Pub Date : 2023-08-22DOI: 10.1136/bmjinnov-2022-001066
Cyan Brittany Brown, L. McDermott
Objective Globally, 5 billion people lack access to safe surgery and annually, only 6% of surgeries occur in low-income countries. Surgical frugal innovations can reduce cost and optimise the function for the context; however, there is limited evidence about what enables success. Design A systematic literature review (SLR) was performed to understand the barriers and facilitators of frugal innovation for surgical care in low-income and middle-income countries (LMICs). Data sources Web of Science, PubMed, Embase at Ovid, Google Scholar and EThOs were searched. Eligibility criteria for selecting studies Inclusion criteria were original research in English containing a frugal surgical innovation. Research must be focused on LMICs. Studies were excluded if the content was not focused on LMICs or did not pertain to barriers and facilitators. 26 studies from 2006 to 2021 were included. The GRADE tool was used to assess overall review quality. Results Results were analysed using the modified consolidated framework for implementation research. The lack of formal evidence regarding frugal innovation in LMICs was the most reported barrier. The adaptability of frugal innovations to the context was the most reported facilitator. The limitations of this study were that most frugal innovations are not included in formal literature and that only English studies were included. Conclusion Frugal surgical innovations that are highly adaptable to the local context hold significant potential to scale and positively affect healthcare access and outcomes. Furthermore, supporting formal research about frugal innovations is important when aiming to innovate for health equity.
全球有50亿人无法获得安全手术，每年只有6%的手术发生在低收入国家。手术节约型创新可以降低成本，优化功能;然而，关于成功的因素的证据有限。设计进行了系统的文献综述(SLR)，以了解中低收入国家(LMICs)外科护理节俭创新的障碍和促进因素。检索了Web of Science、PubMed、Embase at Ovid、Google Scholar和EThOs等数据源。入选标准为英文原创研究，包含一项节俭的外科创新。研究必须集中在中低收入国家。如果研究的内容不侧重于中低收入国家或不涉及障碍和促进因素，则排除研究。纳入了2006年至2021年的26项研究。GRADE工具用于评估总体评价质量。结果采用改进的综合框架对结果进行分析，进行实施研究。缺乏关于中低收入国家节俭创新的正式证据是报道最多的障碍。节约型创新对环境的适应性是被报道最多的促进因素。本研究的局限性在于大多数节约型创新没有被包括在正式文献中，而且只包括了英语研究。结论高度适应当地环境的节俭外科创新具有巨大的规模潜力，并对医疗服务的可及性和结果产生积极影响。此外，支持关于节约型创新的正式研究在旨在为卫生公平而创新时很重要。
{"title":"Systematic literature review of the barriers and facilitators of frugal innovation for surgical care in low-income and middle-income countries","authors":"Cyan Brittany Brown, L. McDermott","doi":"10.1136/bmjinnov-2022-001066","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-001066","url":null,"abstract":"Objective Globally, 5 billion people lack access to safe surgery and annually, only 6% of surgeries occur in low-income countries. Surgical frugal innovations can reduce cost and optimise the function for the context; however, there is limited evidence about what enables success. Design A systematic literature review (SLR) was performed to understand the barriers and facilitators of frugal innovation for surgical care in low-income and middle-income countries (LMICs). Data sources Web of Science, PubMed, Embase at Ovid, Google Scholar and EThOs were searched. Eligibility criteria for selecting studies Inclusion criteria were original research in English containing a frugal surgical innovation. Research must be focused on LMICs. Studies were excluded if the content was not focused on LMICs or did not pertain to barriers and facilitators. 26 studies from 2006 to 2021 were included. The GRADE tool was used to assess overall review quality. Results Results were analysed using the modified consolidated framework for implementation research. The lack of formal evidence regarding frugal innovation in LMICs was the most reported barrier. The adaptability of frugal innovations to the context was the most reported facilitator. The limitations of this study were that most frugal innovations are not included in formal literature and that only English studies were included. Conclusion Frugal surgical innovations that are highly adaptable to the local context hold significant potential to scale and positively affect healthcare access and outcomes. Furthermore, supporting formal research about frugal innovations is important when aiming to innovate for health equity.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"42 1","pages":"226 - 239"},"PeriodicalIF":2.0,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89304948","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}
Pub Date : 2023-08-22DOI: 10.1136/bmjinnov-2022-001012
A. E. El Ayadi, Pushpendra Singh, Mona Duggal, Vijay Kumar, Jasmeet Kaur, Preetika Sharma, K. Vosburg, N. Diamond-Smith
Introduction Pregnant and breastfeeding women are priority targets for COVID-19 vaccination due to adverse maternal and fetal consequences of perinatal COVID-19 infection and the opportunity for protecting infants through maternal antibodies. Saheli (‘female friend’) is a WhatsApp-deployed chatbot providing evidence-based guidance on COVID-19 for pregnant and breastfeeding women. Objectives To understand the feasibility and acceptability of Saheli and its impact on COVID-19 vaccination. Methods We pilot-tested Saheli among pregnant and breastfeeding participants of pre-existing WhatsApp educational groups led by a community-based non-governmental organisation in Haryana, India from January to March 2022 using a pre/post design. Results 829 unique participants completed precommunity surveys or postcommunity surveys; 238 completed both. 829 individuals used Saheli, including 88% postintervention survey participants. Users reported Saheli was easy to engage with (79%), easy to understand (91%), quick (83%) and met their information needs (97%). 89% indicated it improved their COVID-19 knowledge a lot, 72% recommended it to others and 88% shared chatbot-derived information with others. Most participants received ≥1 COVID-19 vaccine (86% vs 88%, preintervention to postintervention); full vaccination was 55% and 61%, respectively. Vaccination over time increased marginally for ≥1 dose (OR 1.15, 95% CI 0.99 to 1.36) and significantly for 2 doses (OR 1.21, 95% CI 1.09 to 1.34), and increases were significant among pregnant (≥1 dose) and breastfeeding participants (2 doses). Vaccine hesitancy was low. Chatbot use was high, yet individual chatbot engagement did not alter COVID-19 vaccination. Conclusion Chatbots are a promising health education strategy due to high acceptability and deployment potential. Interpreting community chatbot impact must acknowledge the co-occurring constellation of multilevel interventions, community and pandemic factors.
