BMJ Innovations最新文献

{"title":"Healing at Home: applying innovation principles to redesign and optimise postpartum care","authors":"J. Gaulton, Kirstin Leitner, Lauren Hahn, Ryan Schumacher, L. Christ, Laura F. Scalise, Deborah S Driscoll, R. Rosin, R. Merchant","doi":"10.1136/bmjinnov-2021-000791","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000791","url":null,"abstract":"Gaulton JS, et al. BMJ Innov 2021;0:1–5. doi:10.1136/bmjinnov-2021-000791 Neonatology, Jefferson Health–Abington, Abington, Pennsylvania, USA HUP Obstetrics and Gynecology, Penn Medicine, Philadelphia, Pennsylvania, USA Center for Health Care Innovation, Penn Medicine, Philadelphia, Pennsylvania, USA Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA Office of the Dean of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA Emergency Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"64 1","pages":"37 - 41"},"PeriodicalIF":2.0,"publicationDate":"2021-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84002651","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":"Why is Kangaroo Mother Care not yet scaled in the UK? A systematic review and realist synthesis of a frugal innovation for newborn care","authors":"Giulietta Stefani, Mark Skopec, C. Battersby, M. Harris","doi":"10.1136/bmjinnov-2021-000828","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000828","url":null,"abstract":"Objective Kangaroo Mother Care (KMC) is a frugal innovation improving newborn health at a reduced cost compared with incubator use. KMC is widely recommended; however, in the UK, poor evidence exists on KMC, and its implementation remains inconsistent. Design This Systematic Review and Realist Synthesis explores the barriers and facilitators in the implementation of KMC in the UK. Data source OVID databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and Google Scholar were searched. Eligibility criteria Studies were UK based, in maternity/neonatal units, for full-term/preterm children. First screening included studies on (1) KMC, Kangaroo Care (KC) or skin-to-skin contact (SSC) or (2) Baby Friendly Initiative, Small Wonders Change Program or family-centred care if in relation to KMC/KC/SSC. Full texts were reviewed for evidence regarding KMC/KC/SSC implementation. Results The paucity of KMC research in the UK did not permit a realist review. However, expanded review of available published studies on KC and SSC, used as a proxy to understand KMC implementation, demonstrated that the main barriers are the lack of training, knowledge, confidence and clear guidelines. Conclusion The lack of KMC implementation research in the UK stands in contrast to the already well-proven benefits of KMC for stable babies in low-income contexts and highlights the need for further research, especially in sick and small newborn population. Implementation of, and research into, KC/SSC is inconsistent and of low quality. Improvements are needed to enhance staff training and parental support, and to develop guidelines to properly implement KC/SSC. It should be used as an opportunity to emphasise the focus on KMC as a potential cost-effective alternative to reduce the need for incubator use in the UK.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"57 1","pages":"9 - 20"},"PeriodicalIF":2.0,"publicationDate":"2021-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86563077","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":"Bone conduction hearing kit for children with glue ear","authors":"Tamsin Mary Holland Brown, I. Fitzgerald O’Connor, J. Bewick, Colin Morley","doi":"10.1136/bmjinnov-2021-000676","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000676","url":null,"abstract":"© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Background Hearing loss is one of the most common disabilities in childhood. One in 10 children starting school in UK or Europe have hearing loss secondary to glue ear (Otitis Media with Effusion (OME)). 2 This is much higher in lower income countries. Eighty per cent of children have at least one episode of glue ear, where fluid builds up behind their eardrum after a cough, cold or ear infection. OME often selfresolves or children can be offered grommets (also known as ‘tympanostomy tubes’) if persistent. Grommets ‘only offer short term hearing improvement’ of ~12 dB, diminishing to ~4 dB 6–9 months later, therefore grommets improve a child’s symptoms for about 6 months while ‘natural resolution continues’. Grommet insertion is common, requiring a general anaesthetic, and risks include opening the middle ear to infection (requiring treatment in approximately a third of patients), perforation (1% of cases) and variable scarring the eardrum (tympanosclerosis). Hearing aids are not an easy solution, since glue ear fluctuates and multiple audiology appointments are needed to avoid overamplification or underamplification. Children need to hear to learn. Poor hearing can affect speech, language, social skills, listening, attention and learning. While some children catch up learning after an episode of glue ear, others do not. Glue ear mostly affects those under 8 years old, which is a critical time for development, speech acquisition, learning, writing, spelling and phonics. Deafness at this time interferes with speech development, language, communication, auditory