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Mwanzia L, Baliddawa J, Biederman E, Perkins SM, Champion VL. Promoting childbirth in a rural health facility: A quasi-experimental study in western Kenya. Birth 2024; 51:319-325. [PMID: 37902183 DOI: 10.1111/birt.12788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND The high maternal and neonatal mortality rate in sub-Saharan Africa could be reduced by using navigation by means of mobile devices to increase the number of women who choose to give birth in a health center (HC) with a skilled healthcare practitioner. METHODS A quasi-experimental design was used to test a midwife-delivered navigation by means of mobile phone. A total of 208 women were randomized to two groups (intervention and control). Women in the intervention group received up to three navigation calls from midwives. Women in the control group received usual antenatal education during prenatal visits. Data were collected using semistructured questionnaires. Childbirth location was determined through medical records. RESULTS Overall, 180 (87%) women gave birth in a HC with a 3% advantage for the intervention group. A total of 86% (88/102) of the control group gave birth in a HC versus 89% (92/103) for the intervention group (Χ2 = 0.44, p-value = 0.51), with an unadjusted odds ratio of 1.33 (95% CI: 0.57, 3.09). Among those with personal phones, 91% (138/152) had a birth in a HC versus 79% (42/53) in those without a personal phone (Χ2 = 4.89, p-value = 0.03). CONCLUSIONS The results of this study indicate that it is feasible to deliver phone-based navigation to support birth in a HC; personal phone ownership may be a factor in the success of this strategy.
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Affiliation(s)
- Lydia Mwanzia
- Department of Midwifery and Gender, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Joyce Baliddawa
- Department of Behavioural Sciences and Mental Health, School of Medicine, Moi University, Eldoret, Kenya
| | - Erika Biederman
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Susan M Perkins
- Department of Biostatistics and Health Data Science, School of Medicine and Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
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2
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Qian C, Li P, Wang J, Hong X, Zhao X, Wu L, Miao Z, Du W, Feng X, Li Y, Chen P, Liu BF. Centrifugo-Pneumatic Reciprocating Flowing Coupled with a Spatial Confinement Strategy for an Ultrafast Multiplexed Immunoassay. Anal Chem 2024; 96:7145-7154. [PMID: 38656793 DOI: 10.1021/acs.analchem.4c00651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Immunoassays serve as powerful diagnostic tools for early disease screening, process monitoring, and precision treatment. However, the current methods are limited by high costs, prolonged processing times (>2 h), and operational complexities that hinder their widespread application in point-of-care testing. Here, we propose a novel centrifugo-pneumatic reciprocating flowing coupled with spatial confinement strategy, termed PRCM, for ultrafast multiplexed immunoassay of pathogens on a centrifugal microfluidic platform. Each chip consists of four replicated units; each unit allows simultaneous detection of three targets, thereby facilitating high-throughput parallel analysis of multiple targets. The PRCM platform enables sequential execution of critical steps such as solution mixing, reaction, and drainage by coordinating inherent parameters, including motor rotation speed, rotation direction, and acceleration/deceleration. By integrating centrifugal-mediated pneumatic reciprocating flow with spatial confinement strategies, we significantly reduce the duration of immune binding from 30 to 5 min, enabling completion of the entire testing process within 20 min. As proof of concept, we conducted a simultaneous comparative test on- and off-the-microfluidics using 12 negative and positive clinical samples. The outcomes yielded 100% accuracy in detecting the presence or absence of the SARS-CoV-2 virus, thus highlighting the potential of our PRCM system for multiplexed point-of-care immunoassays.
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Affiliation(s)
- Chungen Qian
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
- Shenzhen YHLO Biotech Co., Ltd., Shenzhen, Guangdong 518116, China
| | - Pengjie Li
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Jingjing Wang
- Shenzhen YHLO Biotech Co., Ltd., Shenzhen, Guangdong 518116, China
| | - Xianzhe Hong
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Xudong Zhao
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Liqiang Wu
- Shenzhen YHLO Biotech Co., Ltd., Shenzhen, Guangdong 518116, China
| | - Zeyu Miao
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Wei Du
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Xiaojun Feng
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Yiwei Li
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Peng Chen
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Bi-Feng Liu
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
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Sampson JB, Koka R, Tomobi O, Chima A, Jackson EV, Rosen M, Koroma M, Nelson-Williams H, David E, Lee B. Bridging the mismatch: observing the introduction of new anesthesia technology for a low-resource environment. Front Med (Lausanne) 2024; 11:1373593. [PMID: 38756942 PMCID: PMC11097898 DOI: 10.3389/fmed.2024.1373593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/04/2024] [Indexed: 05/18/2024] Open
Abstract
Objective The objective of this study was to examine the impact of the introduction of the Universal Anaesthesia Machine (UAM), a device designed for use in clinical environments with limited clinical perioperative resources, on the choice of general anesthesia technique and safe anesthesia practice in a tertiary-care hospital in Sierra Leone. Methods We introduced an anesthesia machine (UAM) into Connaught Hospital, Freetown, Sierra Leone. We conducted a prospective observational study of anesthesia practice and an examination of perioperative clinical parameters among surgical patients at the hospital to determine the usability of the device, its impact on anesthesia capacity, and changes in general anesthesia technique. Findings We observed a shift from the use of ketamine total intravenous anesthesia to inhalational anesthesia. This shift was most demonstrable in anesthesia care for appendectomies and surgical wound management. In 10 of 17 power outages that occurred during inhalational general anesthesia, anesthesia delivery was uninterrupted because inhalational anesthesia was being delivered with the UAM. Conclusion Anesthesia technologies tailored to overcome austere environmental conditions can support the delivery of safe anesthesia care while maintaining fidelity to recommended international anesthesia practice standards.
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Affiliation(s)
- John Burthorne Sampson
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rahul Koka
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Oluwakemi Tomobi
- Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, WV, United States
| | - Adaora Chima
- Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | | | - Michael Rosen
- Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael Koroma
- Department of Anaesthesiology, Princess Christian Maternity Hospital, Freetown, Sierra Leone
| | | | | | - Benjamin Lee
- Emory University School of Medicine, Atlanta, GA, United States
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Dako F, Omofoye TS, Scheel J. Radiologists' Role in Decolonizing Global Health. J Am Coll Radiol 2024:S1546-1440(24)00272-2. [PMID: 38461914 DOI: 10.1016/j.jacr.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/29/2023] [Accepted: 10/16/2023] [Indexed: 03/12/2024]
Abstract
The colonial origins and power imbalances between Western high-income countries and low- and middle-income countries (LMICs) are barriers to self-reliance and sustained structural improvements to health care systems. Radiologists working in global health (global radiologists) are tasked with improving the state of imaging in LMICs while mitigating the effects of colonial structures and processes. To accomplish this, we need to be aware of factors such as colonialism, neocolonialism, parachute research, and brain drain that contribute to global health inequities. Potential solutions to decolonizing global radiology include commitment to understanding local context; strengthening local capacity for technology advancement, research, and development; and policies and educational programs to combat medical brain drain from LMICs. In this article, we describe how the legacies of colonialism can interfere with improving health in LMICS, despite the best intentions, and provide a call to action for decolonizing our field with intentional approaches and equitable partnerships that emphasize investments in sustainable infrastructure, robust training of personnel, and policies that support self-reliance to match true health system strengthening with our passion for addressing health equity.