由于围产期COVID-19感染对孕产妇和胎儿的不良后果以及通过母体抗体保护婴儿的机会，孕妇和哺乳期妇女是COVID-19疫苗接种的优先目标。Saheli(“女性朋友”)是一个部署在whatsapp上的聊天机器人，为孕妇和哺乳期妇女提供关于COVID-19的循证指导。目的了解萨赫勒的可行性和可接受性及其对COVID-19疫苗接种的影响。方法:2022年1月至3月，我们在印度哈里亚纳邦一个社区非政府组织领导的已有WhatsApp教育小组的孕妇和哺乳期参与者中，采用前后设计对Saheli进行了试点测试。结果829名参与者完成了社区前调查和社区后调查;238人两者都完成了。829人使用Saheli，其中88%为干预后调查参与者。用户表示，Saheli易于参与(79%)，易于理解(91%)，快速(83%)，并满足他们的信息需求(97%)。89%的人表示这大大提高了他们对COVID-19的了解，72%的人向他人推荐，88%的人与他人分享聊天机器人衍生的信息。大多数参与者接种了1支以上的COVID-19疫苗(干预前和干预后分别为86%和88%);完全疫苗接种率分别为55%和61%。≥1剂的疫苗接种率随着时间的推移略有增加(OR 1.15, 95% CI 0.99至1.36)，2剂的疫苗接种率显著增加(OR 1.21, 95% CI 1.09至1.34)，孕妇(≥1剂)和母乳喂养参与者(2剂)的疫苗接种率显著增加。疫苗犹豫率低。聊天机器人的使用率很高，但个人聊天机器人的参与并没有改变COVID-19疫苗接种。结论聊天机器人具有较高的可接受性和部署潜力，是一种很有前途的健康教育策略。解释社区聊天机器人的影响必须承认多层干预、社区和流行病因素共同发生的星座。
{"title":"Feasibility and acceptability of Saheli, a WhatsApp Chatbot, on COVID-19 vaccination among pregnant and breastfeeding women in rural North India","authors":"A. E. El Ayadi, Pushpendra Singh, Mona Duggal, Vijay Kumar, Jasmeet Kaur, Preetika Sharma, K. Vosburg, N. Diamond-Smith","doi":"10.1136/bmjinnov-2022-001012","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-001012","url":null,"abstract":"Introduction Pregnant and breastfeeding women are priority targets for COVID-19 vaccination due to adverse maternal and fetal consequences of perinatal COVID-19 infection and the opportunity for protecting infants through maternal antibodies. Saheli (‘female friend’) is a WhatsApp-deployed chatbot providing evidence-based guidance on COVID-19 for pregnant and breastfeeding women. Objectives To understand the feasibility and acceptability of Saheli and its impact on COVID-19 vaccination. Methods We pilot-tested Saheli among pregnant and breastfeeding participants of pre-existing WhatsApp educational groups led by a community-based non-governmental organisation in Haryana, India from January to March 2022 using a pre/post design. Results 829 unique participants completed precommunity surveys or postcommunity surveys; 238 completed both. 829 individuals used Saheli, including 88% postintervention survey participants. Users reported Saheli was easy to engage with (79%), easy to understand (91%), quick (83%) and met their information needs (97%). 89% indicated it improved their COVID-19 knowledge a lot, 72% recommended it to others and 88% shared chatbot-derived information with others. Most participants received ≥1 COVID-19 vaccine (86% vs 88%, preintervention to postintervention); full vaccination was 55% and 61%, respectively. Vaccination over time increased marginally for ≥1 dose (OR 1.15, 95% CI 0.99 to 1.36) and significantly for 2 doses (OR 1.21, 95% CI 1.09 to 1.34), and increases were significant among pregnant (≥1 dose) and breastfeeding participants (2 doses). Vaccine hesitancy was low. Chatbot use was high, yet individual chatbot engagement did not alter COVID-19 vaccination. Conclusion Chatbots are a promising health education strategy due to high acceptability and deployment potential. Interpreting community chatbot impact must acknowledge the co-occurring constellation of multilevel interventions, community and pandemic factors.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"43 1","pages":"195 - 206"},"PeriodicalIF":2.0,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90212357","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}
Pub Date : 2023-07-27DOI: 10.1136/bmjinnov-2023-001090
Ian N Gaston, Alexander G Samworth, Emery H. McCrory, J. Bavaro, Mahesh Vaidyanathan
Introduction Neuraxial procedures are performed by many specialties among a wide variety of patients. Palpation is the standard practice to locate a target insertion site. Procedural difficulty may prompt the use of alternative modalities. In a 2020 feasibility study, a neuraxial imaging device called VerTouch was shown to be reliable and easy to learn. In this study, we compared VerTouch to palpation and ultrasound (US). Methods An investigator-initiated prospective, randomised study was conducted on a labour and delivery ward at a large tertiary care hospital. Participants were randomised to either palpation, US or the VerTouch device. The primary endpoint was the total number of redirections. Secondary endpoints included the number of reinsertions and the total procedure time. Results 95 patients were enrolled and 81 completed the study. The VerTouch group required fewer redirections (0.72 vs 2.35 and 2.81, p=0.041) and reinsertions (0.11 vs 0.50 and 0.96, p=0.017) without prolonging the overall procedure time (8.66 mins vs 7.88 and 9.81, p=0.121) when compared to palpation and US, respectively. Conclusion This study supports the potential for VerTouch to improve procedural success for patients who might otherwise require radiology referral and for providers who may lack the resources or training to accommodate US guidance. The results also demonstrate the potential value in clinician involvement in the development of technology from the point of inception through implementation into clinical practice.
