov-2024-001234
Aimee Rowe, Matthew A Ellison, Karamveer Narang, Alex Saunders, Steve Furnell, Jagtar Dhanda
#### WHAT ARE THE NEW FINDINGS #### HOW MIGHT THIS IMPACT HEALTHCARE IN THE FUTURE Virtual reality (VR) is a promising modality for healthcare education with ample qualitative evaluation.1–3 There is meagre quantitative study of using VR in healthcare training. This study aims to gain quantitative and qualitative insights into the fidelity and validity of cardiopulmonary resuscitation (CPR) training using VR. Good quality, timely chest compressions improve survival outcomes in cardiac arrest.4–6 Traditionally, chest compressions are taught to healthcare professionals (HCPs) as part of resuscitation training using manikin-based simulation.4 Resuscitation bodies, such as The European Resuscitation Council and Resuscitation Council UK, certify trainers to deliver CPR training using scenario-based simulation with manikins. Delivering this training has logistical barriers; accessing space, equipment, staff and time to conduct training. E-learning has been widely adopted in healthcare education, helping to reduce the logistical burden of providing mandatory training to the healthcare workforce.7 Emerging technology such as VR is appealing as it has the flexibility associated with e-learning while offering a more immersive experience,8 along with the potential to increase global accessibility and reduce the environmental impact of in-person training. Novel approaches must be assessed for efficacy before committing resources to their implementation. While there are data exploring VR use for CPR training,9–11 there …
#### 新发现是什么 #### 这可能会对未来的医疗保健产生什么影响 虚拟现实(VR)是一种前景广阔的医疗保健教育模式,目前已有大量定性评估。本研究旨在从定量和定性角度深入了解使用 VR 进行心肺复苏(CPR)培训的保真度和有效性。优质、及时的胸外按压可提高心脏骤停患者的存活率。4-6 传统上,胸外按压是作为使用人体模型进行复苏培训的一部分教授给医护专业人员(HCPs)的。4 欧洲复苏委员会和英国复苏委员会等复苏机构对培训师进行认证,以使用人体模型进行情景模拟心肺复苏培训。开展这种培训有后勤方面的障碍:需要场地、设备、人员和时间来开展培训。7 VR 等新兴技术具有与电子学习相关的灵活性,同时还能提供更加身临其境的体验,8 并且具有提高全球可及性和减少现场培训对环境影响的潜力,因此很有吸引力。在投入资源实施新方法之前,必须对其效果进行评估。虽然有数据探讨了 VR 在心肺复苏培训中的应用,9-11 但...
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引用次数: 0
iCount: a human-factors engineered solution to vaginal swab retention – an early-stage innovation report iCount:针对阴道拭子滞留问题的人因工程解决方案--早期创新报告
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-08-30 DOI: 10.1136/bmjinnov-2024-001248
Ahmed Nader Elgharably, Kiran Desai, Alan Michael Nevill, Aaron Vance, Jon Lester, Emma Bonfiglio, Colin Rigby, Andrew Forrester, Peter Ogrodnik, Jeffrey Faint, Tom Clutton-Brock, Aditi Desai
### WHAT ARE THE NEW FINDINGS #### HOW MIGHT IT IMPACT ON HEALTHCARE IN THE FUTURE Although uncommon, unintentionally retained surgical items remain a persistent and poorly understood medical error with the potential to cause significant harm. They are termed patient safety ‘never events’ and are considered unacceptable and largely preventable.1 The most commonly retained surgical item is the surgical swab, also known as ‘sponge’ in the USA, with the highest rates of swab retention found in the maternity setting. The UK never events database identifies vaginal swabs (used during perineal trauma repair) as the source of the largest number of swab retention events.2 3 NHS England data identifies 338 separate incidents of vaginal swab retention between 2012 and 2022 with evidence of global under-reporting due to the significant reputational impacts of these incidents as well as the difficulty in diagnosis and identification of error.1 3–6 This long-standing problem, also called ‘Gossypiboma’, was first reported in 1884 by the American Obstetrician and Gynaecologist Dr Wilson. …
#### 新发现是什么 #### 这可能对未来的医疗保健产生怎样的影响?虽然意外滞留的手术物品并不常见,但仍是一种长期存在且鲜为人知的医疗差错,有可能造成重大伤害。1 最常见的滞留手术物品是手术棉签,在美国也被称为 "海绵",在产科环境中棉签滞留率最高。英国从未发生过的事件数据库显示,阴道拭子(会阴创伤修复时使用)是造成最多拭子滞留事件的原因。3 英国国家医疗服务系统(NHS)的数据显示,2012 年至 2022 年间共发生 338 起阴道拭子滞留事件,由于这些事件对声誉造成重大影响,且难以诊断和识别错误,因此有证据表明全球存在报告不足的情况。...
