BMJ Innovations最新文献

{"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":"8 1","pages":"105 - 110"},"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":"119 1","pages":"111 - 116"},"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":"39 1","pages":"60 - 63"},"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":"49 1","pages":"55 - 59"},"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}

{"title":"Low-income and middle-income countries leading the way with tobacco control policies","authors":"Joanna E. Cohen, Graziele Grilo, Lauren Czaplicki, Jennifer L Brown, K. Welding, M. Hefler, R. Kennedy, A. Perucic","doi":"10.1136/bmjinnov-2021-000857","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000857","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. GLOBAL TOBACCO USE AND POLICY INTERVENTIONS Tobacco products are the world’s single largest cause of preventable death, accounting for more than 8 million deaths each year and causing suffering from avoidable illnesses among tens of millions more. Tobaccocaused death and disease disproportionately affects people in lowincome and middleincome countries (LMICs). 2 The WHO Framework Convention on Tobacco Control (FCTC), with 182 parties from all regions of the world, was developed in response to the globalisation of the tobacco epidemic and lays out evidencebased demand and supply reduction strategies. These strategies have resulted in measurable progress: global cigarette sales have been declining since 2012 despite overall population growth. It is estimated that tobacco control interventions have saved more than 37 million lives as fewer people start and more people quit, using tobacco products. However, there is much more work needed ahead. Over 1 billion people worldwide still use tobacco products, and the tobacco industry continues to aggressively fight the enactment and effective implementation of proven policy interventions. The demand and supply measures outlined in the FCTC, adopted by the World Health Assembly in 2003, are considered a floor (after all, the Framework Convention was based on the best evidence available through the dawn of the 21st century). However, FCTC Article 2.1 explicitly encourages countries to go beyond the measures outlined, and they have! Early tobacco control policy innovations, with data of their impacts feeding into the development of the FCTC, included smokefree air policies in states and cities in the USA, pictorial health warning labels (HWLs) in Canada, restrictions on tobacco advertising and sponsorship in Canada, and the use of tobacco excise taxes as a measure to reduce smoking in Canada. Since the FCTC came into force, innovations have included a ban on the display of tobacco products at the point of sale in Iceland, and plain and standardised packaging in Australia. However, policy innovations have also occurred across LMICs. This commentary highlights seven diverse examples from across the globe, selected by the authors, of world precedent setting, firstoftheir kind interventions that have originated in LMICs.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"1 1","pages":"4 - 8"},"PeriodicalIF":2.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83665724","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":"Transforming the once-a-day pill for HIV prevention from medicine to empowering self-care using human-centred design in Zimbabwe","authors":"E. Harris, K. Shelley, Thenjiwe Sisimayi, Catherine Wandie, Cal Bruns","doi":"10.1136/bmjinnov-2021-000739","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000739","url":null,"abstract":"Objective For adolescent girls and young women (AGYW) in sub-Saharan Africa, oral tenofovir‐based pre‐exposure prophylaxis (commonly referred to as PrEP) provides a user-controlled HIV prevention method, critical to addressing their HIV risk and unmet prevention needs. Addressing the gap between clinical and real-world PrEP efficacy requires new approaches, such as ‘V’. ‘V’ reframes PrEP from medicine to self-care that is as easy to use as a young women’s favourite fashion or beauty brand. This article describes how human-centred design (HCD) was used to adapt the ‘V’ brand and service delivery strategy for implementation in Zimbabwe from its development via formative research in South Africa. Methods Following literature review, stakeholder analysis and landscaping, the ‘V’ brand and service delivery strategy were assessed through participatory immersion sessions with 152 participants in four Zimbabwe districts. Insights were synthesised across learning questions: What do AGYW and health workers think about ‘V’?; Which of the ‘V’ materials are most acceptable and relevant for Zimbabwe?; What adaptations are necessary for the selected ‘V’ materials for Zimbabwe?; and How should the selected ‘V’ assets be integrated? Results The ‘V’ innovative design principles—delightfully bold branding, a discreet starter kit and user-friendly materials that put young women in control of educating others—remained resonant. Feasible modifications were identified to adapt the ‘V’ brand and service delivery strategy to suit the local context. Conclusion ‘V’ delivers a ‘delightfully discreet’ approach that puts AGYW in charge of preventing HIV. The resonance of the core ‘V’ design concepts demonstrates how HCD can be applied to reframe PrEP as a product category (ie, from a stigmatising medicine to empowering self-care).","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"69 1","pages":"29 - 36"},"PeriodicalIF":2.