导言轴突手术是由许多专业在各种各样的病人中进行的。触诊是定位目标插入部位的标准做法。程序上的困难可能促使使用其他方式。在2020年的可行性研究中，一种名为VerTouch的轴向成像设备被证明是可靠且易于学习的。在这项研究中，我们将VerTouch与触诊和超声(US)进行了比较。方法对某大型三级医院产房进行前瞻性随机研究。参与者被随机分配到触诊、US或VerTouch设备。主要终点是重定向的总次数。次要终点包括重新插入的次数和总手术时间。结果95例患者入组，81例完成研究。与触诊和US相比，VerTouch组需要更少的重定向(0.72 vs 2.35和2.81,p=0.041)和重新插入(0.11 vs 0.50和0.96,p=0.017)，而不延长整个手术时间(8.66分钟vs 7.88和9.81,p=0.121)。结论:本研究支持VerTouch提高手术成功率的潜力，对于那些可能需要放射科转诊的患者，以及可能缺乏资源或培训以适应美国指导的提供者。研究结果也证明了临床医生从技术开发开始到临床实践的潜在价值。
{"title":"From feasibility study to randomised control trial: the evolution of a novel neuraxial procedure device","authors":"Ian N Gaston, Alexander G Samworth, Emery H. McCrory, J. Bavaro, Mahesh Vaidyanathan","doi":"10.1136/bmjinnov-2023-001090","DOIUrl":"https://doi.org/10.1136/bmjinnov-2023-001090","url":null,"abstract":"Introduction Neuraxial procedures are performed by many specialties among a wide variety of patients. Palpation is the standard practice to locate a target insertion site. Procedural difficulty may prompt the use of alternative modalities. In a 2020 feasibility study, a neuraxial imaging device called VerTouch was shown to be reliable and easy to learn. In this study, we compared VerTouch to palpation and ultrasound (US). Methods An investigator-initiated prospective, randomised study was conducted on a labour and delivery ward at a large tertiary care hospital. Participants were randomised to either palpation, US or the VerTouch device. The primary endpoint was the total number of redirections. Secondary endpoints included the number of reinsertions and the total procedure time. Results 95 patients were enrolled and 81 completed the study. The VerTouch group required fewer redirections (0.72 vs 2.35 and 2.81, p=0.041) and reinsertions (0.11 vs 0.50 and 0.96, p=0.017) without prolonging the overall procedure time (8.66 mins vs 7.88 and 9.81, p=0.121) when compared to palpation and US, respectively. Conclusion This study supports the potential for VerTouch to improve procedural success for patients who might otherwise require radiology referral and for providers who may lack the resources or training to accommodate US guidance. The results also demonstrate the potential value in clinician involvement in the development of technology from the point of inception through implementation into clinical practice.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"13 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87296846","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}
Pub Date : 2023-07-05DOI: 10.1136/bmjinnov-2022-001077
D. Sharma, V. Agrawal, N. Sam-Agudu, P. Agarwal, S. Yadav, J. Bajaj
Importance Affordable surgical innovations (ASIs) provide simple, safe and equitable solutions in resource-limited settings. Effective dissemination is needed for widespread adoption and uptake of ASIs in low and middle-income countries (LMICs). However, surgical systems in these settings face challenges with adoption and uptake of ASIs, which remain unknown and/or unused even after supporting evidence is published. A surgery-specific, implementation science-informed framework can provide a roadmap delineating the actions needed to achieve this goal; however, none exist currently. This prompted the development of a well-defined roadmap for this purpose. Methods The roadmap was developed after several rounds of structured brainstorming discussions among the authors, who are LMIC-based experts in academic surgery, ASIs, global health and implementation science. Results and conclusion The proposed ‘DISSEMINATE’ roadmap presents 18 non-sequential domains to be considered in a comprehensive approach to equitable accessibility for surgical innovations: Design of the innovation; Innovate by combining the IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up) surgical innovation framework with local multidisciplinary expertise; Substantiate available evidence; Scale up application of evidence in surgical practice; Share knowledge on multidisciplinary platforms; Sustainability; Endorsement of the innovation by local catalysts; Media promotion; Identify early adopters; Improve and refine the innovation; Improvise during setbacks; Implementation science methods; Navigate through barriers; Aspirational affordability; Advocacy for the value of ASIs; Tools for scalability and adoption; Evaluate impact of dissemination; and Extend use of the innovation to resource-rich settings. This surgery-specific roadmap provides structure for effective dissemination to help in overcoming know-do gaps in the use of ASIs in LMICs.