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引用次数: 0
Spreading and scaling innovation and improvement: understanding why the differences matter 推广和扩大创新与改进:了解差异为何重要
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-29 DOI: 10.1136/bmjinnov-2024-001251
Helen Bevan, Diane Ketley, Roseanna Cawthorne, Charitini Stavropoulou, Harry Scarbrough
In this paper, we make a distinction between spreading and scaling innovations and spreading and scaling good practices for improvement, as many healthcare change practitioners often feel there is a “muddle” between them. We argue there are multiple factors where the spread and scale factors are similar for innovation and improvement, such as enabling leadership, the capacity and capability for spread and scale, a process of behaviour change, use of data and evidence and system alignment. However, there are multiple characteristics that may be different, including the level of complexity, the nature of the intervention, the approach to fidelity and adaptability, the source of the innovation or improvement and the outcome metrics. These insights enable us to be better equipped to design and deliver successful spread and scale strategies tailored to the specific intervention and situation and realise the full benefits of our change initiatives.
在本文中,我们将传播和推广创新与传播和推广良好的改进实践区分开来,因为许多医疗变革实践者常常觉得两者之间存在 "混淆"。我们认为,对于创新和改进而言,传播和推广有多种因素是相似的,如有利的领导、传播和推广的能力、行为改变的过程、数据和证据的使用以及系统协调。然而,也有多种特征可能有所不同,包括复杂程度、干预措施的性质、保真度和适应性方法、创新或改进的来源以及成果衡量标准。这些见解使我们能够更好地根据具体干预措施和情况设计和实施成功的推广和规模战略,并实现变革举措的全部效益。
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引用次数: 0
Role of twinnings in scaling up innovative solutions across Europe 姊妹大学在全欧洲推广创新解决方案方面的作用
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-03-15 DOI: 10.1136/bmjinnov-2023-001141
Cláudia Campos, Robbin Kappelhof, Joana Carrilho, Luis Midão, Diogo Henriques, Elísio Costa
Introduction Twinnings are cross-border knowledge exchange activities where two or more organisations learn from each other’s experiences and are often used as a scaling up mechanism. Objectives This paper discusses the importance of twinning activities in scaling up by promoting community building, knowledge sharing and innovation transfer among stakeholders in European countries. It explores the role of twinnings in the scaling up model of the European Innovation Partnership on Active and Healthy Ageing) and the Innovation Networks for Scaling Active and Healthy Ageing (IN-4-AHA) project. Methods The study employed a qualitative approach, drawing insights from various sources, including the Scale AHA study (2017), the IN-4-AHA’s scaling up model and twinning reports. Results The findings reveal that twinning activities provide stakeholders with a unique opportunity to learn from the know-how of other like-minded partners, improve the quality of their work and iterate on their innovations. They also highlight that twinnings are particularly relevant for some stages in the scaling up process, such as in the assessment of a network of potential partners and during the evaluation of the environment, the innovation could potentially be transferred to. Conclusion Twinnings are highly regarded as community-building and knowledge-sharing activities with clear advantages for companies and other stakeholder groups. Including twinning activities in the scaling up model has proven benefits for companies and projects that have a strong need for community building and innovation transfer. Data sharing not applicable as no data sets generated and/or analysed for this study.