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85798590","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":"Evaluation of a novel wireless near-infrared spectroscopy (NIRS) device in the detection of tourniquet induced ischaemia","authors":"M. Gimzewska, M. Berthelot, P. Sarai, L. Geoghegan, S. Onida, J. Shalhoub, P. Strutton, A. Davies","doi":"10.1136/bmjinnov-2021-000752","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000752","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Acute limb ischaemia is a vascular emergency threatening both life and limb, with estimated mortality rates of 9%–22%, and 30day extremity amputation rates of 10%–30%. 3 Timely identification of the acutely ischaemic limb is pivotal. Conventional methods of assessing limb ischaemia rely on repeated clinical examination, serial assessment of Doppler signals and imaging technology such as duplex ultrasound, digital subtraction angiography, CT angiography and MR angiography. While able to assess arterial compromise, these technologies are limited as they provide data for only a single time point, and imaging modalities are high in cost and low in portability. The ability to noninvasively and continually monitor for limb ischaemia could enable identification of compromised tissue earlier, prompting faster revascularisation and reducing complications associated with prolonged ischaemia. A growing interest in the role of the microcirculation in tissue perfusion has led to the use of nearinfrared spectroscopy (NIRS) devices in the evaluation of limb ischaemia. 6 NIRS is a noninvasive spectroscopy method of obtaining regional tissue oxygen saturation (StO 2 ), using light wavelengths in the red and nearred range of the spectrogram. NIRSbased devices can reliably identify the ratio of oxygenated haemoglobin (HbO 2 ) and deoxyhaemoglobin (HHb) present in tissue, and as such are able to determine oxygen desaturation associated with limb ischaemia. 8 A number of commercial devices are available for clinical use. Some current limitations around using existing NIRS devices are cost and bulk around the patient bedspace. As such, they are rarely used outside the operating theatre and intensive care unit settings, where patients are relatively immobile and low nurse:patient ratios make the management of multiple wired devices in the bed space feasible for staff. The aims of this prospective study were: 1. To evaluate the feasibility of using a novel, wireless NIRS device in detecting tissue StO 2 in a tourniquetinduced model of limb ischaemia in healthy volunteers. Summary box","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"9 19 1","pages":"48 - 54"},"PeriodicalIF":2.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88664554","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":"Blockchain technology for immunisation data storage in India: opportunities for population health innovation","authors":"Somalee Banerjee, Sinchan Banerjee, Anshul Bhagi, Aurobindo Sarkar, Bhrigu Kapuria, S. Desai, Venkatraman Sethuraman, A. Ray, Kara Palanuk, S. Patil","doi":"10.1136/bmjinnov-2021-000725","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000725","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. BACKGROUND Childhood vaccination is a costeffective public health intervention with proven positive outcomes on individual, community and global scales as some of the highest return of investment into healthcare. India’s vaccination programme is one of the largest in the world, covering 27 million live births per year and 100 million children under age 5 alone, but coverage is far from universal. Recent investments and improvements in India’s vaccine programme are working to improve the rates of immunised children, including the recent Mission Indradhanush. However, immunisation data in India is stored in complex fragmented data storage systems that have led to mismatch in resources and systemwide shortfalls. The fragmentation has been due to various innovations being developed in real time in a decentralised manner. With the global need for tracking immunisation data due to the COVID19 pandemic, solutions for improving immunisation data storage are critical. There is a great deal of interest surrounding use cases for blockchain technology in development and healthcare. Blockchain, the technology underlying cryptocurrencies such as bitcoin, can be especially useful in improving decentralised and error prone information storage. There has been limited use of blockchain technology in the field of healthcare data management despite the enthusiasm surrounding it, specifically no prior exploration of the use of blockchain technology in the national storage of healthcare data. In partnership with the Biotechnology and Research Council of India and Gates Grand Challenges India as part of the Immunisation Data: Innovating for Action programme, we explored means for improvement in digitisation of data through the use of blockchain technology.