重要性负担得起的外科创新(ASIs)为资源有限的环境提供了简单、安全和公平的解决方案。为了在低收入和中等收入国家广泛采用和吸收ASIs，需要进行有效的传播。然而，这些地区的外科系统在采用和吸收ASIs方面面临着挑战，即使在发表了支持证据后，这种情况仍然未知和/或未被使用。一个特定手术的、科学的实施框架可以提供一个路线图，描述实现这一目标所需的行动;然而，目前还不存在。这促使为此目的制定了一个定义良好的路线图。方法路线图是由lmic的学术外科、ASIs、全球健康和实施科学专家经过几轮有组织的头脑风暴讨论后制定的。提出的“传播”路线图提出了18个非顺序领域，在全面的方法中需要考虑外科创新的公平可及性:创新的设计;将IDEAL (Idea, Development, Exploration, Assessment and Long-term follow- term)外科创新框架与当地多学科专业知识相结合进行创新;证实现有证据;扩大证据在外科实践中的应用;在多学科平台上分享知识;可持续性;本地催化剂对创新的认可;媒体推广;确定早期采用者;完善和细化创新;在挫折中即兴发挥;实施科学的方法;穿越障碍;的支付能力;倡导亚洲发展协会的价值;可扩展性和采用的工具;评价传播的影响;将创新推广到资源丰富的地区。该特定手术路线图为有效传播提供了结构，以帮助克服中低收入国家在使用ASIs方面的知识差距。
{"title":"‘DISSEMINATE’: a roadmap for facilitating adoption of affordable surgical innovations in low and middle-income countries","authors":"D. Sharma, V. Agrawal, N. Sam-Agudu, P. Agarwal, S. Yadav, J. Bajaj","doi":"10.1136/bmjinnov-2022-001077","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-001077","url":null,"abstract":"Importance Affordable surgical innovations (ASIs) provide simple, safe and equitable solutions in resource-limited settings. Effective dissemination is needed for widespread adoption and uptake of ASIs in low and middle-income countries (LMICs). However, surgical systems in these settings face challenges with adoption and uptake of ASIs, which remain unknown and/or unused even after supporting evidence is published. A surgery-specific, implementation science-informed framework can provide a roadmap delineating the actions needed to achieve this goal; however, none exist currently. This prompted the development of a well-defined roadmap for this purpose. Methods The roadmap was developed after several rounds of structured brainstorming discussions among the authors, who are LMIC-based experts in academic surgery, ASIs, global health and implementation science. Results and conclusion The proposed ‘DISSEMINATE’ roadmap presents 18 non-sequential domains to be considered in a comprehensive approach to equitable accessibility for surgical innovations: Design of the innovation; Innovate by combining the IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up) surgical innovation framework with local multidisciplinary expertise; Substantiate available evidence; Scale up application of evidence in surgical practice; Share knowledge on multidisciplinary platforms; Sustainability; Endorsement of the innovation by local catalysts; Media promotion; Identify early adopters; Improve and refine the innovation; Improvise during setbacks; Implementation science methods; Navigate through barriers; Aspirational affordability; Advocacy for the value of ASIs; Tools for scalability and adoption; Evaluate impact of dissemination; and Extend use of the innovation to resource-rich settings. This surgery-specific roadmap provides structure for effective dissemination to help in overcoming know-do gaps in the use of ASIs in LMICs.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"65 1","pages":"207 - 214"},"PeriodicalIF":2.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74597051","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}
Pub Date : 2023-07-01DOI: 10.1136/bmjinnov-2022-001051
Chris Zielinski
> Wealthy nations must step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change The 2022 report of the Intergovernmental Panel on Climate Change paints a dark picture of the future of life on earth, characterised by ecosystem collapse, species extinction and climate hazards such as heatwaves and floods.1 These are all linked to physical and mental health problems, with direct and indirect consequences of increased morbidity and mortality. To avoid these catastrophic health effects across all regions of the globe, there is broad agreement—as 231 health journals argued together in 2021—that the rise in global temperature must be limited to <1.5°C compared with pre-industrial levels. While the Paris Agreement of 2015 outlines a global action framework that incorporates providing climate finance to low-income and middle-income countries, this support has yet to materialise.2 COP27 is the fifth Conference of the Parties (COP) to be organised in Africa since its inception in 1995. Ahead of this meeting, we—as health journal editors from across the continent—call for urgent action to ensure it is the COP that finally delivers climate justice for Africa and vulnerable countries. This is essential for the health of those countries, and for the health of the whole world. The climate crisis has had an impact on the environmental and social determinants of health across Africa, leading to devastating health effects.3 Impacts on health can result directly from environmental shocks and indirectly through socially mediated effects.4 Climate change-related risks in Africa include flooding, drought, heatwaves, reduced food production and reduced labour productivity.5 Droughts in sub-Saharan Africa …
{"title":"COP27 climate change conference: urgent action needed for Africa and the world","authors":"Chris Zielinski","doi":"10.1136/bmjinnov-2022-001051","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-001051","url":null,"abstract":"> Wealthy nations must step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change The 2022 report of the Intergovernmental Panel on Climate Change paints a dark picture of the future of life on earth, characterised by ecosystem collapse, species extinction and climate hazards such as heatwaves and floods.1 These are all linked to physical and mental health problems, with direct and indirect consequences of increased morbidity and mortality. To avoid these catastrophic health effects across all regions of the globe, there is broad agreement—as 231 health journals argued together in 2021—that the rise in global temperature must be limited to <1.5°C compared with pre-industrial levels. While the Paris Agreement of 2015 outlines a global action framework that incorporates providing climate finance to low-income and middle-income countries, this support has yet to materialise.2 COP27 is the fifth Conference of the Parties (COP) to be organised in Africa since its inception in 1995. Ahead of this meeting, we—as health journal editors from across the continent—call for urgent action to ensure it is the COP that finally delivers climate justice for Africa and vulnerable countries. This is essential for the health of those countries, and for the health of the whole world. The climate crisis has had an impact on the environmental and social determinants of health across Africa, leading to devastating health effects.3 Impacts on health can result directly from environmental shocks and indirectly through socially mediated effects.4 Climate change-related risks in Africa include flooding, drought, heatwaves, reduced food production and reduced labour productivity.5 Droughts in sub-Saharan Africa …","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"40 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138528789","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}
Pub Date : 2023-06-26DOI: 10.1136/bmjinnov-2022-001003
J. H. Wong, Katharina Näswall, Fleur Pawsey, J. Chase, S. Malinen
Technological advancements are vital for improving the capacity of the health system to deliver health and well-being benefits to individuals. Despite significant financial investments in technological innovations in healthcare, patients reported benefiting from only 30%–60% of new healthcare technologies. We argue that failed adoption can be attributed to the underprioritisation of the human aspect of innovation development and uptake. In this paper, we elaborate on the psychological experience of being introduced to new technology at work through the perspective of a healthcare employee. We then present a psychology-based practical framework called ‘Tech-ISM’ for healthcare decision-makers to encourage more human-centric technology implementation processes, resources and leadership. The framework identifies the key individuals and relationships within a healthcare delivery context that can influence individual attitudes towards adoption, before offering recommendations for how decision-makers can socialise new technology into the workplace (ie, types of organisational resources and processes to provide), and manage these social dynamics over time (ie, types of work cultures to cultivate through leadership). While Tech-ISM is written for a healthcare decision-maker, any individuals involved with healthcare technology implementation can benefit from a holistic understanding of how social and organisational factors of a workplace inter-relate with the human experience of novelty and change.
