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Communicable disease outbreaks can spread rapidly, causing enormous losses to individual health, national economies and social well-being. Therefore, communicable disease surveillance is essential for protecting public health. In Qatar, electronic reporting from primary health centres was proposed as a means of improving disease notification, replacing a paper-based method of reporting (via internal mail, facsimile, email or telephone), which has disadvantages and requires active cooperation and engagement of staff. This study is a predescriptive and postdescriptive analysis, which compared disease notifications received from electronic and paper-based systems during 3-month evaluation periods (quarter 2 in 2016 and quarter 2 in 2018 for paper-based and electronic reporting, respectively) in terms of comprehensiveness, timeliness and completeness. For the 23 notifiable diseases included in this study, approximately twice as many notifications were received through the electronic reporting system as from the paper-based reporting system, demonstrating it is more comprehensive. An overall increase in notifications is likely to have a positive public health impact in Qatar. 100% of electronic notifications were received in a timely manner, compared with 28% for paper-based notifications. Findings of the study show that electronic reporting presents a revolutionary opportunity to advance public health surveillance. It is recommended that electronic reporting be rolled out more widely to improve the completeness, stability and representativeness of the national public health surveillance system in Qatar as well as other countries.

Background Many maternal, newborn and child health (MNCH) programmes have paired community health workers with mobile technologies to strengthen the ability of health information systems (HIS) to track women and children across time and beyond the clinical setting. However, little is known regarding the comparative effectiveness of using mobile technologies to enhance HIS data in resource-poor settings. Methods Focus group discussions were conducted with community health workers called Health Activists (HAs; n=30), Community Organisation Leaders (n=28), HA Trainers (n=21), district and tribal area officials (n=3) and State Officials (n=4). We analysed user perceptions along seven key HIS processes: data collection, transmission, processing, analysis, display, quality checking and feedback. Results The mobile-based health information system (mHIS) was found to be supportive of the MNCH continuum of care by improving the regularity and timeliness of access to robust data. Respondents noted that data errors were reduced in real time through automated error checking and data processing, which also reduced users’ workloads. The mHIS additionally enabled users to analyse both individual and aggregate data, allowing them to identify specific individuals in need of services or training as well as to identify general trends in service delivery. The system9s data display and feedback mechanisms were viewed as improving data use for decision-making. The remaining challenges of the mHIS versus the paper-based HIS included resource, infrastructural and technological barriers that hindered efficient use over time. Conclusions As compared to paper-based HIS systems, mobile technologies can improve health information processes in resource-poor settings. More efforts are needed to ensure sufficient financial investment, training and use of mHIS data at all levels of the HIS.

In September 2017, Medecins Sans Frontieres (MSF) held a hackathon—a concentrated event that brings together various professionals and end users to build innovative solutions to challenges end users face in their work1—in Tokyo for 2 days. The event aimed (1) to identify new ideas to address challenges in humanitarian surgical care and (2) to deepen innovation networks in the humanitarian medical aid sector. This paper describes how MSF organised the hackathon and subsequently supported four projects launched at the event. The paper shares lessons learnt based on this experience for others holding hackathons with similar aims. To identify the challenges to tackle in the hackathon, we interviewed a range of surgical experts within MSF. Numerous challenges were raised. Following the Field Guide To Human-Centred Design , we tried and devised five possible solutions to each challenge in just a few minutes2: this tests their suitability for a hackathon-type event. We also narrowed the scope of our challenges by giving them a specific context while still trying to provide enough latitude for creative solutions to emerge. MSF asked Japan Biodesign—a partner of the Stanford University Biodesign programme with trained leaders in innovating medical devices using design thinking principles3—to mentor participants. MSF surgical care experts also provided medical advice. Fifty-seven people, comprising medical professionals, engineers, developers, business people and students, were recruited mostly from MSF and Biodesign’s own networks. While several participants worked at medical device companies, all came representing themselves. Mentors strongly encouraged participant groups to employ principles of design thinking. In contrast to more conventional hackathons,4 therefore, participants began the hackathon by thoroughly investigating and fully deconstructing their chosen problem and identifying the specific needs arising therein. Only then did they ideate solutions. We employed three specific criteria to judge solutions: originality, impact and …

This paper demonstrates that Lean management serves as a foundation to leverage innovation throughout the healthcare projects. An organisation that successfully accommodates both Lean and innovation will gain higher competitive advantage and reach long-term sustainability. Innovation in the healthcare sector in the United Arab Emirates (UAE) is encouraged through responses to the challenges of patient needs and government pressure on the organisations towards innovation and sustainability concerns. The objective of the paper is to investigate critical success factors (CSFs) for effective diffusion of Lean innovation in healthcare projects in the UAE. A conceptual model is developed to explain the CSFs for diffusion of Lean innovation in the healthcare projects. A public hospital that implemented Lean innovation projects in the UAE was selected as a case study and the data provided through the interviews were reviewed and analysed. It is concluded that the successful implementation of Lean innovation had outstanding implications: It has markedly and sustainably decreased patient access and waiting time, improved safety and patient satisfaction and supported the hospital culture of empowering front-line caregivers. The championing role of leadership commitment and management support, and employee involvement across all levels is required for successful implementation.