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Affiliation(s)
- Farouk Dako
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Director of the Center for Global and Population Health Research in Radiology.
| | - Toma S Omofoye
- Strategic Director of Education, Department of Breast Imaging, Department of Clinical Radiology and Radiological Sciences, Vanderbilt University Medical Center. Nashville, Tennessee. https://twitter.com/TomaOmofoyeMD
| | - John Scheel
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center. Houston, Texas; Vice Chair of Global and Planetary Health. https://twitter.com/JohnRScheel
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Seethapathi N, Jain AK, Srinivasan M. Walking speeds are lower for short distance and turning locomotion: Experiments and modeling in low-cost prosthesis users. PLoS One 2024; 19:e0295993. [PMID: 38166012 PMCID: PMC10760709 DOI: 10.1371/journal.pone.0295993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/04/2023] [Indexed: 01/04/2024] Open
Abstract
Preferred walking speed is a widely-used performance measure for people with mobility issues, but is usually measured in straight line walking for fixed distances or durations, and without explicitly accounting for turning. However, daily walking involves walking for bouts of different distances and walking with turning, with prior studies showing that short bouts with at most 10 steps could be 40% of all bouts and turning steps could be 8-50% of all steps. Here, we studied walking in a straight line for short distances (4 m to 23 m) and walking in circles (1 m to 3 m turning radii) in people with transtibial amputation or transfemoral amputation using a passive ankle-foot prosthesis (Jaipur Foot). We found that the study participants' preferred walking speeds are lower for shorter straight-line walking distances and lower for circles of smaller radii, which is analogous to earlier results in subjects without amputation. Using inverse optimization, we estimated the cost of changing speeds and turning such that the observed preferred walking speeds in our experiments minimizes the total cost of walking. The inferred costs of changing speeds and turning were larger for subjects with amputation compared to subjects without amputation in a previous study, specifically, being 4x to 8x larger for the turning cost and being highest for subjects with transfemoral amputation. Such high costs inferred by inverse optimization could potentially include non-energetic costs such as due to joint or interfacial stress or stability concerns, as inverse optimization cannot distinguish such terms from true metabolic cost. These experimental findings and models capturing the experimental trends could inform prosthesis design and rehabilitation therapy to better assist changing speeds and turning tasks. Further, measuring the preferred speed for a range of distances and radii could be a more comprehensive subject-specific measure of walking performance than commonly used straight line walking metrics.
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Affiliation(s)
- Nidhi Seethapathi
- Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH, United States of America
| | - Anil Kumar Jain
- Santokba Durlabhji Memorial Hospital, Jaipur, Rajasthan, India
| | - Manoj Srinivasan
- Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH, United States of America
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6
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Asma E, Heenan M, Banda G, Kirby RP, Mangwiro L, Acemyan CZ, Palamountain KM, Kortum P, Kawaza K, Oden ZM, Richards-Kortum R. Avoid equipment graveyards: rigorous process to improve identification and procurement of effective, affordable, and usable newborn devices in low-resource hospital settings. BMC Pediatr 2023; 23:569. [PMID: 37968578 PMCID: PMC10652423 DOI: 10.1186/s12887-023-04362-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 10/12/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Millions of newborns die annually from preventable causes, with the highest rates occurring in Africa. Reducing neonatal mortality requires investment to scale hospital care, which includes providing hospitals with appropriate technology to care for small and sick newborns. Expensive medical devices designed for high-resource settings often fail to withstand conditions in low-resource hospitals, including humidity, dust, frequent user turnover, complex maintenance, lack of stable power, or difficulty sourcing expensive consumables. Rigorous evaluation protocols are needed to identify effective, affordable, rugged, and easy-to-use medical devices appropriate for quality hospital-based newborn care in low-resource hospitals. METHODS We developed an evidence-based technology review process to identify medical devices suitable for small and sick newborn care in low-resource hospitals. The eight-step process consists of: identifying devices needed for effective newborn care; defining Target Product Profiles (TPPs); identifying commercially-available products that may meet TPPs; conducting desk research to evaluate technologies against TPPs; performing technical performance verification testing under laboratory conditions; verifying technical performance after exposure to heat, humidity, dust, and power loss; performing usability evaluations with nurses, and qualifying devices that pass all steps. Devices were purchased, installed, and monitored in newborn wards across Kenya, Malawi, Nigeria, and Tanzania. RESULTS Of 271 devices considered, only 45 (16.6%) met corresponding TPPs based on desk research. Thirty-nine were purchased and evaluated in the laboratory; five (12.8%) failed to meet TPPs. Thirty-four products passing laboratory evaluation underwent short-term environmental testing; only one (2.9%) device failed. Thirty-seven products underwent usability testing with 127 clinicians; surprisingly, 14 (37.8%) failed to meet TPPs. Twenty-three products passed all evaluations, and 2457 devices were installed across 65 newborn wards in Kenya, Malawi, Nigeria, and Tanzania. Continuous device monitoring reported minimal device failures, with failed devices typically returned to service within two days, resulting in an average uptime (service days divided by days installed) of 99%. CONCLUSION An evidence-based device selection process can improve procurement of effective, affordable, rugged, usable newborn care devices for low-resource hospitals, and feedback to manufacturers can improve device quality. Similar processes could be adapted beyond newborn care to identify medical devices suitable for implementation in any low-resource setting.
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Affiliation(s)
- Elizabeth Asma
- Rice University Rice360 Institute for Global Health Technologies, Houston, TX, USA.
| | - Megan Heenan
- Rice University Rice360 Institute for Global Health Technologies, Houston, TX, USA
| | - George Banda
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Rebecca P Kirby
- Northwestern University Kellogg School of Management, Evanston, IL, USA
| | | | | | | | - Philip Kortum
- Department of Psychological Sciences, Rice University, Houston, TX, USA
| | | | - Z Maria Oden
- Rice University Rice360 Institute for Global Health Technologies, Houston, TX, USA
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Rebecca Richards-Kortum
- Rice University Rice360 Institute for Global Health Technologies, Houston, TX, USA
- Department of Bioengineering, Rice University, Houston, TX, USA
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7
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Yeung AWK, Torkamani A, Butte AJ, Glicksberg BS, Schuller B, Rodriguez B, Ting DSW, Bates D, Schaden E, Peng H, Willschke H, van der Laak J, Car J, Rahimi K, Celi LA, Banach M, Kletecka-Pulker M, Kimberger O, Eils R, Islam SMS, Wong ST, Wong TY, Gao W, Brunak S, Atanasov AG. The promise of digital healthcare technologies. Front Public Health 2023; 11:1196596. [PMID: 37822534 PMCID: PMC10562722 DOI: 10.3389/fpubh.2023.1196596] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/04/2023] [Indexed: 10/13/2023] Open
Abstract
Digital health technologies have been in use for many years in a wide spectrum of healthcare scenarios. This narrative review outlines the current use and the future strategies and significance of digital health technologies in modern healthcare applications. It covers the current state of the scientific field (delineating major strengths, limitations, and applications) and envisions the future impact of relevant emerging key technologies. Furthermore, we attempt to provide recommendations for innovative approaches that would accelerate and benefit the research, translation and utilization of digital health technologies.