{"title":"Adoption of technological innovation in healthcare delivery: a psychological perspective for healthcare decision-makers","authors":"J. H. Wong, Katharina Näswall, Fleur Pawsey, J. Chase, S. Malinen","doi":"10.1136/bmjinnov-2022-001003","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-001003","url":null,"abstract":"Technological advancements are vital for improving the capacity of the health system to deliver health and well-being benefits to individuals. Despite significant financial investments in technological innovations in healthcare, patients reported benefiting from only 30%–60% of new healthcare technologies. We argue that failed adoption can be attributed to the underprioritisation of the human aspect of innovation development and uptake. In this paper, we elaborate on the psychological experience of being introduced to new technology at work through the perspective of a healthcare employee. We then present a psychology-based practical framework called ‘Tech-ISM’ for healthcare decision-makers to encourage more human-centric technology implementation processes, resources and leadership. The framework identifies the key individuals and relationships within a healthcare delivery context that can influence individual attitudes towards adoption, before offering recommendations for how decision-makers can socialise new technology into the workplace (ie, types of organisational resources and processes to provide), and manage these social dynamics over time (ie, types of work cultures to cultivate through leadership). While Tech-ISM is written for a healthcare decision-maker, any individuals involved with healthcare technology implementation can benefit from a holistic understanding of how social and organisational factors of a workplace inter-relate with the human experience of novelty and change.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"9 1","pages":"240 - 252"},"PeriodicalIF":2.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75372617","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}
Pub Date : 2023-05-31DOI: 10.1136/bmjinnov-2021-000861
Christopher Tejun Law, Catharina Moenig, Hammad Jeilani, M. Jeilani, Tony Young
Drones have been pioneered and used in the military, however, only recently non-military drones have been introduced. The COVID-19 pandemic has brought into focus the potential value of drones in moving medical supplies. With the onset of social distancing policies and quarantine regulations, the efficiency of traditional logistics systems has been limited. Several companies have recently accelerated their development in this domain, conducting pilot projects at pace, paving the way for the future of the medical logistics supply chain. In this review, we examine both narrative and grey literature for in and out of hospital settings, in order to describe the current state of drone technology in healthcare around the world and some of the most cutting-edge examples of how drones can benefits patients, clinicians and the wider public. We investigate the economic viability and barriers to adopting drones at scale which include regulatory hurdles, public perception and safety of drone technologies, and propose how to overcome these challenges. Further work should look at quantifying the impact and outcomes of how such a service could impact the health outcomes of patients and clinical efficiency. This review aims to equip the National Health Service and more broadly other healthcare systems around the world with the tools to embrace and implement this novel and upcoming technology.
{"title":"Transforming healthcare logistics and evaluating current use cases of UAVs (drones) as a method of transportation in healthcare to generate recommendations for the NHS to use drone technology at scale: a narrative review","authors":"Christopher Tejun Law, Catharina Moenig, Hammad Jeilani, M. Jeilani, Tony Young","doi":"10.1136/bmjinnov-2021-000861","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000861","url":null,"abstract":"Drones have been pioneered and used in the military, however, only recently non-military drones have been introduced. The COVID-19 pandemic has brought into focus the potential value of drones in moving medical supplies. With the onset of social distancing policies and quarantine regulations, the efficiency of traditional logistics systems has been limited. Several companies have recently accelerated their development in this domain, conducting pilot projects at pace, paving the way for the future of the medical logistics supply chain. In this review, we examine both narrative and grey literature for in and out of hospital settings, in order to describe the current state of drone technology in healthcare around the world and some of the most cutting-edge examples of how drones can benefits patients, clinicians and the wider public. We investigate the economic viability and barriers to adopting drones at scale which include regulatory hurdles, public perception and safety of drone technologies, and propose how to overcome these challenges. Further work should look at quantifying the impact and outcomes of how such a service could impact the health outcomes of patients and clinical efficiency. This review aims to equip the National Health Service and more broadly other healthcare systems around the world with the tools to embrace and implement this novel and upcoming technology.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"183 1","pages":"150 - 164"},"PeriodicalIF":2.0,"publicationDate":"2023-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73733981","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}
Pub Date : 2023-05-11DOI: 10.1136/bmjinnov-2022-001062
V. Dhyani, Jisha B. Krishnan, E. Mathias, M. Hossain, Carrie Price, Nachiket Gudi, S. Pattanshetty, S. Zodpey
Objective To identify the barriers and facilitators for uptake of telemedicine services in low-income and middle-income countries (LMICs). Design The rapid review approach to identify the barriers and facilitators for the uptake/delivery of telemedicine in health system from both the provider and the patient’s perspective. A two-stage sequential screening process was adopted. Data extraction was done using a piloted data extraction form. Data sources A search on PubMed (NCBI), Embase (Ovid), the Cochrane Library (Wiley), Scopus (Elsevier) and the WHO Global Index Medicus was conducted. Eligibility criteria for selecting studies Studies published between 1 January 2012 and 1 July 2022 on barriers and facilitators for uptake of telemedicine services in LMICs were included. Results Database search identified a total of 2829 citations. After removing 1069 duplicates, 1760 were taken forward for title and abstract screening. A total of 43 articles were included at full text stage and 8 articles were included in this overview for narrative synthesis. Barriers and facilitators to telemedicine adoption and use were categorised under four subheadings, namely organisational and environmental, individual and cultural barriers, financial barriers and technological barriers. Providers, patient and health policy-makers perspectives were captured. Conclusion Any development of telemedicine services should engage the primary users such as patients and their family caregivers to design people-centred digital health systems and services. Usability studies must be commissioned by the governments and host agencies to enhance the interaction experience pending which investments would remain futile. Future research should employ mixed methods or multi methods approaches to understand the interaction between patients and providers.