This article argues that plastics ought to be included under the category of ‘hazardous’ healthcare waste and suggests that health professionals should strive for alternatives as part of their mission to improve health. The focus of this paper is on replacing, rather than recycling, plastics. The rationale for this stance stems from the unbridled escalation of plastics use, the fact that few countries have significant recycling capacity, and because the process of recycling as well as the end products of recycled plastics remain hazardous to health and the environment.Issues related to incinerated plastic, plastics in single-use items, plastic blister packs and containers for medicines, as well as plastics which are unrelated to healthcare but which nevertheless make up a substantial part of general healthcare waste are discussed. Suggestions are put forward to dramatically reduce plastics in all such cases.To support needed reforms and to guide best practice for single-use plastics in particular, a call for a reliable reference source is made—similar to the Essential Medicines Lists, which would share updated information on the most problematic items in use and environmentally friendly alternatives in each case.It is argued that concerted action by health professionals to improve healthcare waste, beginning with plastics, would send much needed market signals to industry to produce environmentally-friendly products for healthcare and would likely lead to solutions for domestic waste, too.

IntroductionYouth engagement has the potential to enhance the design, implementation and relevance of research. Without strategies to capacitate young people with research skills, youth engagement in research is often tokenistic and ineffective. In this paper, we detail the implementation and evaluation of an innovative research training programme for youth (aged 18–24 years) in Zimbabwe called the Youth Researchers Academy (YRA).MethodsQuantitative programme data and qualitative interviews and focus group discussions assessed acceptability of the YRA, youth researcher and mentor experiences, and impact of the YRA over time.ResultsWe received 60 applications in 2019 and 89 applications in 2021. Ongoing feedback led to changes in the second programme (including longer training and certification). Youth researcher experiences included being motivated by learning new skills and valuing the relationship with mentors and peer networks. Many described long-term impact, including facilitation of higher education, setting up of new businesses through the stipends received, and, for some, opportunities to work in research.DiscussionOverall, the programme was acceptable, facilitated meaningful youth-led research and trained a cohort of empowered youth researchers. Young people were eager to learn and capable of both learning and implementing critical research skills in a professional working environment. Implementation challenges included limited freedom in the co-design of research projects and the additional burden of work for YRA mentors.ConclusionThe YRA provides a template for other academics to support similar training to facilitate capacity building and meaningful youth engagement for research with and for youth.

‘Design with the user’ is a guiding principle for creating digital solutions to solve systemic developmental challenges. According to this principle, digital solutions are more likely to be effective if the intended users are involved in the design process, thereby rooting design thinking in a human-centric approach that seeks to understand their characteristics, needs and challenges. However, few examples exist for human-centred design (HCD) processes being successfully applied in low-and-middle-income countries to create digital health interventions that achieve both scale and sustainability. This paper describes the application of a five-stage HCD process to develop a suite of mobile solutions to improve reproductive, maternal, neonatal and child health in Bihar, India, and discusses lessons learnt. Two of the solutions were later adopted by the government and scaled to 10 million subscribers and more than 300 000 front-line health workers (FLHWs) in 13 states. The socio-ecological model, which considers the interplay between individual, interpersonal, organisational, community and public policy factors, provides a conceptual framework for understanding key learnings from the HCD process. At the organisational level, we found that demand generation was constrained by deficiencies in the public health system, while at the community level, gender norms were a barrier to changing health practices. At the interpersonal level, mobile health solutions for mothers also had to address fathers, because they controlled women’s access to mobile phones. At the individual level, FLHWs had limited time to build their skills and needed more flexible, home-based learning opportunities; most FLHWs had access to mobile phones, but devices were overwhelmingly basic and digital skills limited; voice technology was required to maximise reach among low literate women and an authoritative yet empathetic narrator was required to humanise the digital experience, lend credibility and create engagement.

The regulatory framework around medical devices in the European Union has always focused on upholding patient safety. However, over the years, certain scandals have come to light in which patient safety has been compromised considerably. As a consequence, the overwhelming opprobrium was the cause for a radical change. The new Medical Device Regulation (MDR) has now been introduced (but yet to be fully implemented) to primarily combat the issues that have arisen as a result of these scandals. The MDR has been subject to significant commentary, particularly the effect it will have on relevant stakeholders. The stakeholders in the context of the MDR are the manufacturers, distributors, authorised representatives and importers. There is a general consensus among various professionals that the new requirements are far more onerous than the obligations contained in the previous regulatory framework. Moreover, there has been a lengthy delay in the date of application for the MDR. In particular, the approval of the notified bodies is raising a great concern. This paper will provide a critical analysis of the new requirements that stakeholders must comply with and, in addition, will review the postponement of the MDR.