引言 结对活动是两个或两个以上组织相互学习经验的跨境知识交流活动,通常被用作扩大规模的机制。目的 本文讨论了结对活动通过促进欧洲国家利益相关者之间的社区建设、知识共享和创新转让在扩大规模方面的重要性。本文探讨了结对活动在 "欧洲老有所事和健康老龄化创新伙伴关系"(European Innovation Partnership on Active and Healthy Ageing)和 "加强老有所事和健康老龄化创新网络"(IN-4-AHA)项目的推广模式中的作用。方法 本研究采用定性方法,从各种来源汲取见解,包括 "Scale AHA 研究"(2017 年)、IN-4-AHA 的推广模式和结对报告。结果 研究结果表明,结对活动为利益相关者提供了一个独特的机会,使他们能够学习其他志同道合的合作伙伴的专门技能,提高工作质量,并对创新进行迭代。调查结果还强调,结对活动与扩大规模过程中的某些阶段特别相关,例如在评估潜在合作伙伴网络和评估创新可能转移到的环境期间。结论 结对活动被视为社区建设和知识共享活动,对企业和其他利益相关群体具有明显的优势。事实证明,将结对活动纳入扩大规模模式,对那些非常需要社区建设和创新转让的公司和项目大有裨益。数据共享不适用,因为本研究没有生成和/或分析数据集。
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引用次数: 0
Wings of Healing: regulatory landscape, case studies and the Indian prologue of drones in healthcare 医治之翼:无人机在医疗保健领域的监管格局、案例研究和印度序幕
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-03-05 DOI: 10.1136/bmjinnov-2023-001179
Ankita Sharma, Anju Vijayan, Pavan Ananth, Deepshikha Chhetri, Rahul Konapur, Nachiket Gudi
The healthcare sector is among the most rapidly expanding sectors. Drones are increasingly being used to reach the unreached in healthcare. Drones exhibit profound significance by overcoming accessibility challenges and offering versatile solutions. The future of healthcare is in the air, and new government initiatives uncover the country’s rapid market growth. Investments in drone technologies are rising, with research predicting significant drone expansion in the upcoming decade. Since this sector is still in its nascent stage, the time is ripe for stakeholders to collectively work for the effective implementation of drone technology in India. In this context, the paper seeks to bridge existing knowledge gaps by analysing the global regulatory landscape, the evolution of drones in India, used cases in healthcare, and the barriers that constrain their deployment in the healthcare domain. It explores the obstacles that hinder the widespread adoption of drones. Addressing these challenges becomes essential in unlocking the full potential of drone technology in revolutionising healthcare delivery, enhancing patient outcomes and overcoming logistical constraints. The report argues about the potential shift drones can bring to healthcare delivery while underlining the necessity of addressing regulatory concerns and fostering public trust.
医疗保健行业是发展最迅速的行业之一。无人机正被越来越多地用于医疗保健领域,以帮助那些未曾接触过的人。无人机克服了可及性方面的挑战,并提供了多功能解决方案,因而具有深远的意义。医疗保健行业的未来蕴藏在空气中,政府的新举措揭示了该国市场的快速增长。对无人机技术的投资不断增加,研究预测未来十年无人机将大幅扩张。由于该行业仍处于起步阶段,利益相关者为在印度有效实施无人机技术而共同努力的时机已经成熟。在此背景下,本文试图通过分析全球监管格局、无人机在印度的发展、医疗保健领域的应用案例以及制约无人机在医疗保健领域应用的障碍,来弥补现有的知识差距。报告探讨了阻碍无人机广泛应用的障碍。要充分释放无人机技术的潜力,彻底改变医疗保健服务方式、提高患者治疗效果并克服物流限制,解决这些挑战至关重要。报告论证了无人机可为医疗服务带来的潜在转变,同时强调了解决监管问题和促进公众信任的必要性。
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引用次数: 0
Conversational AI facilitates mental health assessments and is associated with improved recovery rates 对话式人工智能有助于心理健康评估,并能提高康复率
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-03-01 DOI: 10.1136/bmjinnov-2023-001110
Max Rollwage, Johanna Habicht, Keno Juchems, Ben Carrington, Tobias U Hauser, Ross Harper
Mental health services across the globe are overburdened due to increased patient need for psychological therapies and a shortage of qualified mental health practitioners. This is unlikely to change in the short-to-medium term. Digital support is urgently needed to facilitate access to mental healthcare while creating efficiencies in service delivery. In this paper, we evaluate the use of a conversational artificial intelligence (AI) solution ( Limbic Access ) to assist both patients and mental health practitioners with referral, triage, and clinical assessment of mild-to-moderate adult mental illness. Assessing this solution in the context of England’s National Health Service (NHS) Talking Therapies services, we demonstrate in a cohort study design that deploying such an AI solution is associated with improved recovery rates. We find that those NHS Talking Therapies services that introduced the conversational AI solution improved their recovery rates, while comparable NHS Talking Therapies services across the country reported deteriorating recovery rates during the same time period. Further, we provide an economic analysis indicating that the usage of this AI solution can be highly cost-effective relative to other methods of improving recovery rates. Together, these results highlight the potential of AI solutions to support mental health services in the delivery of quality care in the context of worsening workforce supply and system overburdening. For transparency, the authors of this paper declare our conflict of interest as employees and shareholders of Limbic Access, the AI solution referred to in this paper. Data available at a dedicated GitHub repository. Code and data supporting this study are available at a dedicated GitHub repository.