目的确定在低收入和中等收入国家(LMICs)采用远程医疗服务的障碍和促进因素。设计快速审查方法，从提供者和患者的角度确定卫生系统中接受/提供远程医疗的障碍和促进因素。采用两阶段顺序筛选工艺。数据提取是使用试点数据提取表单完成的。检索PubMed (NCBI)、Embase (Ovid)、Cochrane Library (Wiley)、Scopus (Elsevier)和WHO Global Index Medicus。选取研究的资格标准纳入了2012年1月1日至2022年7月1日期间发表的关于中低收入国家采用远程医疗服务的障碍和促进因素的研究。结果在数据库中检索到共2829篇引文。在删除1069个重复条目后，1760个条目进行了标题和摘要筛选。全文阶段共收录43篇文章，本综述共收录8篇文章进行叙事综合。采用和使用远程医疗的障碍和促进因素分为四个小标题，即组织和环境障碍、个人和文化障碍、财务障碍和技术障碍。获取了提供者、患者和卫生政策制定者的观点。结论任何远程医疗服务的发展都应该让患者及其家庭护理人员等主要用户参与进来，设计以人为本的数字卫生系统和服务。可用性研究必须由政府和主办机构委托，以提高交互体验，在此之前投资将是徒劳的。未来的研究应采用混合方法或多方法来了解患者与提供者之间的相互作用。
{"title":"Barriers and facilitators for the adoption of telemedicine services in low-income and middle-income countries: a rapid overview of reviews","authors":"V. Dhyani, Jisha B. Krishnan, E. Mathias, M. Hossain, Carrie Price, Nachiket Gudi, S. Pattanshetty, S. Zodpey","doi":"10.1136/bmjinnov-2022-001062","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-001062","url":null,"abstract":"Objective To identify the barriers and facilitators for uptake of telemedicine services in low-income and middle-income countries (LMICs). Design The rapid review approach to identify the barriers and facilitators for the uptake/delivery of telemedicine in health system from both the provider and the patient’s perspective. A two-stage sequential screening process was adopted. Data extraction was done using a piloted data extraction form. Data sources A search on PubMed (NCBI), Embase (Ovid), the Cochrane Library (Wiley), Scopus (Elsevier) and the WHO Global Index Medicus was conducted. Eligibility criteria for selecting studies Studies published between 1 January 2012 and 1 July 2022 on barriers and facilitators for uptake of telemedicine services in LMICs were included. Results Database search identified a total of 2829 citations. After removing 1069 duplicates, 1760 were taken forward for title and abstract screening. A total of 43 articles were included at full text stage and 8 articles were included in this overview for narrative synthesis. Barriers and facilitators to telemedicine adoption and use were categorised under four subheadings, namely organisational and environmental, individual and cultural barriers, financial barriers and technological barriers. Providers, patient and health policy-makers perspectives were captured. Conclusion Any development of telemedicine services should engage the primary users such as patients and their family caregivers to design people-centred digital health systems and services. Usability studies must be commissioned by the governments and host agencies to enhance the interaction experience pending which investments would remain futile. Future research should employ mixed methods or multi methods approaches to understand the interaction between patients and providers.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"76 1","pages":"215 - 225"},"PeriodicalIF":2.0,"publicationDate":"2023-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86566265","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}
Pub Date : 2023-05-11DOI: 10.1136/bmjinnov-2023-001081
R. Ramchandani, Simon Berry, Jane Berry, Beth A. Pratt, Albert Saka, R. Black
Introduction We explored whether greater consideration of product design, informed by end users’ opinions, led to improved utilisation (ie, rational use) of oral rehydration salts (ORS) in home settings. We tested whether a ‘design thinking’ approach, focusing on product acceptability, functionality and ease of use, contributed to an increased likelihood of appropriate ORS use, specifically dosing and preparation of ORS in the correct concentration. Methods Intervention design decisions were used to develop a co-packaged diarrhoea treatment kit containing ORS and zinc, branded as ‘Kit Yamoyo’. In addition to co-packaging, key product design features were the inclusion of 200 mL ORS sachets and a water measurement function incorporated in the packaging design. Cross-sectional data from household surveys of caregivers in rural Zambia were then used to compare ORS preparation and use for diarrhoea patients aged <5 years, who used either the novel co-pack or standard 1 L sachets of ORS. Design benefits were demonstrated to caregivers from two rural areas by trained community health workers (CHWs). Results Odds of correct ORS preparation were 10.93 times greater (p<0.001; 95% CI 5.74 to 20.78) among Kit Yamoyo users versus individuals who used 1 L sachets. Co-pack users prepared ORS to the correct concentration 93% (95% CI 0.89% to 0.96%) of the time, while non-users prepared it in the correct concentration just 60% (95% CI 0.54% to 0.66%) of the time. Conclusion Application of design thinking to the development of a co-packaged ORS and zinc diarrhoea treatment kit, coupled with demonstrations by CHWs, can improve rational use of ORS.