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Affiliation(s)
- Andy Wai Kan Yeung
- Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, University of Hong Kong, Hong Kong, China
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Ali Torkamani
- Department of Integrative Structural and Computational Biology, Scripps Research Translational Institute, La Jolla, CA, United States
| | - Atul J. Butte
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, United States
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Benjamin S. Glicksberg
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Björn Schuller
- Department of Computing, Imperial College London, London, United Kingdom
- Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
| | - Blanca Rodriguez
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Daniel S. W. Ting
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - David Bates
- Department of General Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Eva Schaden
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Hanchuan Peng
- Institute for Brain and Intelligence, Southeast University, Nanjing, China
| | - Harald Willschke
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Jeroen van der Laak
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Josip Car
- Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
- Centre for Population Health Sciences, LKC Medicine, Nanyang Technological University, Singapore, Singapore
| | - Kazem Rahimi
- Deep Medicine Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Leo Anthony Celi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Lodz, Poland
- Department of Cardiology and Adult Congenital Heart Diseases, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
| | - Maria Kletecka-Pulker
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute for Ethics and Law in Medicine, University of Vienna, Vienna, Austria
| | - Oliver Kimberger
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Roland Eils
- Digital Health Center, Berlin Institute of Health (BIH), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | - Stephen T. Wong
- Department of Systems Medicine and Bioengineering, Houston Methodist Cancer Center, T. T. and W. F. Chao Center for BRAIN, Houston Methodist Academic Institute, Houston Methodist Hospital, Houston, TX, United States
- Departments of Radiology, Pathology and Laboratory Medicine and Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, United States
| | - Tien Yin Wong
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Wei Gao
- Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA, United States
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Poland
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Samenjo KT, Ramanathan A, Gwer SO, Bailey RC, Otieno FO, Koksal E, Sprecher B, Price RA, Bakker C, Diehl JC. Design of a syringe extension device (Chloe SED®) for low-resource settings in sub-Saharan Africa: a circular economy approach. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1183179. [PMID: 37727273 PMCID: PMC10505716 DOI: 10.3389/fmedt.2023.1183179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/16/2023] [Indexed: 09/21/2023] Open
Abstract
Underfunded healthcare infrastructures in low-resource settings in sub-Saharan Africa have resulted in a lack of medical devices crucial to provide healthcare for all. A representative example of this scenario is medical devices to administer paracervical blocks during gynaecological procedures. Devices needed for this procedure are usually unavailable or expensive. Without these devices, providing paracervical blocks for women in need is impossible resulting in compromising the quality of care for women requiring gynaecological procedures such as loop electrosurgical excision, treatment of miscarriage, or incomplete abortion. In that perspective, interventions that can be integrated into the healthcare system in low-resource settings to provide women needing paracervical blocks remain urgent. Based on a context-specific approach while leveraging circular economy design principles, this research catalogues the development of a new medical device called Chloe SED® that can be used to support the provision of paracervical blocks. Chloe SED®, priced at US$ 1.5 per device when produced in polypropylene, US$ 10 in polyetheretherketone, and US$ 15 in aluminium, is attached to any 10-cc syringe in low-resource settings to provide paracervical blocks. The device is designed for durability, repairability, maintainability, upgradeability, and recyclability to address environmental sustainability issues in the healthcare domain. Achieving the design of Chloe SED® from a context-specific and circular economy approach revealed correlations between the material choice to manufacture the device, the device's initial cost, product durability and reuse cycle, reprocessing method and cost, and environmental impact. These correlations can be seen as interconnected conflicting or divergent trade-offs that need to be continually assessed to deliver a medical device that provides healthcare for all with limited environmental impact. The study findings are intended to be seen as efforts to make available medical devices to support women's access to reproductive health services.
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Affiliation(s)
- Karlheinz Tondo Samenjo
- Department of Sustainable Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
- Nyanza Reproductive Health Society, Kisumu, Kenya
| | - Aparna Ramanathan
- Nyanza Reproductive Health Society, Kisumu, Kenya
- Department of Obstetrics and Gynecology, National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Georgetown University, Washington, DC, United States
| | - Stephen Otieno Gwer
- Nyanza Reproductive Health Society, Kisumu, Kenya
- Department of Obstetrics and Gynaecology, Maseno University, Kisumu, Kenya
| | - Robert C. Bailey
- Nyanza Reproductive Health Society, Kisumu, Kenya
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | | | | | - Benjamin Sprecher
- Department of Sustainable Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Rebecca Anne Price
- Department of Sustainable Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Conny Bakker
- Department of Sustainable Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Jan Carel Diehl
- Department of Sustainable Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
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9
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Rodriguez NM, Burleson G, Linnes JC, Sienko KH. Thinking Beyond the Device: An Overview of Human- and Equity-Centered Approaches for Health Technology Design. Annu Rev Biomed Eng 2023; 25:257-280. [PMID: 37068765 PMCID: PMC10640794 DOI: 10.1146/annurev-bioeng-081922-024834] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
A shift in the traditional technocentric view of medical device design to a human-centered one is needed to bridge existing translational gaps and improve health equity. To ensure the successful and equitable adoption of health technology innovations, engineers must think beyond the device and the direct end user and must seek a more holistic understanding of broader stakeholder needs and the intended context of use early in a design process. The objectives of this review article are (a) to provide rationale for the need to incorporate meaningful stakeholder analysis and contextual investigation in health technology development and biomedical engineering pedagogy, (b) to review existing frameworks and human- and equity-centered approaches to stakeholder engagement and contextual investigation for improved adoption of innovative technologies, and (c) to present case studyexamples of medical device design that apply these approaches to bridge the gaps between biomedical engineers and the contexts for which they are designing.
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Affiliation(s)
- Natalia M Rodriguez
- Weldon School of Biomedical Engineering, College of Engineering, Purdue University, West Lafayette, Indiana, USA;
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Grace Burleson
- Design Science, College of Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Jacqueline C Linnes
- Weldon School of Biomedical Engineering, College of Engineering, Purdue University, West Lafayette, Indiana, USA;
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Kathleen H Sienko
- Design Science, College of Engineering, University of Michigan, Ann Arbor, Michigan, USA
- Department of Mechanical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan, USA
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10
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Chin-Yee B, Nimmon L, Veen M. Technical Difficulties: Teaching Critical Philosophical Orientations toward Technology. TEACHING AND LEARNING IN MEDICINE 2023; 35:240-249. [PMID: 36286229 DOI: 10.1080/10401334.2022.2130334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 08/09/2022] [Indexed: 06/16/2023]
Abstract
Issue: Technological innovation is accelerating, creating less time to reflect on the impact new technologies will have on the medical profession. Modern technologies are becoming increasingly embedded in routine medical practice with far-reaching impacts on the patient-physician relationship and the very essence of the health professions. These impacts are often difficult to predict and can create unintended consequences for medical education. This article is driven by a main question: How do we prepare trainees to critically assess technologies that we cannot foresee and effectively use technology to support equitable and compassionate care? Evidence: We translate insights from the philosophy of technology into a proposal for integrating critical technical consciousness in medical curricula. We identify three areas required to develop critical consciousness with regard to emerging technologies. The first area is technical literacy, which involves not just knowing how to use technology, but also understanding its limitations and appropriate contexts for use. The second area is the ability to assess the social impact of technology. This practice requires understanding that while technification creates new possibilities it can also have adverse, unintended consequences. The third area is critical reflection on the relationship between 'the human' and 'the technical' as it relates to the values of the medical profession and professional identity formation. Human and technology are two sides of the same coin; therefore, thinking critically about technology also forces us to think about what we consider 'the human side of medicine'. Implications: Critical technical consciousness can be fostered through an educational program underpinned by the recognition that, although technological innovation can create new possibilities for healing, technology is never neutral. Rather, it is imperative to emphasize that technology is interwoven with the social fabric that is essential to healing. Like medication, technology can be both potion and poison.