IntroductionThe delay in seeking emergency obstetric care leads to significant maternal morbidity and mortality and can worsen during pandemics, especially in humanitarian conflict settings with low uptake of obstetric services. To mitigate the challenges related to the second delay caused by lack of transport in the COVID-19 pandemic, the organisation United Nations Population Fund implements a community-based referral project called Referral Hub in the Rohingya refugee population in Bangladesh. The objective of the paper is to describe the implementation process of the Referral hub and present clients’ utilisation and perception of the service.MethodsFindings from part of a larger mixed-method study, the analysis of the standard operating protocol of the intervention, secondary data of routine utilisation of the 12 referral hubs between January and August 2020, 21 key informant interviews and a community survey among 100 pregnant women are presented in this paper.ResultsThe findings show an increasing trend in the referral hub utilisation and a strong recommendation of the service.ConclusionDue to a robust referral mechanism by collaborating with the community and engaging accessible and free of cost transport service, the intervention has high potential to improve access to facility care in low-resource and humanitarian contexts, especially during pandemics.

IntroductionContact tracing is an integral component of the overall public health strategy for controlling the outbreak of infectious diseases such as COVID-19. In addition to the conventional contact tracing, Qatar has implemented Ehteraz, a proximity-tracing mobile phone App using global positioning system and Bluetooth technologies. In this paper, we aim to evaluate the accuracy of Ehteraz as a contact tracing App based on the WHO contact tracing criteria and compare its effectiveness to the traditional human led case investigation.MethodsA cross-sectional study was conducted using two databases, including Ehteraz proximity data and swab collection and case investigations reports for the same period.Results46.9% of contacts identified by the Ehteraz app did not meet WHO duration and distance criteria. Among the 5650 contacts flagged by Ehteraz during the period, 4973 (88.0%) of contacts did not share any known relation with the index case they are linked to.ConclusionThe study highlighted the inaccuracy of the Ehteraz tool as its technology enables signals passing through walls, so people in different rooms could be unnecessarily flagged as having had contact. Big segments of the population (eg, Children) do not necessarily use smartphones and are not, therefore, flagged by Ehteraz digital contact tracing App. Similarly, Ehteraz rarely flags close contacts identified by human investigation as Bluetooth is usually turned off in a household or at a workplace. These findings highlight that digital contact tracing would be an efficient public health strategy when integrated to and complementing human investigation.

Globally, it is estimated that 15 million babies are born prematurely each year. Approximately one million of these newborns die due to complications of preterm birth, and these deaths occur disproportionately in low/middle-income countries (LMICs).1 Respiratory distress syndrome (RDS) is a common cause of death among those born preterm, and continuous positive airway pressure (CPAP) has been established as an effective therapy for reducing mortality and morbidity from RDS among preterm neonates.2 Unfortunately, the high cost of conventional CPAP devices has limited its availability in low-resource settings.3 To fill this gap, multiple low-cost, effective and safe CPAP devices have emerged, although this space remains an area for active innovation and development. In this paper, we focus on the use of the target product profile (TPP) as a tool for aligning innovators and other stakeholders for product innovation. As a funding organisation, we are invested in the implementation of technology products that improve health outcomes at scale. We have observed the presence of multiple CPAP products without clear alignment on the key features and specifications, nor the systemic and delivery factors required for successful implementation.4 This has resulted in a major barrier to large scale uptake and implementation of CPAP devices for the treatment of RDS in preterm infants in LMICs. Newborn technology design for respiratory distress can be done in a purposeful way. While clinical guidelines and recommendations on the clinical use of CPAP for newborn care are available, there is insufficient guidance to align innovators, investors and other stakeholders developing new product prototypes. The WHO (2015) issued a recommendation on the use of CPAP for the treatment of preterm newborns with RDS immediately on diagnosis. It includes provision of blended oxygen, monitoring of oxygen saturation and cardiorespiratory status, and use in facilities that can provide quality …

With a considerably high level of poverty, high population density and relatively fragile health systems, most African countries have a predominance of factors that could contribute to the rapid spread of the COVID-19 pandemic Despite these challenges, the continent has shown capacity in its response to the pandemic This may be related to the continent's experience in responding to several infectious disease outbreaks such as Ebola disease, Lassa fever and cholera Since the beginning of the COVID-19 pandemic, several local innovations have been developed and implemented These innovations take into consideration unique circumstances in countries such as multiple government levels, belief in traditional medicine, limited access to medical supplies and others This paper describes the various strategies developed in African countries across leadership and coordination, surveillance, laboratory capacity, case management, infection, prevention and control, risk communications, points of entry, research, logistics and supply chain, partnership, food security and education We highlight the impact of these strategies on the response so far, and lessons that other regions across the world can learn from Africa's response to COVID-19 Finally, we recommend the urgent need for increased investment in African health and social institutions to enable the development of African-owned and led strategies in response to disease outbreaks © Author(s) (or their employer(s)) 2021 No commercial re-use See rights and permissions Published by BMJ