由于病人对心理治疗的需求增加,而合格的心理健康从业人员却短缺,全球的心理健康服务不堪重负。这种情况在中短期内不太可能改变。我们迫切需要数字化支持,以方便患者获得心理保健服务,同时提高服务效率。在本文中,我们评估了对话式人工智能(AI)解决方案(Limbic Access)的使用情况,该解决方案可协助患者和心理健康从业人员进行轻度至中度成人精神疾病的转诊、分诊和临床评估。通过在英格兰国民健康服务系统(NHS)谈话治疗服务中对该解决方案进行评估,我们在一项队列研究设计中证明,部署这种人工智能解决方案与提高康复率有关。我们发现,那些引入了对话式人工智能解决方案的 NHS 会话治疗服务提高了康复率,而同期全国的同类 NHS 会话治疗服务的康复率却在下降。此外,我们提供的经济分析表明,与其他提高康复率的方法相比,使用这种人工智能解决方案具有很高的成本效益。这些结果共同凸显了人工智能解决方案在劳动力供应恶化和系统负担过重的情况下支持心理健康服务提供优质医疗服务的潜力。为透明起见,本文作者声明我们作为本文提及的人工智能解决方案 Limbic Access 的员工和股东存在利益冲突。数据可在专门的 GitHub 存储库中获取。支持本研究的代码和数据可在专门的 GitHub 存储库中获取。
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引用次数: 0
What is the impact of healthcare innovation on measurable outcomes of healthcare organisation performance? A systematic review 医疗创新对医疗机构绩效的可衡量结果有何影响?系统回顾
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-01-10 DOI: 10.1136/bmjinnov-2023-001097
Caoimhe Madden, Róisín O'Malley, Emily O'Dowd, Paul O'Connor, Sinéad Lydon, Jared Gormly, Dara Byrne
Objective The lack of quantitative evidence of effectiveness has been cited as a notable shortcoming of initiation and diffusion of innovations in healthcare. Therefore, this review aimed to synthesise research assessing the impact of healthcare innovations on measurable outcomes of healthcare organisation performance. Design A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources Systematic searches were conducted across three electronic databases, namely MEDLINE, CINAHL and PsycINFO. Eligibility criteria for selecting studies Articles were required to: (a) be published in an English-language, peer-reviewed journal since 2000; (b) describe the application of a specific innovation within a secondary healthcare setting; (c) report data on the summative evaluation of the impact of the innovation on healthcare outcomes, using an outcome measure in line with Level Four of Kirkpatrick’s Evaluation Hierarchy (ie, a measure of organisation performance) and (d) consist of a research design that allowed for evaluation of innovation impact on outcome measures by means of a comparator. Results Innovations targeting organisational change were most commonly implemented. Innovations generally had a positive impact, evident in almost two-thirds of the outcome measures assessed across the included articles. Innovation impact was predominantly measured via health utilisation metrics and medical-clinical indicators, with safety outcomes and patient/family perceptions less frequently assessed. Conclusion There is evidence to show that innovations result in discernible change in organisational importance, including on important metrics such as finance and healthcare utilisation. Bundling outcome measures are recommended to provide a more complete picture of the true impact of innovation on healthcare organisation performance. Data are available on reasonable request.