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Affiliation(s)
- Benjamin Chin-Yee
- Schulich School of Medicine and Rotman Institute of Philosophy, Western University, London, Ontario, Canada
| | - Laura Nimmon
- Centre for Health Education Scholarship Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mario Veen
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
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11
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Suwalowska H, Kingori P, Parker M. Navigating uncertainties of death: Minimally Invasive Autopsy Technology in global health. Glob Public Health 2023; 18:2180065. [PMID: 36853068 PMCID: PMC9988304 DOI: 10.1080/17441692.2023.2180065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Global health practitioners and policymakers have become increasingly vocal about the complex challenges of identifying and quantifying the causes of death of the world's poorest people. To address this cause-of-death uncertainty and to minimise longstanding sensitivities about full autopsies, the Bill and Melinda Gates Foundation have been one of the foremost advocates of minimally invasive autopsy technology (MIA). MIA involves using biopsy needles to collect samples from key organs and body fluids; as such, it is touted as potentially more acceptable and less invasive than a complete autopsy, which requires opening the cadaver. In addition, MIA is considered a good means of collecting accurate bodily samples and can provide the crucial information needed to address cause-of-death uncertainty. In this paper, we employ qualitative data to demonstrate that while MIA technology has been introduced as a solution to the enduring cause-of-death uncertainty, the development and deployment of technologies such as these always constitute interventions in complex social and moral worlds; in this respect, they are both the solutions to and the causes of new kinds of uncertainties. We deconstruct the ways in which those new dimensions of uncertainty operate at different levels in the global health context.
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Affiliation(s)
- Halina Suwalowska
- Ethox Centre, Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Halina Suwalowska Ethox Centre and Wellcome Centre for Ethics and Humanities Nuffield Department of Population Health, University of Oxford, Oxford | OX3 7LF, UK
| | - Patricia Kingori
- Ethox Centre, Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael Parker
- Ethox Centre, Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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12
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Worth C, Hoskyns L, Salomon-Estebanez M, Nutter PW, Harper S, Derks TG, Beardsall K, Banerjee I. Continuous glucose monitoring for children with hypoglycaemia: Evidence in 2023. Front Endocrinol (Lausanne) 2023; 14:1116864. [PMID: 36755920 PMCID: PMC9900115 DOI: 10.3389/fendo.2023.1116864] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023] Open
Abstract
In 2023, childhood hypoglycaemia remains a major public health problem and significant risk factor for consequent adverse neurodevelopment. Irrespective of the underlying cause, key elements of clinical management include the detection, prediction and prevention of episodes of hypoglycaemia. These tasks are increasingly served by Continuous Glucose Monitoring (CGM) devices that measure subcutaneous glucose at near-continuous frequency. While the use of CGM in type 1 diabetes is well established, the evidence for widespread use in rare hypoglycaemia disorders is less than convincing. However, in the few years since our last review there have been multiple developments and increased user feedback, requiring a review of clinical application. Despite advances in device technology, point accuracy of CGM remains low for children with non-diabetes hypoglycaemia. Simple provision of CGM devices has not replicated the efficacy seen in those with diabetes and is yet to show benefit. Machine learning techniques for hypoglycaemia prevention have so far failed to demonstrate sufficient prediction accuracy for real world use even in those with diabetes. Furthermore, access to CGM globally is restricted by costs kept high by the commercially-driven speed of technical innovation. Nonetheless, the ability of CGM to digitally phenotype disease groups has led to a better understanding of natural history of disease, facilitated diagnoses and informed changes in clinical management. Large CGM datasets have prompted re-evaluation of hypoglycaemia incidence and facilitated improved trial design. Importantly, an individualised approach and focus on the behavioural determinants of hypoglycaemia has led to real world reduction in hypoglycaemia. In this state of the art review, we critically analyse the updated evidence for use of CGM in non-diabetic childhood hypoglycaemia disorders since 2020 and provide suggestions for qualified use.
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Affiliation(s)
- Chris Worth
- Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, United Kingdom
- Department of Computer Science, University of Manchester, Manchester, United Kingdom
- *Correspondence: Chris Worth,
| | - Lucy Hoskyns
- Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - Maria Salomon-Estebanez
- Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - Paul W. Nutter
- Department of Computer Science, University of Manchester, Manchester, United Kingdom
| | - Simon Harper
- Department of Computer Science, University of Manchester, Manchester, United Kingdom
| | - Terry G.J Derks
- Section of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, Groningen, Netherlands
| | - Kathy Beardsall
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Indraneel Banerjee
- Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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13
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Kousha O, Ganesananthan S, Shahin B, Ellis J, Blaikie A. Comparative evaluation of a new frugal binocular indirect ophthalmoscope. Eye (Lond) 2023; 37:160-162. [PMID: 34949786 PMCID: PMC9829681 DOI: 10.1038/s41433-021-01901-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/25/2021] [Accepted: 12/09/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES We compare the optical quality and design characteristic a new low cost solar powered binocular indirect ophthalmoscope (BIO), Holo, to Keeler BIO. METHODS Twenty-four participants each examined 10 simulation eyes using both the Holo and the Keeler BIO with a 30-diopter condensing lens. Number of Lea symbols printed on the retina of simulation eyes seen and time taken to identify them was recorded. Stereoacuity of 12 participants was tested while using the BIOs. Using 7-point Likert scale, participants gave feedback on design characteristic of both BIOs. RESULTS There was no statistical difference in number of Lea symbols correctly identified (15.63/20 for Holo vs. 15/20 for Keeler BIO, p = 0.366, paired t test) or time taken to correctly identify each symbol (Holo 0.39 s faster; 95% confidence interval -2.24 to 3.03 s, p = 0.763) using each device. 12 out of 12 participants achieved stereoacuity of 60 arcsec using the Holo while with the Keeler BIO 11 achieved 60 arcsec and one 90 arcsec. There was no statistically significant difference in the scores for clarity of view, quality of illumination, field of view, binocularity, eye strain and robustness between the two devices. The Holo, scored higher for ease of use (6.5 vs. 6, p = 0.00488, Wilcoxon signed-rank test), comfort of wear (6 vs. 5, p = 0.000337) and portability (7 vs. 6, p = 0.000148). CONCLUSION The Holo has the potential to be a clinically useful yet affordable diagnostic tool suitable for the first time of equipping eye care workers in low resource settings with a BIO at volume.
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Affiliation(s)
- Obaid Kousha
- Infection & Global Health Division, School of Medicine, Medical and Biological Sciences Building, North Haugh, St Andrews, KY16 9TF UK ,grid.416266.10000 0000 9009 9462Ninewells Hospital, NHS Tayside, James Arrott Dr, Dundee, DD2 1SG UK
| | - Sharma Ganesananthan
- Infection & Global Health Division, School of Medicine, Medical and Biological Sciences Building, North Haugh, St Andrews, KY16 9TF UK
| | - Bayan Shahin
- grid.416266.10000 0000 9009 9462Ninewells Hospital, NHS Tayside, James Arrott Dr, Dundee, DD2 1SG UK
| | - John Ellis
- Infection & Global Health Division, School of Medicine, Medical and Biological Sciences Building, North Haugh, St Andrews, KY16 9TF UK
| | - Andrew Blaikie
- Infection & Global Health Division, School of Medicine, Medical and Biological Sciences Building, North Haugh, St Andrews, KY16 9TF UK ,grid.415547.60000 0004 0624 7354Queen Margaret Hospital, NHS Fife, Whitefield Road, Dunfermline, KY12 OSU UK
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14
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Cezario S, Marques T, Pinto R, Lacerda J, Silva L, Santos Lima T, Santana O, Ribeiro AG, Cruz A, Araújo AC, Miranda AE, Cadaxa A, Teixeira C, Muñoz A, Valentim R. Similarity Analysis in Understanding Online News in Response to Public Health Crisis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17049. [PMID: 36554926 PMCID: PMC9778775 DOI: 10.3390/ijerph192417049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/27/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The "Syphilis No!" campaign the Brazilian Ministry of Health (MoH) launched between November 2018 and March 2019, brought forward the concept "Test, Treat and Cure" to remind the population of the importance of syphilis prevention. In this context, this study aims to analyze the similarity of syphilis online news to comprehend how public health communication interventions influence media coverage of the syphilis issue. METHODS This paper presented a computational approach to assess the effectiveness of communication actions on a public health problem. Data were collected between January 2015 and December 2019 and processed using the Hermes ecosystem, which utilizes text mining and machine learning algorithms to cluster similar content. RESULTS Hermes identified 1049 google-indexed web pages containing the term 'syphilis' in Brazil. Of these, 619 were categorized as news stories. In total, 157 were grouped into clusters of at least two similar news items and a single cluster with 462 news classified as "single" for not featuring similar news items. From these, 19 clusters were identified in the pre-campaign period, 23 during the campaign, and 115 in the post-campaign. CONCLUSIONS The findings presented in this study show that the volume of syphilis-related news reports has increased in recent years and gained popularity after the SNP started, having been boosted during the campaign and escalating even after its completion.