The COVID-19 pandemic has been circulating in the world for over a year since 2019, resulting in over 80 million cases with almost 1.8 million deaths in 2020. The first vaccine that hit the global market is BNT162b2, given by Pfizer/BioNTech, which was approved in December 2020. Stepping into 2021, more COVID-19 vaccines are becoming accessible in the global market. Until February 2021, four vaccines have been approved for full use, while six more have been authorised for early or limited use in different countries around the world. As vaccination programmes are gradually launched by various jurisdictions, post-trial surveillance with real-world evidence is of utter importance for close monitoring of their safety and effectiveness. This paper would introduce a vaccine passport concept implemented with blockchain technology. In the following, the methods of contact tracing and vaccine efficacy monitoring with intact personal privacy protection will be discussed. As SARS-CoV-2 infection can be asymptomatic, transmission is hard to stop. Despite various containment policies enacted, such as city lockdown, mandatory masking and QR (quick response) code contact tracing, COVID-19 vaccine presents new hope, another ammunition rather, combating the COVID-19 pandemic. Traditional vaccine development takes 10–15 years. With huge social and economic pressure, scientists around the world have been working on accelerated pace in vaccine development as authorised by government. SARS-CoV-2 vaccines are developed at an unprecedented rate with various types. In the face of a global public health crisis, vaccine development has been accelerated. This is accredited to the investigation years for the former severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus vaccine, helping identify the coronavirus spike protein as the antigenic target.1 Governments worldwide are rolling out mass vaccination programmes accordingly, with 40 million COVID-19 vaccine doses administered globally. A vaccine passport concept with data encryption, such as …

BackgroundChildren’s health and healthcare use are impacted by both medical conditions and social factors, such as their home and community environment. As healthcare systems manage a pediatric population, information about these factors is crucial to providing quality care coordination.MethodsThe authors developed a novel methodology combining medical complexity (using the Pediatric Medical Complexity Algorithm) and social complexity (using available family social factors known to impact a child’s health and healthcare use) to create a new health complexity model at both the population-level and individual-level. System-level data from Oregon’s Medicaid Management Information Systems and Integrated Client Services database was analysed, examining claims data and service utilization, to calculate the health complexity of children enrolled in Medicaid/Child Health Insurance Program (CHIP) across Oregon.ResultsOf the 390 582 children ages 0 to 17 enrolled in Medicaid/CHIP in Oregon from July 2015 to June 2016, 83.4% (n=325 900) had some level of medical and/or social complexity and 22.1% (n=85 839) had health complexity (both medical and social complexity). Statistically significant (pConclusionsGiven the high proportion of children with health complexity, these findings demonstrate that a large number of Medicaid/CHIP-insured children could benefit from targeted care coordination and differential resource allocation. Reports have been shared with state, county and health system leaders to drive work across the state. This paper describes the collaborative process necessary for other states considering similar work.

This paper presents the design, development and testing of a novel neck chamber device for non-invasive stimulation of an individual carotid baroreceptor in a graded manner. The proposed neck chamber device is a strap-free design that avoids discomfort during testing due to tight seal generated by the neck collar design, and facilitates unilateral testing and targeted assessment without stimulating other neck baroreceptors. The device consists of two independent components to achieve these requirements: an outer suction mechanism and an inner chamber. The outer mechanism consists of multiple suction cups to grip the device over the human neck, while the inner chamber creates controlled positive and negative pressure for stimulation of baroreceptors using a pump. The indigenously developed device was employed for the testing by providing neck chamber stimulation in discrete steps of –20 mm Hg, –40 mm Hg, −60 mm Hg, 0 mm Hg, 20 mm Hg, 40 mm Hg and 60 mm Hg with the gap of 60 s between each stimulation as per the standard test protocol of autonomic function test. The changes in heart rate and RR interval were recorded to determine the baroreceptor gain using the logistic equation derivative and gain curve plot. The results of the present study show that the estimated baroreceptor gain is –0.109±0.04, which is consistent with the previous studies conducted using neck collar devices. The testing results showed that the desired objectives are achieved successfully by the prototype device, opening up the possibility of its use for the treatment of resistant hypertension.

The Health and Family Welfare Department, Government of Gujarat, is implementing a program named Technology for Community Health Operation or TeCHO+ addressing state’s priority health issues. This program envisages replacing the existing mother and child tracking system or e-Mamta application in the state. This program is based on ImTeCHO—Innovative Mobile Technology for Community Health Operations—which was piloted in Jhagadia, Bharuch district of Gujarat in 2013. The program showed improvements not only in terms of coverage of maternal and newborn care packages averting malnutrition but also was cost-effective. This paper details the protocol for health technology assessment to assess the impact of TeCHO+ program on data quality, improvement in service delivery coverage, reduction in morbidity and mortality as well as assess the cost-effectiveness. The study will be conducted in five districts of the state. A mixed-method approach will be adopted. Data will be validated in a phased manner over a period of 3 years along with an assessment of key outcome indicators. Additionally, key informant interviews will be conducted and cost data will be gathered to perform cost-effectiveness analysis. The study will inform policymakers about the impact of TeCHO+ program on quality, access and cost-effectiveness of healthcare services.