processing, selfesteem, socialisation, listening and learning. Operational aims and objectives Bone conduction hearing aids work well in OME because they send sound as a vibration through the bones of the skull directly to the cochlea (bypassing the eardrum and middle ear bones where the fluid, mucus or ‘glue’ accumulates) but they are often prohibitively expensive, costing up to £3000. Bone conduction headphones are marketed at cyclists, allowing sound from mobile phones to be directed straight to the cochlea while sound from traffic noises still accessible through the ear canals. These headphones cost ~£100 commercially (figure 1) . An initial study in 2016–2018 trialled these simple bone conduction headphones paired to a microphone for the first time in children with OME. The Hear Glue Ear app was trialled in 2019. It was codesigned with a patient Summary box","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"14 1","pages":"600 - 603"},"PeriodicalIF":2.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74621905","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":"Defining frugal innovation: a critical review","authors":"C. Hindocha, Grazia Antonacci, J. Barlow, M. Harris","doi":"10.1136/bmjinnov-2021-000830","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000830","url":null,"abstract":"Frugal innovation (FI), which has gained traction in various sectors, is loosely defined as developing quality solutions in a resource-constrained environment that are affordable to low-income consumers. However, with its popularity, multiple and diverse definitions have emerged that often lack a theoretical foundation. This has led to a convoluted conceptualisation that hinders research and adoption in practice. Despite this plethora of perspectives and definitions, scholars do agree that there is a need for a unified definition. This critical review across the management, entrepreneurship, business and organisation studies literatures explores the multiple definitions of FI that have appeared in the last two decades and seeks to examine the commonalities and differences. One definition is supported by a theoretical underpinning, and main themes include affordability, adaptability, resource scarcity, accessibility and sustainability, however, there remains significant ambiguity around what constitutes an FI. Defining FI as a concept should not deter from focusing on its core aim and identifying an FI may be best achieved by comparing it to an incumbent alternative, rather than against an ill-defined concept. There is merit in developing a common understanding of FI to support strategies for its successful acceptance and diffusion globally.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"3 1","pages":"647 - 656"},"PeriodicalIF":2.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79012811","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":"Frugal development and deployment of an innovative mobile health platform for COVID-19 in Sri Lanka: the case of SelfShield app","authors":"P. Siribaddana, Chathura Wirasinghe, Sahan Perera, Dilshan Ganepola, V. Dissanayake","doi":"10.1136/bmjinnov-2021-000836","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000836","url":null,"abstract":"© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION During the early phases of the COVID19 pandemic, emerging technologies focused largely on strengthening the health system, supporting law enforcement authorities, and enabling researchers to model COVID19 outbreaks and resource requirements. When the health systems are burdened by the influx of patients with COVID19, it is neither practical nor rational to treat all patients with COVID19 in the hospital as many will either be asymptomatic or mildly symptomatic. Thus, home monitoring of patients has been practised in many countries. 3 Respiratory involvement was the first documented site of complications and still continues to be responsible for majority of the deaths. Therefore, in order to provide effective home care for patients with COVID19, we recognised the need for a frugal technology tool to monitor patients remotely including monitoring the breathing performance. Guided by the Commonwealth Centre for Digital Health (CWCDH), a voluntary group of medical doctors, health informaticians and software developers from Sri Lanka embarked on a mission to fulfil this need by developing a smart phonebased selfhealth checking tool. Named the SelfShield project, the system comprised a smart phone app, a dashboard for medical teams and machine learning algorithms capable of analysing breathing and voice signals. This report reflects on our early experience with the SelfShield system and we were guided by the following key objectives: 1. Identifying already validated bedside clinical tests that may be cost effectively transformed into a mobile platform. 2. Designing and developing a mobile app to capture subjective and objective COVID19related data in a userfriendly manner and a dashboard that can help medical professionals assist consenting users. 3. Developing machine learning algorithms capable of analysing sound signals to facilitate decision making related to COVID19. 4. Deploying the system as a COVID19 response tool with a focus on citizen empowerment.