我们探讨了更多地考虑产品设计，并根据最终用户的意见，是否会提高口服补液盐(ORS)在家庭环境中的利用率(即合理使用)。我们测试了关注产品可接受性、功能性和易用性的“设计思维”方法是否有助于增加适当使用口服补液的可能性，特别是正确浓度的口服补液的剂量和制备。方法采用干预设计决策开发含有ORS和锌的共包装腹泻治疗包，品牌为“kit Yamoyo”。除了共同包装，关键的产品设计特点是包括200毫升ORS小袋和水测量功能纳入包装设计。然后使用来自赞比亚农村护理人员家庭调查的横断面数据来比较5岁以下腹泻患者口服补液的制备和使用，这些患者使用新型联合包装或标准1l小袋口服补液。由训练有素的社区卫生工作者(CHWs)向两个农村地区的护理人员展示了设计的好处。结果ORS制备正确的几率为10.93倍(p<0.001;Kit Yamoyo使用者与使用1l小袋的个体之间的95%可信区间为5.74至20.78)。共包装使用者在93%的时间(95% CI 0.89%至0.96%)将ORS配制成正确的浓度，而非使用者仅在60%的时间(95% CI 0.54%至0.66%)将ORS配制成正确的浓度。结论将设计思维应用于口服补液和锌腹泻共包装治疗包的开发，并辅以卫生工作者的示范，可提高口服补液的合理使用。
{"title":"Design thinking to improve rational use of oral rehydration salts: lessons from an innovative co-packaged diarrhoea treatment kit","authors":"R. Ramchandani, Simon Berry, Jane Berry, Beth A. Pratt, Albert Saka, R. Black","doi":"10.1136/bmjinnov-2023-001081","DOIUrl":"https://doi.org/10.1136/bmjinnov-2023-001081","url":null,"abstract":"Introduction We explored whether greater consideration of product design, informed by end users’ opinions, led to improved utilisation (ie, rational use) of oral rehydration salts (ORS) in home settings. We tested whether a ‘design thinking’ approach, focusing on product acceptability, functionality and ease of use, contributed to an increased likelihood of appropriate ORS use, specifically dosing and preparation of ORS in the correct concentration. Methods Intervention design decisions were used to develop a co-packaged diarrhoea treatment kit containing ORS and zinc, branded as ‘Kit Yamoyo’. In addition to co-packaging, key product design features were the inclusion of 200 mL ORS sachets and a water measurement function incorporated in the packaging design. Cross-sectional data from household surveys of caregivers in rural Zambia were then used to compare ORS preparation and use for diarrhoea patients aged <5 years, who used either the novel co-pack or standard 1 L sachets of ORS. Design benefits were demonstrated to caregivers from two rural areas by trained community health workers (CHWs). Results Odds of correct ORS preparation were 10.93 times greater (p<0.001; 95% CI 5.74 to 20.78) among Kit Yamoyo users versus individuals who used 1 L sachets. Co-pack users prepared ORS to the correct concentration 93% (95% CI 0.89% to 0.96%) of the time, while non-users prepared it in the correct concentration just 60% (95% CI 0.54% to 0.66%) of the time. Conclusion Application of design thinking to the development of a co-packaged ORS and zinc diarrhoea treatment kit, coupled with demonstrations by CHWs, can improve rational use of ORS.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"112 1","pages":"132 - 143"},"PeriodicalIF":2.0,"publicationDate":"2023-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79218235","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}
Pub Date : 2023-05-09DOI: 10.1136/bmjinnov-2022-001017
Shobhana Sugirthamuthu, S. Sundaram, Radha Annamalai, S. Prabhakar, Neha Arora, Arthi Mohanendran, Parikumar Periasamy
Sugirthamuthu S, et al. BMJ Innov 2023;0:1–4. doi:10.1136/bmjinnov-2022-001017 Department of Ophthalmology, The Light Eye Hospital, Dharmapuri, Tamil Nadu, India Department of Pathology, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India Department of Ophthalmology, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India Consultant Ophthalmologist, The Light Eye Hospital, Dharmapuri, Tamil Nadu, India
{"title":"Feasibility of morphometric analysis of conjunctival blood vessel as an additional diagnostic indicator of health and vascular disease status","authors":"Shobhana Sugirthamuthu, S. Sundaram, Radha Annamalai, S. Prabhakar, Neha Arora, Arthi Mohanendran, Parikumar Periasamy","doi":"10.1136/bmjinnov-2022-001017","DOIUrl":"https://doi.org/10.1136/bmjinnov-2022-001017","url":null,"abstract":"Sugirthamuthu S, et al. BMJ Innov 2023;0:1–4. doi:10.1136/bmjinnov-2022-001017 Department of Ophthalmology, The Light Eye Hospital, Dharmapuri, Tamil Nadu, India Department of Pathology, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India Department of Ophthalmology, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India Consultant Ophthalmologist, The Light Eye Hospital, Dharmapuri, Tamil Nadu, India","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"61 1","pages":"253 - 256"},"PeriodicalIF":2.0,"publicationDate":"2023-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86416123","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}
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