BackgroundUp to 70% of medical devices in low-income and middle-income countries are partially or completely non-functional, impairing service provision and patient outcomes. In Sub-Saharan Africa, medical devices not designed for local conditions, lack of well-trained biomedical engineers and diverse donated equipment have led to poor maintenance and non-repair. The Maker Project’s aim was to test the effectiveness of an innovative partnership ecosystem network, the ‘Maker Hub’, in reducing gaps in the supply of essential medical devices for maternal, newborn and child health. This paper describes the first phase of the project, the building of the Maker Hub.MethodsKey activities in setting up the Maker Hub—a collaborative partnership between the University of Nairobi (UoN) and the Kenyatta National Hospital (KNH), catalysed by Concern Worldwide Kenya—are described using a product development partnership approach. Using a health systems approach, a needs assessment identified a medical equipment shortlist. Design thinking with a capacity building component was used by the UoN (innovators, public health specialists, engineers) working closely and with KNH nurses, physicians and biomedical engineers to develop the prototypes.ResultsTo date, four medical device prototypes have been developed. Two have been evaluated by the National Bureau of Standards and one has undergone clinical testing.ConclusionsWe have demonstrated an innovative partnership ecosystem that has developed medical devices that have undergone national standards evaluation and clinical testing, a first in Sub-Saharan Africa. Promoting a robust innovation ecosystem for medical equipment requires investment in building trust in the innovation ecosystem.

Early detection of physiological deterioration has been shown to improve patient outcomes. Due to recent improvements in technology, comprehensive outpatient vital signs monitoring is now possible. This is the first review to collate information on all wearable devices on the market for outpatient physiological monitoring.A scoping review was undertaken. The monitors reviewed were limited to those that can function in the outpatient setting with minimal restrictions on the patient’s normal lifestyle, while measuring any or all of the vital signs: heart rate, ECG, oxygen saturation, respiration rate, blood pressure and temperature.A total of 270 papers were included in the review. Thirty wearable monitors were examined: 6 patches, 3 clothing-based monitors, 4 chest straps, 2 upper arm bands and 15 wristbands. The monitoring of vital signs in the outpatient setting is a developing field with differing levels of evidence for each monitor. The most common clinical application was heart rate monitoring. Blood pressure and oxygen saturation measurements were the least common applications. There is a need for clinical validation studies in the outpatient setting to prove the potential of many of the monitors identified.Research in this area is in its infancy. Future research should look at aggregating the results of validity and reliability and patient outcome studies for each monitor and between different devices. This would provide a more holistic overview of the potential for the clinical use of each device.

ObjectivesThe primary objective of this paper was to independently evaluate the currently available web-based software options for virtual consultations in a secondary care setting.DesignComparative study.SettingUK.ParticipantsWeb-based software options for virtual consultations in a secondary care setting.Main outcome measuresEight predetermined measures of functionality were assessed including time to setup, availability of a diary system, ability to book appointments in advance, ability to send patient reminders, ability to add a second caller, text messaging functionality, need for the patient to download an app and web browser compatibility.ResultsNine platforms met the inclusion criteria for web-based standalone video consultation solutions. Four offered immediate access via an nhs.net email address. Six platforms used an appointment diary system, with five allowing clinicians to see which patients were ready and waiting for consultation at any particular time. Four of the platforms had the facility to book appointments in advance and send appointment details via text message or email. Five of the platforms had the ability to add a second caller. One platform required the patient to download a mobile phone app. All platforms were compatible with Google Chrome, Safari, Firefox and Microsoft Edge (Chromium or Blink versions).ConclusionsThe uptake of virtual online consultations has been accelerated by the COVID-19 pandemic and the National Health Service (NHS) has become a forced ‘early-adopter’. Many of the solutions do well to address the demand; however, more work is required for it to be embedded into routine service and fulfil the aims of the NHS Long Term Plan: allow patients more choice and flexibility in their care. It is vital that once normality resumes, research focuses on the outcomes of virtual online consultations, with focus on factors such as patient satisfaction, length of appointment, time to diagnosis and initiation of management.