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"67 1","pages":"604 - 608"},"PeriodicalIF":2.0,"publicationDate":"2021-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83588395","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":"PatientLink: a patient-centred status dashboard for the perioperative process","authors":"E. Burden, K. Khehra, R. Singla, L. Spooner, Angela Cho, C. Nguan","doi":"10.1136/bmjinnov-2021-000762","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000762","url":null,"abstract":"© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Surgery is stressful. According to the National Center for Health Statistics, 48 million surgical procedures were performed in the USA in a single year. The majority of these procedures reflect instances wherein patients are entering an unfamiliar, foreign environment for the first time. While it is common practice for patients to have family or friends accompany them on the day of their surgery, the clinical world is unfamiliar to those outside the healthcare profession. This is true during the perioperative process, a period of time where supporters are separated from their loved ones. Despite the fact that surgeons agree perioperative communication with family members plays a key role in alleviating anxiety and providing support, there remains inconsistent communication in terms of frequency and content. The need for improved communication between the healthcare team and supporters is recognised across multiple disciplines. 4 There is a noted lack of consistency in the frequency and content of communication in clinical practice. A recent systematic review indicated that improved communication throughout the perioperative process is a wellrecognised need for patient and supporter satisfaction. Currently, the literature focuses on preoperative anxiety among patients themselves, including success of operation, complications, postoperative pain and recovery timeline. 6 It is also recognised that the hospital environment proves stressful to not only the patient, but their supporters as well. Furthermore, the emotional status of supporters can impact a patient’s response and recovery, such as in settings where they are the main representative of the patient. However, limited research on the specific sources of stress for supporters has been conducted. Additionally, existing solutions for improved communication between the healthcare team and patient supporters are lacking. These solutions have covered a spectrum of fidelity. Low fidelity options include inperson reports, pagers and shortmessaging services (SMS otherwise known as ‘texting’). The use of pagers with EMRintegrated text communication capabilities, much like those used by hospital staff, was found to improve both workplace efficiency and satisfaction among families, nurses and surgeons alike. Additional low fidelity interventions include educational strategies in the form of informational cards and booklets outlining the procedural details, expected duration and perioperative process. 13 While promising, these strain hospital staff workflow to provide frequent updates, Summary box","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"1 1","pages":"619 - 625"},"PeriodicalIF":2.0,"publicationDate":"2021-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89649482","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":"Theatres without borders: a systematic review of the use of intraoperative telemedicine in low- and middle-income countries (LMICs)","authors":"H. Subbiah Ponniah, Viraj M Shah, A. Arjomandi Rad, R. Vardanyan, G. Miller, J. Malawana","doi":"10.1136/bmjinnov-2021-000837","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000837","url":null,"abstract":"Objective This systematic review aims to provide a summary of the use of real-time telementoring, telesurgical consultation and telesurgery in surgical procedures in patients in low/middle-income countries (LMICs). Design A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Collaboration published guidelines. Data sources EMBASE, MEDLINE, Cochrane, PubMed and Google Scholar were searched for original articles and case reports that discussed telementoring, telesurgery or telesurgical consultation in countries defined as low-income or middle-income (as per the World Banks’s 2021–2022 classifications) from inception to August 2021. Eligibility criteria for selecting studies All original articles and case reports were included if they reported the use of telemedicine, telesurgery or telesurgical consultation in procedures conducted on patients in LMICs. Results There were 12 studies which discussed the use of telementoring in 55 patients in LMICs and included a variety of surgical specialities. There was one study that discussed the use of telesurgical consultation in 15 patients in LMICs and one study that discussed the use of telesurgery in one patient. Conclusion The presence of intraoperative telemedicine in LMICs represents a principal move towards improving access to specialist surgical care for patients in resource-poor settings. Not only do several studies demonstrate that it facilitates training and educational opportunities, but it remains a relatively frugal and efficient method of doing so, through empowering local surgeons in LMICs towards offering optimal care while remaining in their respective communities.