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Affiliation(s)
- Sidemar Cezario
- Department of Informatics and Applied Mathematics, Federal University of Rio Grande do Norte, Natal 59078-900, Brazil
| | - Thiago Marques
- Department of Informatics and Applied Mathematics, Federal University of Rio Grande do Norte, Natal 59078-900, Brazil
| | - Rafael Pinto
- Department of Informatics and Applied Mathematics, Federal University of Rio Grande do Norte, Natal 59078-900, Brazil
- Laboratory for Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- Information Systems Coordination, Federal Institute of Rio Grande do Norte, Natal 59015-300, Brazil
| | - Juciano Lacerda
- Laboratory for Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- Department of Social Communication, Federal University of Rio Grande do Norte, Natal 59072-970, Brazil
| | - Lyrene Silva
- Department of Informatics and Applied Mathematics, Federal University of Rio Grande do Norte, Natal 59078-900, Brazil
| | - Thaisa Santos Lima
- Laboratory for Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- Federal Senate, Brasília 70165-900, Brazil
| | - Orivaldo Santana
- Laboratory for Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- School of Science and Technology, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil
| | - Anna Giselle Ribeiro
- Laboratory for Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- School of Science and Technology, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil
| | - Agnaldo Cruz
- Laboratory for Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
| | - Ana Claudia Araújo
- Laboratory for Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- Department of Social Communication, Federal University of Rio Grande do Norte, Natal 59072-970, Brazil
| | - Angélica Espinosa Miranda
- Ministry of Health, Brasília 70070-600, Brazil
- Postgraduate Program in Infectious Diseases, Federal University of Espírito Santo, Vitória 29075-910, Brazil
| | - Aedê Cadaxa
- Ministry of Health, Brasília 70070-600, Brazil
| | - César Teixeira
- Department of Informatics Engineering, Centre for Informatics and Systems of the University of Coimbra (CISUC), 3030-290 Coimbra, Portugal
| | - Almudena Muñoz
- Department of Communication Theories and Analysis, Complutense University of Madrid, 28040 Madrid, Spain
| | - Ricardo Valentim
- Laboratory for Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- Department of Biomedical Engineering, Federal University of Rio Grande do Norte, Natal 59628-330, Brazil
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15
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Chen M, Li P, Wang R, Xiang Y, Huang Z, Yu Q, He M, Liu J, Wang J, Su M, Zhang M, Jian A, Ouyang J, Zhang C, Li J, Dong M, Zeng S, Wu J, Hong P, Hou C, Zhou N, Zhang D, Zhou H, Tao G. Multifunctional Fiber-Enabled Intelligent Health Agents. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2200985. [PMID: 35820163 DOI: 10.1002/adma.202200985] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/31/2022] [Indexed: 06/15/2023]
Abstract
The application of wearable devices is promoting the development toward digitization and intelligence in the field of health. However, the current smart devices centered on human health have disadvantages such as weak perception, high interference degree, and unfriendly interaction. Here, an intelligent health agent based on multifunctional fibers, with the characteristics of autonomy, activeness, intelligence, and perceptibility enabling health services, is proposed. According to the requirements for healthcare in the medical field and daily life, four major aspects driven by intelligent agents, including health monitoring, therapy, protection, and minimally invasive surgery, are summarized from the perspectives of materials science, medicine, and computer science. The function of intelligent health agents is realized through multifunctional fibers as sensing units and artificial intelligence technology as a cognitive engine. The structure, characteristics, and performance of fibers and analysis systems and algorithms are reviewed, while discussing future challenges and opportunities in healthcare and medicine. Finally, based on the above four aspects, future scenarios related to health protection of a person's life are presented. Intelligent health agents will have the potential to accelerate the realization of precision medicine and active health.
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Affiliation(s)
- Min Chen
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- State Key Laboratory of Material Processing and Die & Mould Technology, School of Materials Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Pan Li
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Rui Wang
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Yuanzhuo Xiang
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Zhiheng Huang
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Qiao Yu
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Muyao He
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Jia Liu
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Jiaxi Wang
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Minyu Su
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Manni Zhang
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Aijia Jian
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Jingyu Ouyang
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Chenxi Zhang
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Jing Li
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Mengxue Dong
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Shaoning Zeng
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Jiawei Wu
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Ping Hong
- Beijing Sport University, Beijing, 100091, P. R. China
| | - Chong Hou
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- School of Optics and Electronic Information, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Ning Zhou
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Dingyu Zhang
- Hubei Provincial Health and Health Committee, Wuhan, Hubei, 430015, P. R. China
| | - Huamin Zhou
- State Key Laboratory of Material Processing and Die & Mould Technology, School of Materials Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
| | - Guangming Tao
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
- State Key Laboratory of Material Processing and Die & Mould Technology, School of Materials Science and Engineering, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, P. R. China
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Cancedda C, Bonds MH, Nkomazana O, Abimbola S, Binagwaho A. Sustainability in global health: a low ceiling, a star in the sky, or the mountaintop? BMJ Glob Health 2022; 7:bmjgh-2022-011132. [DOI: 10.1136/bmjgh-2022-011132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 11/30/2022] Open
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17
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Wang W, Wang Z, Gong H, Jin L, Wei F. 5G-Assisted Remote Guidance in Laparoscopic Simulation Training Based on 3D Printed Dry Lab Models. Indian J Surg 2022; 85:1-5. [PMID: 36311468 PMCID: PMC9589780 DOI: 10.1007/s12262-022-03590-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/14/2022] [Indexed: 11/29/2022] Open
Abstract
This is a pilot study to assess the utility of applying 5G-assisted remote guidance in laparoscopic simulation training. A single trainee of a junior surgeon was recruited to complete three steps of tasks including basic task 1, basic task 2, and model task, and the performance was recorded and evaluated. The operator completed each task three times. Except for basic task 1, all tasks were remotely guided by a more experienced surgeon using 5G technology. Tasks completion time and a 30-point objective structured assessment of technical skills (OSATS) score were utilized to assess the results of simulation training. All remote guidance processes were successfully completed without significant network latency. Through basic task 1, the operator quickly became familiar with the trained laparoscopic instruments. For basic task 2, OSATS scores increased from 16 to 24 points, and completion time decreased from 1500 to 986 s after training under 5G-assisted remote guidance. For model tasks, OSATS scores increased from 15 to 26 points, and completion time decreased from 1734 to 1142 s. This is a novel mode of laparoscopic simulation training to increase the convenience of training. Perhaps in the near future, surgeons can simulate difficult operations at home or in the office, and accurately grasp the possible situations that may occur in actual operations in advance. Supplementary Information The online version contains supplementary material available at 10.1007/s12262-022-03590-2.