BackgroundStroke events often result in long-term negative health outcomes. People who experience a first stroke event are 30%–40% more likely to experience a second stroke event within 5 years. An online secondary prevention programme for stroke survivors may help stroke survivors improve their health risk behaviours and lower their risk of a second stroke.ObjectivesThis paper describes the development and early iteration testing of the usability and acceptability of an online secondary prevention programme for stroke survivors (Prevent 2nd Stroke, P2S). P2S aims to address six modifiable health risk behaviours of stroke: blood pressure, physical activity, nutrition, depression and anxiety, smoking, and alcohol consumption.MethodsP2S was developed as an eight-module online secondary prevention programme for stroke survivors. Modelled on the DoTTI (Design and development, Testing early iterations, Testing for effectiveness, Integration and implementation) framework for the development of online programmes, the following stages were followed during programme development: (1) content development and design; and (2) testing early iteration. The programme was pilot-tested with 15 stroke survivors who assessed P2S on usability and acceptability.ResultsIn stage 1, experts provided input for the content development of P2S. In stage 2, 15 stroke survivors were recruited for usability testing of P2S. They reported high ratings of usability and acceptability of P2S. P2S was generally regarded as ‘easy to use’ and ‘relevant to stroke survivors’. Participants also largely agreed that it was appropriate to offer lifestyle advice to stroke survivors through the internet.ConclusionsThe study found that an online secondary prevention programme was acceptable and easily usable by stroke survivors. The next step is to conduct a randomised controlled trial to assess the effectiveness of the programme regarding behaviour change and determine the cost-effectiveness of the intervention.

Background Telemedicine holds promise for improving access to care. Telementoring—defined as mentoring by means of telecommunication and computer networks—can be used for remote education of healthcare professionals. Furthermore, it is rapidly establishing itself as a valuable asset in medicine and education. This paper aims to establish a financially and practically feasible, stable telementoring network using wearables for sterile and hands-free remote control, to be used during surgical procedures. Methods Two stand-alone computer systems, located at an academic hospital in the Netherlands and at a surgical research facility in Spain, were connected using TeamViewer software allowing for remote, hands-free controlling of radiological images using Myo gesture control armband. The operating surgeon consulted the remote surgeon through an audio, video and desktop sharing system during a live surgical procedure on a single porcine model. The system was analysed for feasibility and connection quality. Results The sensors used were commercially available and relatively cheap, with the integrating computer system being responsible for the majority of costs. A successful connection was established without any downtime and with only a minor time lag, not interfering with the telementoring procedures. The operating surgeon effectively consulted with and was mentored by the remote surgeon, through video, audio and the desktop sharing system, using the wearable sensors. Conclusions This proof of principle shows the feasibility of using an internet-based remote desktop sharing system in combination with wearable sensors and TedCube technology for telementoring purposes during surgical procedures.

Randomised clinical trials are designed to determine whether a particular treatment is appropriate to make a significant difference to the health of a defined population and to aid its approval for use. For an accurate, cheap and simple assessment to see if a treatment benefits an individual person, all that is needed is a pen, paper, simple pocket calculator and daily recording of a few variables. It requires the ability to read and write and to understand addition and division. Factorial design of experiments is used to show the impact of several variables and their interaction on the person’s health status. An example of a 75-year-old man with an enlarged prostate is used here to illustrate this approach. This person was able to understand and reduce side effects, lower the costs of medication by 83% and improve measured health status by 28%. A multivariate model for this person was then created with about 450 person-days of data.

Background Tobacco smoking can have negative health outcomes on recovery from surgery. Although it is recommended best practice to provide patients with advice to quit and follow-up support, provision of post-discharge support is rare. Developing an online smoking cessation program may help address this gap. Objectives This paper describes the development and pretesting of an online smoking cessation program (smoke-free recovery, SFR) tailored to the orthopaedic trauma population for use while in hospital and post-discharge. Methods Drawing on the DoTTI framework for developing an online program, the following steps were followed for program development: (1) design and development; (2) testing early iteration; (3) testing for effectiveness and (4) integration and implementation. This article describes the first two stages of SFR program development. Results SFR is a 10-module online smoking cessation program tailored for patients with orthopaedic trauma. Of the participants who completed testing early iterations, none reported any difficulties orientating themselves to the program or understanding program content. The main themes were that it was ‘helpful’, provision of ‘help to quit’ was low and SFR increased thoughts of ‘staying quit post-discharge’. Conclusions This study found that a theory and evidence-based approach as the basis for an online smoking cessation program for patients with orthopaedic trauma was acceptable to users. A randomised controlled trial will be conducted to examine whether the online smoking cessation program is effective in increasing smoking cessation and how it can be integrated and implemented into hospital practice (stages three and four of the DoTTI framework).

Background Governments, universities and pan-African research networks are building durable infrastructure and capabilities for biomedical research in Africa. This offers the opportunity to adopt from the outset innovative approaches and technologies that would be challenging to retrofit into fully established research infrastructures such as those regularly found in high-income countries. In this context we piloted the use of a novel mobile digital health platform, designed specifically for low-resource environments, to support high-quality data collection in a clinical research study. Objective Our primary aim was to assess the feasibility of a using a mobile digital platform for clinical trial data collection in a low-resource setting. Secondarily, we sought to explore the potential benefits of such an approach. Methods The investigative site was a research institute in Nairobi, Kenya. We integrated an open-source platform for mobile data collection commonly used in the developing world with an open-source, standard platform for electronic data capture in clinical trials. The integration was developed using common data standards (Clinical Data Interchange Standards Consortium (CDISC) Operational Data Model), maximising the potential to extend the approach to other platforms. The system was deployed in a pharmacokinetic study involving healthy human volunteers. Results The electronic data collection platform successfully supported conduct of the study. Multidisciplinary users reported high levels of satisfaction with the mobile application and highlighted substantial advantages when compared with traditional paper record systems. The new system also demonstrated a potential for expediting data quality review. Discussion and Conclusions This pilot study demonstrated the feasibility of using a mobile digital platform for clinical research data collection in low-resource settings. Sustainable scientific capabilities and infrastructure are essential to attract and support clinical research studies. Since many research structures in Africa are being developed anew, stakeholders should consider implementing innovative technologies and approaches.