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"86 1","pages":"1 - 3"},"PeriodicalIF":2.0,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83439022","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":"Analysis of the physical and microbiocidal characteristics of an emerging and innovative UV disinfection technology","authors":"G. Messina, D. Amodeo, A. Corazza, N. Nante, G. Cevenini","doi":"10.1136/bmjinnov-2021-000790","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000790","url":null,"abstract":"Introduction Surface disinfection is one of the key points to reduce the risk of transmission both in healthcare and other public spaces. A novel UV-chip disinfection technology is presented. Technological, photonic and microbiocidal characteristics are evaluated taking as reference an ultraviolet-C (UV-C) LED source of equivalent radiant power. Methods The UV chip has a circular radiating surface with a diameter of 1.3 cm, emitting UV cold light at about 5 mW and driven current of about 80 µA. Four bacterial strains were used to conduct the microbiological tests at 4°C and 60°C to evaluate the bactericidal performance of the two technologies under the same operating conditions. Results Spectral differences were found between the UV-C LED and the chip, with an emission curve strictly around 280 nm and a broader band centred around 264 nm, respectively. Between-technology microbiological inactivation levels were comparable, achieving total abatement (99.999%) in 8 min at 7.5 cm. Discussion The UV chip exhibits unique properties that make it applicable in some specific contexts, where UV-C LEDs present the most critical issues. Besides, it is portable and exhibits a broad spectrum of UV wavelengths with a peak where the maximum microbiocidal efficacy occurs. Important issues to be addressed to improve this technology are the high voltage management and the too low energy efficiency. Conclusion This cold emission technology is virtually unaffected by changes in ambient temperature and is particularly useful in short-distance applications. Recent developments in technology are moving towards a progressive increase in the chip’s radiant power.","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"54 1","pages":"21 - 28"},"PeriodicalIF":2.0,"publicationDate":"2021-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87765120","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":"Novel digitally enabled care pathway to support postintensive care recovery and goal attainment following critical illness","authors":"L. Rose, C. Apps, Kate Brooks, E. Terblanche, N. Hart, Joel Meyer","doi":"10.1136/bmjinnov-2021-000842","DOIUrl":"https://doi.org/10.1136/bmjinnov-2021-000842","url":null,"abstract":"© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Intensive care unit (ICU) survivors, particularly with a protracted length of stay such as those mechanically ventilated for COVID19 pneumonitis, experience lasting physical, cognitive and psychological challenges that impede their recovery and functional capability. Survivors also experience substantial symptom burden including breathlessness, extreme fatigue and pain. Together, the healthcare issues faced by ICU survivors are frequently referred to as postintensive care syndrome (PICS). Family members acting as informal caregivers experience substantial psychosocial burden and in some cases loss of employment and financial difficulties due to their informal caregiver commitments. Unfortunately, fragmentation in healthcare delivery following transfer from the ICU to an inpatient ward location, and following hospital discharge, is all too common. This fragmentation results in mismatches in the healthcare services needed and those received, information loss, treatment omissions, hospital readmission, and poor patient and family experience, all of which may interfere with recovery. Despite the wellestablished recovery challenges faced by ICU survivors and their family members, development of a recovery plan and provision of followup recovery services are highly variable, and in some jurisdictions extremely limited. Individualised recovery goal setting, although the standard of care across many areas of rehabilitation is not routine for ICU survivors. Virtual care and telemedicine may provide a solution to bridge the fragmentation prevalent across arbitrary healthcare system boundaries and thus enable individualised patient and familycentred recovery for ICU survivors. Although telemedicine is commonly used in the management of chronic diseases such as Chronic Obstructive Pulmonary Disease (COPD) and congestive heart failure, only a few examples exist that facilitate rehabilitation and recovery of ICU survivors such as the virtual Sepsis Transition and Recovery (STAR) programme for sepsis survivors in the USA. Therefore, as a clinical service innovation, we aimed to create a digital recovery pathway delivered via an ehealth platform (aTouchAway, Aetonix, Canada) Summary box","PeriodicalId":53454,"journal":{"name":"BMJ Innovations","volume":"1 1","pages":"42 - 47"},"PeriodicalIF":2.0,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82226178","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}