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Affiliation(s)
- Weier Wang
- Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Zhejiang Province, Hangzhou, 310014 China
- Emergency Department Trauma Center, College of Medicine, the First Affiliated Hospital, Zhejiang University, Zhejiang Province, Hangzhou, 310003 China
| | - Zhifei Wang
- Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Zhejiang Province, Hangzhou, 310014 China
| | - Haibo Gong
- Ningbo Chuangdao 3D Medical Technology Co., Ltd., Zhejiang Province, 315336 Ningbo, China
| | - Liming Jin
- Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Zhejiang Province, Hangzhou, 310014 China
| | - Fangqiang Wei
- Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Zhejiang Province, Hangzhou, 310014 China
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18
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Samenjo KT, Bengtson M, Onasanya A, Zambrano JCI, Oladunni O, Oladepo O, van Engelen J, Diehl JC. Stakeholders’ Perspectives on the Application of New Diagnostic Devices for Urinary Schistosomiasis in Oyo State, Nigeria: A Q-Methodology Approach. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00780. [PMID: 36041843 PMCID: PMC9426976 DOI: 10.9745/ghsp-d-21-00780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/31/2022] [Indexed: 11/16/2022]
Abstract
New diagnostic devices for schistosomiasis should be designed to function best within the local endemic health care context and support stakeholders at various levels of the health care system in performing the tasks to help control and eventually eliminate schistosomiasis. Urinary schistosomiasis is a waterborne parasitic infection caused by Schistosoma haematobium that affects approximately 30 million people annually in Nigeria. Treatment and eradication of this infection require effective diagnostics. However, current diagnostic tests have critical shortcomings and consequently are of limited value to stakeholders throughout the health care system who are involved in targeting the diagnosis and subsequent control of schistosomiasis. New diagnostic devices that fit the local health care infrastructure and support the different stakeholder diagnostic strategies remain a critical need. This study focuses on understanding, by means of Q-methodology, the context of use and application of a new diagnostic device that is needed to effectively diagnose urinary schistosomiasis in Oyo State, Nigeria. Q-methodology is a technique that investigates subjectivity by exploring how stakeholders rank-order opinion statements about a phenomenon. In this study, 40 statements were administered to evaluate stakeholder perspectives on the context of use and application of potential new diagnostic devices and how these perspectives or viewpoints are shared with other stakeholders. Potential new diagnostic devices will need to be deployable to remote or distant communities, be affordable, identify and confirm infection status before treatment in patients whose diagnosis of urinary schistosomiasis is based on self-reporting, and equip health care facilities with diagnostic devices optimized for the local setting while requiring local minimal infrastructural settings. Similarly, the context of use and application of a potential new diagnostic device for urinary schistosomiasis is primarily associated with the tasks stakeholders throughout the health care system perform or procedures employed. These findings will guide the development of new diagnostic devices for schistosomiasis that match the contextual landscape and diagnostic strategies in Oyo.
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Affiliation(s)
- Karlheinz Tondo Samenjo
- Department of Sustainable Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands.
| | - Michel Bengtson
- Department of Parasitology, Leiden University Medical Center, Leiden, Netherlands
| | - Adeola Onasanya
- Department of Sustainable Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Juan Carlo Intriago Zambrano
- Department of Water Management, Faculty of Civil Engineering and Geosciences, Delft University of Technology, Delft, Netherlands
| | - Opeyemi Oladunni
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oladimeji Oladepo
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jo van Engelen
- Department of Sustainable Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Jan-Carel Diehl
- Department of Sustainable Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
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Chan SM, Laage Gaupp FM, Rockwell HD, Perez AW, Rukundo I, Keller EJ. Global Health and Interventional Radiology: Ethical Considerations. Cardiovasc Intervent Radiol 2022; 45:1881-1883. [PMID: 35918432 DOI: 10.1007/s00270-022-03236-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/20/2022] [Indexed: 11/02/2022]
Affiliation(s)
| | - Fabian M Laage Gaupp
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Helena D Rockwell
- University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
| | - Andrew W Perez
- Vascular and Interventional Radiology Division, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Ivan Rukundo
- Section of Interventional Radiology, Department of Radiology and Imaging, Rwanda Military Hospital, Kigali, Rwanda
| | - Eric J Keller
- Division of Interventional Radiology, Stanford University, Stanford, CA, 94305, USA
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20
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Hydrothermal Synthesis and Photocatalytic Activity of NiO Nanoparticles under Visible Light Illumination. BULLETIN OF CHEMICAL REACTION ENGINEERING & CATALYSIS 2022. [DOI: 10.9767/bcrec.17.2.13680.340-349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this present study, Nickel oxide (NiO) nanoparticles (NPs) have been synthesized using the hydrothermal method and characterized using powder X-ray Diffraction (XRD), UV-vis and Fourier Transform Infra Red (FTIR) spectroscopies, Scanning Electron Microscopy (SEM), and Energy-Dispersive X-ray (EDX) methods. The result of the characterization indicates that the synthesized sample has a pure cubic phase of NiO with roughly spherical shape morphologies and respective estimated crystallinity and microstrain values of about 78% and 5.1. Test of the photocatalytic activity of the synthesized sample towards the model contaminant dye methylene blue (MB) shows a degradation efficiency of 46% in a period of 2 h under nature sunlight irradiation at natural pH and that the reaction could satisfactorily describe both pseudo-first-order and pseudo-second-order kinetic models. So, this synthesis method may potentially be used for the effective elimination of toxic organic pollutants from water and wastewater over prolonged exposure under natural sunlight without adding any oxidant or adjusting the pH of the reaction medium. Copyright © 2022 by Authors, Published by BCREC Group. This is an open access article under the CC BY-SA License (https://creativecommons.org/licenses/by-sa/4.0).
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21
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Sanders EC, Sen SR, Gelston AA, Santos AM, Luo X, Bhuvan K, Tang DY, Raston CL, Weiss GA. Under-5-Minute Immunoblot Assays by Vortex Fluidic Device Acceleration. Angew Chem Int Ed Engl 2022; 61:e202202021. [PMID: 35333430 PMCID: PMC9156566 DOI: 10.1002/anie.202202021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Indexed: 11/09/2022]
Abstract
Unlocking the potential of personalized medicine in point-of-care settings requires a new generation of biomarker and proteomic assays. Ideally, assays could inexpensively perform hundreds of quantitative protein measurements in parallel at the bedsides of patients. This goal greatly exceeds current capabilities. Furthermore, biomarker assays are often challenging to translate from benchtop to clinic due to difficulties achieving and assessing the necessary selectivity, sensitivity, and reproducibility. To address these challenges, we developed an efficient (<5 min), robust (comparatively lower CVs), and inexpensive (decreasing reagent use and cost by >70 %) immunoassay method. Specifically, the immunoblot membrane is dotted with the sample and then developed in a vortex fluidic device (VFD) reactor. All assay steps-blocking, binding, and washing-leverage the unique thin-film microfluidics of the VFD. The approach can accelerate direct, indirect, and sandwich immunoblot assays. The applications demonstrated include assays relevant to both the laboratory and the clinic.