Technology evolves over time through different stages, from centralisation to decentralisation and further on to individualisation. In recent years, this trend has affected every sphere of our lives, including the food chain, accommodation, finance, transportation, safety, hygiene, education and communications. With the passage of time, humans have developed a huge variety of systems, to dispel anxiety and concerns, and to pursue greater convenience and comfort. Medical equipment is no exception.1 In the centralisation stage, the medical equipment for treatment was used only inside limited medical institutions such as hospitals under the close control and management of trained medical personnel because it was expensive and difficult to operate. It gradually became less expensive, easier to operate and more portable as a result of the rapid progress of technology and it came to be used in a distributed or decentralised manner at primary-care medical facilities such as clinics. In more recent years, it has become more individualised in the form of devices for mobile health (mHealth) and handy healthcare devices for disease prevention, health enhancement and healthcare, and has come to be used in medical care outside of formal medical facilities such as home medical care, and is even accessible to ordinary people. In the past, it was generally believed that specialist physicians provided medical care with heavily armed high-grade equipment, whereas primary-care physicians provided it with lightly armed lower-grade equipment. Recent advances in technology, however, have enabled medical personnel other than doctors to provide services with lightly armed high-grade equipment , which is quickly blurring the borderline between medical care and healthcare as it is also used even by ordinary people. This paper discusses the impact of individualised medical equipment, as observed in Japan, a country that is experiencing a rapid ageing of society, and attempts to identify specific challenges on the medical front …

Background Healthcare costs from in-hospital joint surgery for degenerative joint diseases are predicted to significantly increase to potentially unsustainable levels in the next several decades. Aim As an index model, this paper presents cost-effectiveness predictions for an innovative combination treatment of image-guided percutaneous autologous blood-derived growth factors and exercises (IPGFE) for painful knee osteoarthritis managed in an out of hospital interventional radiology (IR) clinic through a disruptive healthcare delivery model. Materials and methods Non-randomised retrospective case registry data were analysed. Patients suitable for TKR who underwent IPGFE were included. Knee function outcome scores were converted to quality of life years (QALY) gained. Median percentage improvement after IPGFE in knee function was converted to cost per QALYs by input of direct costs. Results Median cost per QALY for IPGFE was AU$ 208.33 for 7.2 QALY gained. In comparison, the median cost per QALY for TKR was AU$2739 for 4.5 QALY gained. Incremental cost-effectiveness ratio for IPGFE was AU$4827.77 not spent per QALY gained in comparison to TKR. Conclusions An out of hospital care model may be a less expensive option to gain better quality of life in comparison to knee joint replacement surgery for some patients. Out of hospital IR techniques should be studied further for their efficacy and potential to offer considerable healthcare cost savings in comparison to joint replacement surgery.

This paper describes the development and production of an educational and reference app designed for the medical and pharmaceutical industries as well as interested members of the public. ‘Clinically Speaking’ consists of edited, impromptu movies of clinical interviews of patients with common and rare conditions archived over two decades. Each is indexed by subject area and disease, identified by short title and thumbnail and accompanied by a description and Wikipedia URL. The app design allows users to scroll down through subject areas such as cardiology and gastroenterology, then across to access several hundred edited cases. For users with Windows, Google or Android rather than iOS devices, a similar experience is delivered through a web-based version. The almost complete market penetration of smart phones and computers allows educational database material to be distributed very economically. An opportunity to partially recoup design and coding costs and cover on-going expenses of upgrades, server charges and annual developer fees is afforded by app store sales. Distributed worldwide via the app store, ‘Clinically Speaking’ constitutes a versatile vehicle for addition of further cases and provides experience of conditions that are infrequently seen in practice. Apps and mobile devices capture the current zeitgeist and constitute potentially powerful new vehicles for delivering reference material and clinical medical education. The development process, described herein, is slow, expensive and complex. The market is saturated and the rationale for adding further apps needs careful consideration.