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"75 1","pages":"657 - 668"},"PeriodicalIF":2.0,"publicationDate":"2021-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78777251","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":"Preliminary validation study of the Mindset4Dementia application: assessing remote collection of dementia risk factors and cognitive performance","authors":"R. Rifkin-Zybutz, Hamzah Selim, M. Johal, Narayan Kuleindiren, I. Palmon, Aaron Lin, Yizhou Yu, Mohammad Mahmud","doi":"10.1136/bmjinnov-2021-000780","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000780","url":null,"abstract":"© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION 115.4 million individuals are projected to live with dementia by 2050. Notably, there is consensus that a substantial proportion of dementia cases may be preventable. Therefore, identifying individuals exhibiting cognitive impairment in conjunction with dementia risk factors could improve intervention and reduce disease burden. Existing smartphonebased assessment tools have demonstrated validity in cognitive screening, however, none combine cognitive screening with risk factor assessment and few have the accessible design necessary for unsupervised use at home. 5 Mindset4Dementia is a new smartphonebased application seeking to address this gap by integrating both cognitive screening and risk factor identification. The application can be completed unsupervised at home and takes only 5 min to complete. The user is guided through a conversational interface where risk factors are identified and cognitive screening is assessed via a modified Stroop and Symbol digit modality test. 7 Poor performance on the Stroop and Symbol Digit Modalities (SMT) tests is linked with dementia and mild cognitive impairment (MCI). Studies suggest that Stroop (among other tests) is able to distinguish between patients with dementia and normal controls. 9 The SMT is well suited for distinguishing between people with either MCI and dementia versus normal ageing and also useful in other conditions such as Multiple Sclerosis as a measure of cognition. Currently the app acts solely as a datacollection tool, without giving users feedback on their risk factors or reporting cognitive status. However, the eventual aim is to screen individuals at risk for dementia for apt intervention and prevention. This aim will require several phases including validating the modified Summary box","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"14 1","pages":"626 - 631"},"PeriodicalIF":2.0,"publicationDate":"2021-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73003129","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":"Plea for standardised reporting of frugal innovations","authors":"D. Sharma, M. Harris, V. Agrawal, P. Agarwal","doi":"10.1136/bmjinnov-2021-000710","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000710","url":null,"abstract":"","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"29 1","pages":"642 - 646"},"PeriodicalIF":2.0,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88754322","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":"Challenges and opportunities in employing digital health to address self-management needs of people with NCDs in India","authors":"Nachiket Gudi, U. Yadav, Oommen John, R. Webster","doi":"10.1136/bmjinnov-2020-000620","DOIUrl":"https://doi.org/10.1136/bmjinnov-2020-000620","url":null,"abstract":"© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. The WHO declared COVID-19 as a Public Health Emergency of International Concern on 30 January 2020. On 22 March 2020, the Government of India imposed the ‘Janata Curfew’ to enforce rapid physical distancing measures and prepare the health system to reduce the spread of COVID-19. This lockdown was repeated three times until 17 May 2020, adversely affecting large sectors of people due to lack of access to health services and staff for usual medical care. Evidence shows that people living with noncommunicable diseases (PLWNCDs) in India are presenting less to health facilities and also there are denial of healthcare services under the nation’s lockdown. 4 PLWNCDs were not able to see their physicians in a regular consultation, and access to lab services was limited as many of these labs were converted to COVID-19 testing centres. Access to regular counselling sessions and healthy lifestyle behaviours were affected as PLWNCDs were forced to limit their activity. They were also unable to secure healthy foods and had limited access to preventive or health promotion services owing to strict lockdown. A WHO survey from 2020 highlighted the disruption of NCD services for diabetes, cancer treatment and cardiovascular emergencies thereby urging countries to promote innovations to address an emerging tsunami of NCDs. The ongoing pandemic has had welldocumented economic, sociocultural and systemic impacts which have been well debated in the press and academic literature, but there is also growing concern of the effect on health for PLWNCDs and is termed as the syndemic effect of COVID-19.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"17 1","pages":"19 - 22"},"PeriodicalIF":2.0,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88929692","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}