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Affiliation(s)
- Emily C. Sanders
- Departments of Chemistry, Molecular Biology and Biochemistry, and Pharmaceutical Sciences, University of California, Irvine, Irvine, CA 92697-2025 (USA)
| | - Sanjana R. Sen
- Departments of Chemistry, Molecular Biology and Biochemistry, and Pharmaceutical Sciences, University of California, Irvine, Irvine, CA 92697-2025 (USA)
| | - Aidan A. Gelston
- Departments of Chemistry, Molecular Biology and Biochemistry, and Pharmaceutical Sciences, University of California, Irvine, Irvine, CA 92697-2025 (USA)
| | - Alicia M. Santos
- Departments of Chemistry, Molecular Biology and Biochemistry, and Pharmaceutical Sciences, University of California, Irvine, Irvine, CA 92697-2025 (USA)
| | - Xuan Luo
- Flinders Institute for Nanoscale Sciences and Technology, Flinders University, Adelaide, SA 5042 (AU)
| | - Keertna Bhuvan
- Departments of Chemistry, Molecular Biology and Biochemistry, and Pharmaceutical Sciences, University of California, Irvine, Irvine, CA 92697-2025 (USA)
| | - Derek Y. Tang
- Departments of Chemistry, Molecular Biology and Biochemistry, and Pharmaceutical Sciences, University of California, Irvine, Irvine, CA 92697-2025 (USA)
| | - Colin L. Raston
- Flinders Institute for Nanoscale Sciences and Technology, Flinders University, Adelaide, SA 5042 (AU)
| | - Gregory A. Weiss
- Departments of Chemistry, Molecular Biology and Biochemistry, and Pharmaceutical Sciences, University of California, Irvine, Irvine, CA 92697-2025 (USA)
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22
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Mehta G, Cornell SE, Krief A, Hopf H, Matlin SA. A shared future: chemistry's engagement is essential for resilience of people and planet. ROYAL SOCIETY OPEN SCIENCE 2022; 9:212004. [PMID: 35601450 PMCID: PMC9039782 DOI: 10.1098/rsos.212004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/14/2022] [Indexed: 05/03/2023]
Abstract
Strengthening resilience-elasticity or adaptive capacity-is essential in responding to the wide range of natural hazards and anthropogenic changes humanity faces. Chemistry's roles in resilience are explored for the first time, with its technical capacities set in the wider contexts of cross-disciplinary working and the intersecting worlds of science, society and policy. The roles are framed by chemistry's contributions to the sustainability of people and planet, examined via the human security framework's four material aspects of food, health, economic and environmental security. As the science of transformation of matter, chemistry is deeply involved in these material aspects and in their interfacing with human security's three societal and governance aspects of personal, community and political security. Ultimately, strengthening resilience requires making choices about the present use of resources as a hedge against future hazards and adverse events, with these choices being co-determined by technical capacities and social and political will. It is argued that, to intensify its contributions to resilience, chemistry needs to take action along at least three major lines: (i) taking an integrative approach to the field of 'chemistry and resilience'; (ii) rethinking how the chemical industry operates; and (iii) engaging more with society and policy-makers.
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Affiliation(s)
- Goverdhan Mehta
- School of Chemistry, University of Hyderabad, Gachibowli, Hyderabad, Telangana 500046, India
- International Organization for Chemical Sciences in Development, 61 rue de Bruxelles, 5000 Namur, Belgium
| | - Sarah E. Cornell
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, 10691 Stockholm, Sweden
| | - Alain Krief
- International Organization for Chemical Sciences in Development, 61 rue de Bruxelles, 5000 Namur, Belgium
- Department of Chemistry, University of Namur, 61 rue de Bruxelles, 5000 Namur, Belgium
| | - Henning Hopf
- International Organization for Chemical Sciences in Development, 61 rue de Bruxelles, 5000 Namur, Belgium
- Institute of Organic Chemistry, Technical University of Braunschweig, Hagenring 30, 38106 Braunschweig, Germany
| | - Stephen A. Matlin
- International Organization for Chemical Sciences in Development, 61 rue de Bruxelles, 5000 Namur, Belgium
- Institute of Global Health Innovation, Imperial College London, South Kensington, London SW7 2AZ, UK
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Weiss GA, Sanders EC, Sen SR, Gelston AA, Santos AM, Luo X, Bhuvan K, Tang DY, Raston CL. Under‐5‐Minute Immunoblot Assays by Vortex Fluidic Device Acceleration. Angew Chem Int Ed Engl 2022. [DOI: 10.1002/ange.202202021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Gregory Alan Weiss
- University of California, Irvine Department of Chemistry 1102 Natural Sciences 2 92697-2025 Irvine UNITED STATES
| | | | - Sanjana R. Sen
- University of California Irvine Molecular Biology and Biochemistry UNITED STATES
| | | | | | - Xuan Luo
- Flinders University aFlinders Institute for Nanoscale Science and Technology AUSTRALIA
| | | | - Derek Y. Tang
- University of California Irvine Chemistry UNITED STATES
| | - Colin L. Raston
- Flinders University aFlinders Institute for Nanoscale Science and Technology UNITED STATES
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Thapa R, Yih A, Chauhan A, Poudel S, Singh S, Shrestha S, Tamang S, Shrestha R, Rajbhandari R. Effect of deploying biomedical equipment technician on the functionality of medical equipment in the government hospitals of rural Nepal. HUMAN RESOURCES FOR HEALTH 2022; 20:21. [PMID: 35246155 PMCID: PMC8895523 DOI: 10.1186/s12960-022-00719-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/15/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medical equipment plays a crucial role in the provision of quality healthcare services, despite this more than 50% of equipment in developing countries are non-functioning due to a lack of appropriate human resources to maintain. To address this problem some government hospitals of Nepal have deployed a mid-level technical cadre called 'Biomedical Equipment Technician' (BMET). This study aims to evaluate the effectiveness of deploying a BMET on the functionality of medical equipment in government hospitals of rural Nepal. METHODS We used a mixed-methods approach with a comparative research design. A comprehensive range of 2189 pieces of medical equipment at 22 hospitals with and without BMET were observed to assess their functional status. Medical equipment were stratified into 6 categories based on department and T tests were conducted. We collected qualitative data from 9 BMETs, 22 medical superintendents, and 22 health staff using semi-structured interviews and focus-group discussions. Thematic content analysis was conducted to explore how the BMET's work was perceived. FINDINGS The quantity of non-functional devices in hospitals without BMETs was double that of hospitals with BMETs (14% and 7% respectively, p < 0.005). Results were similar across all departments including General (16% versus 3%, p = 0.056), Lab (15% versus 7%, p < 0.005) and Operation Theater (14% versus 5%, p < 0.005). Hospitals with BMETs had fewer overall non-functional devices requiring simple or advanced repair compared to hospitals without BMETs [3% versus 7% (p < 0.005) simple; 4% versus 6% (p < 0.005) advanced]. In our qualitative analysis, we found that BMETs were highly appreciated by hospital staff. Hospital workers perceived that having a BMET on staff, rather than twice-yearly visits from central-level maintenance technicians, is an effective way to keep medical equipment functional. However, without a favorable working environment, the BMET alone cannot perform optimally. CONCLUSIONS Having a BMET at a rural government hospital has a substantial positive effect on the functional status of medical devices at the hospital. BMETs should be deployed at all rural hospitals to increase the functionality of medical devices, thereby improving the working environment and quality of health services provided.