目标 缺乏有效性的定量证据一直被认为是医疗创新的启动和推广过程中的一个明显缺陷。因此,本综述旨在综合评估医疗创新对医疗机构绩效可衡量结果的影响的研究。设计 根据《系统综述和元分析首选报告项目》指南进行了系统综述。数据来源 在 MEDLINE、CINAHL 和 PsycINFO 三个电子数据库中进行了系统检索。选择研究的资格标准 文章必须具备以下条件(a) 自 2000 年以来发表在同行评审的英文期刊上;(b) 描述了在二级医疗机构中应用特定创新的情况;(c) 使用符合 Kirkpatrick 评价等级体系第四级的结果衡量标准(即组织绩效衡量标准),报告创新对医疗结果影响的总结性评价数据;(d) 研究设计允许通过比较对象来评价创新对结果衡量标准的影响。结果 以组织变革为目标的创新最常见。创新通常会产生积极影响,这在所纳入文章的近三分之二的成果评估指标中都很明显。创新的影响主要通过健康利用指标和医疗临床指标来衡量,而安全结果和患者/家属的看法则较少被评估。结论 有证据表明,创新能明显改变组织的重要性,包括财务和医疗利用率等重要指标。建议采用捆绑式结果测量,以更全面地反映创新对医疗机构绩效的真实影响。如有合理要求,可提供相关数据。
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引用次数: 0
Exploratory study to assess the functional capacity, safety and ability to isolate novel COVID-19 of a novel self-administrative nasopharyngeal wash specimen collecting device 一项探索性研究,旨在评估新型自取式鼻咽清洗标本收集装置的功能能力、安全性和分离新型 COVID-19 的能力
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-01-10 DOI: 10.1136/bmjinnov-2023-001122
S K Mohanasundari, Sivam Thanigainathan, R Gadapalli, Pankaj Rawat, S Vandana, K Deepak, N Gupta
Introduction Although nasopharyngeal/oropharyngeal swabs are considered the gold standard for SARS-CoV-2 diagnosis, these procedures are distressing, require trained personnel and may pose a risk of transmission. Aim This study aims to assess the functional capacity, safety, ability to isolate the novel COVID-19 and end-users’ acceptance of a novel self-collection device for obtaining nasopharyngeal wash samples. Methods Initially, the novel device’s functional capacity (amount of nasopharyngeal wash specimen collected by participants themselves using the novel device) and safety (procedure-related complications such as bleeding, aspiration or syncope) were assessed in 15 healthy volunteers. Then, its ability to isolate the novel COVID-19 in symptomatic patients, procedure-related discomfort and end-users’ acceptance were compared with the conventional nasopharyngeal/oropharyngeal swab technique. Results All 15 volunteers obtained more than 1 mL of nasopharyngeal wash sample using the novel device, with no reported medical complications. Out of 14 COVID-19-suspected patients, 9 tested positive using the novel method compared with 8 with the conventional method (p=0.09). The novel method demonstrated significantly less discomfort (median score 1 vs 5, p<0.001) and significantly higher acceptability (median score 9 vs 2, p<0.001) compared with the conventional method. Conclusion The novel self-administrative nasopharyngeal wash specimen-collecting device allowed patients to collect samples safely. The procedure could isolate the novel COVID-19 from the nasopharynx, similar to the conventional nasopharyngeal swab technique. The novel method was less discomforting and more acceptable for end-users compared with the conventional method and is suitable for mass screening.
引言 尽管鼻咽/咽拭子被认为是诊断 SARS-CoV-2 的黄金标准,但这些过程令人痛苦,需要训练有素的人员,并可能带来传播风险。目的 本研究旨在评估用于获取鼻咽洗液样本的新型自取装置的功能能力、安全性、分离新型 COVID-19 的能力以及最终用户的接受程度。方法 首先,在 15 名健康志愿者中评估了新型装置的功能能力(参与者使用新型装置自行采集的鼻咽洗液样本量)和安全性(程序相关并发症,如出血、吸入或晕厥)。然后,比较了新型 COVID-19 与传统鼻咽/咽拭子技术在无症状患者中的分离能力、手术相关不适以及最终用户的接受程度。结果 所有 15 名志愿者都使用新型装置获得了超过 1 毫升的鼻咽冲洗样本,未报告医疗并发症。在 14 名疑似 COVID-19 患者中,使用新型方法检测出 9 例阳性,而使用传统方法检测出 8 例阳性(P=0.09)。与传统方法相比,新型方法的不适感明显降低(中位数为 1 vs 5,p<0.001),可接受性明显提高(中位数为 9 vs 2,p<0.001)。结论 新型自我鼻咽清洗标本采集装置可让患者安全地采集标本。该方法可从鼻咽分离出新型 COVID-19,与传统的鼻咽拭子技术相似。与传统方法相比,这种新方法对终端用户的不适感更小,更容易被接受,适合大规模筛查。
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引用次数: 0
Development and introduction of a mixed realities playkit: decreasing the incidence of general anaesthesia for paediatric MRI 开发和引入混合现实工具包:降低小儿MRI全麻的发生率
Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-07 DOI: 10.1136/bmjinnov-2023-001083
Jill Thompson, Dylan Yamada-Rice, Sean Thompson, Louise Murray, Matthew Taylor
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引用次数: 0
Time to treat the climate and nature crisis as one indivisible global health emergency 是时候将气候和自然危机视为一个不可分割的全球卫生紧急事件
Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-10-25 DOI: 10.1136/bmjinnov-2023-001188
Chris Zielinski
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引用次数: 0
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