Background The present paper is about developing an indigenous technology to spin ultra low-cost hemodialysis fibres. It presents a complete engineering design and specific operating conditions to spin dialysis grade, hollow fibre membranes. Methods Simple, lab-made, disposable needle assemblies have been used to extrude fibres, replacing the conventional spinneret-based technique. A complete arrangement of spinning paraphernalia has been designed and discussed to make the process less energy intensive. Biocompatible polymer such as polysulfone (PSf) has been used as base material, along with biocompatible additives such as polyvinylpyrrolidone (PVP) and polyethylene glycol (PEG-200). Results Three grades of hollow fibres have been spun (6, 12 and 16 kDa molecular weight cut-off) and are characterised in terms of surface morphology and molecular weight cut-off. In vitro clearances and the transient permeation of uremic toxins has also been evaluated in diffusion governed dialysis mode. Conclusions An ultra low cost technology was developed and optimised to spin dialysis fibres of clinical specifications, with inner diameter of 220 µ and thickness of 35–40 μ. 6 kDa fibres are found to be high efficiency dialysis grade, whereas 12 and 16 kDa are potential high performance membranes.

Experts probably have to immerse themselves in their discipline for at least a decade before they have the knowledge and insights needed to produce world-class work. Medical practitioners with long experience in their specialist fields are particularly well placed to know what type of devices might be needed to make their patients’ journeys back to health more comfortable, secure and cost-effective. Medical school curriculae, however, are devoid of formal innovation and business training at least in the UK. The strategies required to convert an idea into reality remain beyond most medical graduates’ terms of references, and progressing a ‘Eureka moment’ is perceived, perhaps understandably, as an overwhelming challenge. Indeed, as exciting, interesting and satisfying though the field can be, medical device development is a complex, time consuming and expensive undertaking requiring more than a fair share of good fortune. Contrary to the impression given by reality television programmes in which budding entrepreneurs pitch their ideas to successful businessmen, funding does not necessarily mean that an idea is worthy of success or destined for it, and vice versa. Equally, the acquisition of intellectual property is in many cases a pyrrhic victory. Using as an example the development of Tube Anchor, a novel device to secure intravenous crystalloid administration tubing, this paper outlines the pathway from concept to a marketed clinical device.

The antipsychotic clozapine has been shown to have superior efficacy to most other treatments for psychosis, especially where treatment-resistant schizophrenia has been diagnosed. Like all medications, clozapine has a number of well-recognised adverse effects, some of which can be fatal. Evidence also suggests that those for whom clozapine is the most suitable treatment option do not receive it because the doctor or health system views the risks as too great to prescribe. The provision of guidelines including innovative consumer and general practitioner resources regarding the ways to most safely monitor and manage people who are exposed to clozapine has the potential to increase the safe use of the product and also to provide potential prescribers with more confidence in using it. This paper outlines both the process for development and the final package produced by a large metropolitan District Health Board service in Auckland, New Zealand. This material was aimed at non-specialist prescribers as well as consumers and their family/carers and other supports.

Age-based weight estimation methods are used in the resuscitation of children deemed too sick to weigh. Some methods involve multiple formulae, which can be difficult to recall and use. This paper presents a conceptually simple finger-counting method that can be used to rapidly estimate weight based on existing age-based formulae.

The uptake of smartphones is growing exponentially around the globe.1 ,2 Their use by health consumers and healthcare professionals is increasing.1–4 Smartphone technology particularly impacts on health policy via two new challenges: (1) smartphone app stores can act as mass global media channels to augment or undermine public health efforts and (2) smartphone apps are portals to a multitude of health interventions with unprecedented proximity to health consumers. This paper discusses the issues related to smartphone apps regulations, safety, privacy and quality. Apps promoting harmful behaviours such as smoking and illicit drug use have previously been identified.5–7 In the case of ‘pro-smoking’ apps, they violated international and local public health laws in many countries, not only through promotion to adults but also by targeting children directly and indirectly.5 ,6 The major stakeholder that can play an immediate and significant role in the regulatory process are the app stores, as they are operating as business entities under, and obligated to abide by, local and international laws. Providentially, in April 2014, Apple updated its app age rating policy and introduced a new section guiding the process of publishing apps that target children (figure 1).8 In the new policy, Apple provides a table indicating how their rating relates to other media rating standards, such as the ‘Entertainment Software Rating Board’ and ‘Pan European Game Information’.8 However, unlike ratings for video games that are covered by the two previous standards, smartphone apps may include audio, video, books and software combined within one item. Therefore, assessing app content based on video game criteria is potentially problematic, especially for health-related content, as the previously mentioned standards do not also have health-specific rating criteria. Although Apple store policy has a ‘medical/treatment variable’ to its age rating criteria (figure 1 …

Over the past decade, there have been major advances in Web 2.0 and Smartphone technologies. A recent systematic review carried out in 2013 has highlighted the lack of evidence base for existing mental health applications. Zhang et al have underscored how psychiatrists could be app-developers to negate the drawbacks of the current lack of evidence base for mental health applications. The new Mental Health Wellness application has been developed by Clinicians with experiences in mood disorder, and the aim of the app is to empower individuals to better manage their mental health conditions. The paper will illustrate the key features of the smartphone application and describes how a patient could make use of the application as a bridging tool between consults.