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Affiliation(s)
- Rita Thapa
- Nick Simons Institute, EPC 1813 Sanepa, Box 8975, Lalitpur, Nepal.
| | - Alison Yih
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Ashish Chauhan
- Nick Simons Institute, EPC 1813 Sanepa, Box 8975, Lalitpur, Nepal
| | - Salomi Poudel
- Nick Simons Institute, EPC 1813 Sanepa, Box 8975, Lalitpur, Nepal
| | - Sagar Singh
- Nick Simons Institute, EPC 1813 Sanepa, Box 8975, Lalitpur, Nepal
| | - Suresh Shrestha
- Nick Simons Institute, EPC 1813 Sanepa, Box 8975, Lalitpur, Nepal
| | - Suresh Tamang
- Nick Simons Institute, EPC 1813 Sanepa, Box 8975, Lalitpur, Nepal
| | - Rishav Shrestha
- Nick Simons Institute, EPC 1813 Sanepa, Box 8975, Lalitpur, Nepal
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Zackery A, Zolfagharzadeh MM, Hamidi M. Policy Implications of the Concept of Technological Catch-Up for the Management of Healthcare Sector in Developing Countries. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221076964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The concept of technological catch-up can be used as a theoretical platform to design policies for the management of the healthcare sector in developing countries. In this article, initially, the factors affecting a technological catch-up process were collected through a conceptual literature review and prioritised using a fuzzy Delphi survey. The interdependences among important contributory factors were investigated as well. They were then used to create some policy recommendations for the management of the healthcare sector in developing countries through an interdisciplinary integration of the literature of technological catch-up and healthcare. Some exemplary projects/initiatives using these policies were collected too. The quality of human resources, a comprehensive knowledge management system, interactive learning and innovation-encouraging culture were rated as the most important contributing factors to an effectual technological catch-up in the healthcare sector in developing countries. Also, the creation of distributed health social networks, development of systematic knowledge management systems, forming strategic partnerships and designing path-creating technological catch-up processes by focusing on indigenous innovation were the final policy recommendations. All in all, the healthcare sector in developing countries should stop chasing frontiers, should try taking detours and flying a balloon by adopting a strategy of differentiation.
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Affiliation(s)
- Ali Zackery
- Department of Industrial Engineering and Futures Studies, Faculty of Engineering, University of Isfahan, Isfahan, Iran
| | | | - Mahdi Hamidi
- Faculty of Management and Accounting, Allame Tabataba’I University, Tehran, Iran
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Webb MM, Bridges P, Aruparayil N, Chugh C, Beacon T, Singh T, Sawhney SS, Bains L, Hall R, Jayne D, Gnanaraj J, Mishra A, Culmer PR. The RAIS Device for Global Surgery: Using a Participatory Design Approach to Navigate the Translational Pathway to Clinical Use. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2022; 10:3700212. [PMID: 35865752 PMCID: PMC9292337 DOI: 10.1109/jtehm.2022.3177313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 11/19/2022]
Abstract
Background: Over 5 billion people worldwide have no access to surgery worldwide, typically in low-resource settings, despite it being a primary life-saving treatment. Gas Insufflation-Less Laparoscopic Surgery (GILLS) can address this inequity, by improving current GILLS instrumentation to modern surgical standards. Objective: to develop and translate a new Retractor for Abdominal Insufflation-less Surgery (RAIS) into clinical use and thus provide a context-appropriate system to advance GILLS surgery. Methods: A collaborative multidisciplinary team from the UK and India was formed, embedding local clinical stakeholders and an industry partner in defining user and contextual needs. System development was based on a phased roadmap for ‘surgical device design in low resource settings’ and embedded participatory and frugal design principles in an iterative process supported by traditional medical device design methodologies. Each phase of development was evaluated by the stakeholder team through interactive workshops using cadaveric surgical simulations. A Commercialisation phase undertook Design to Manufacture and regulatory approval activities. Clinical validation was then conducted with rural surgeons performing GILLS procedures using the RAIS system. Semi-structured questionnaires and interviews were used to evaluate device performance. Results: A set of user needs and contextual requirements were defined and formalised. System development occurred across five iterations. Stakeholder participation was instrumental in converging on a design which met user requirements. A commercial RAIS system was then produced by an industry partner under Indian regulatory approval. This was successfully used in clinical validation to conduct 12 surgical procedures at two locations in rural India. Surgical feedback showed that the RAIS system provided a valuable and usable surgical instrument which was appropriate for use in low-resource contexts. Conclusions: Using a context-specific development approach with close engagement of stakeholders was crucial to develop the RAIS system for low-resource regions. The outcome is translation from global health need into a fully realized commercial instrument which can be used by surgeons in low-resource regions across India.
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Affiliation(s)
- M. Marriott Webb
- School of Mechanical Engineering, University of Leeds, Leeds, U.K
| | | | - N. Aruparayil
- Leeds Institute of Medical Research, University of Leeds, Leeds, U.K
| | - C. Chugh
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - T. Beacon
- Medical Aid International, Bedford, U.K
| | - T. Singh
- XLO Ortho Life Systems, New Delhi, India
| | | | - L. Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - R. Hall
- Pd-m International, Thirsk, U.K
| | - D. Jayne
- Department of Academic Surgery, University of Leeds, Leeds, U.K
| | - J. Gnanaraj
- Department of Electronics and Instrumentation Engineering, Karunya University, Coimbatore, India
| | - A. Mishra
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - P. R. Culmer
- School of Mechanical Engineering, University of Leeds, Leeds, U.K
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Chang F, Kuoppamäki S, Östlund B. Technology scripts in care practice: A case study of assistant nurses’ use of a social alarm system in Swedish nursing homes. Digit Health 2022; 8:20552076221089077. [PMID: 35355808 PMCID: PMC8958713 DOI: 10.1177/20552076221089077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background Technologies such as social alarm systems contain expectations about how they should be integrated and used in practice. These expectations, also called technology scripts, usually fail to consider all the complexity in care practice. Shifting the focus from technology scripts to care practice, this paper examines how a social alarm system is used in assistant nurses’ care practices in nursing homes. Methods The paper draws on observations of assistant nurses’ daily tasks (32 h) and semi-structured interviews with assistant nurses ( n = 12) in two Swedish nursing homes. The observation data were used to understand the care contexts and assistant nurses’ technology-mediated care practices, while interviews were used to deeply understand assistant nurses’ perceptions of the system, their care practices, and which aspects they considered during the provision of care. Findings We show the complexities involved in integrating a social alarm system into care practices based on assistant nurses’ situational and personal interpretations of both technology scripts and quality of care. The technology-mediated care practices consist of receiving alarms from residents, checking alarms via alarm phones, responding to alarms via alarm phones, checking specific residents’ situations in person, documenting all finished alarms, and documenting some finished alarms. In these practices, the assistant nurses defined technology scripts according to their expected requirements and outcomes, and meanwhile considered the quality of care by evaluating the priority of practical, moral or relational care in the situations at hand. Through further negotiations with the defined scripts and the considered quality of care, the assistant nurses decided on the final way of following (or not following) specific scripts in practice. Conclusion Results from our study portray the complexity of technology in care practices. The findings contribute to increased understanding of technology-mediated care practices in nursing homes, and research on technology scripts in institutional settings.
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Affiliation(s)
- Fangyuan Chang
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Sanna Kuoppamäki
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Britt Östlund
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
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Bandyopadhyay S. In Reply to the Letter to the Editor Regarding "Traumatic Brain Injury-Related Pediatric Mortality and Morbidity in Low- and Middle-Income Countries: A Systematic Review". World Neurosurg 2021; 157:256. [PMID: 34929777 DOI: 10.1016/j.wneu.2021.10.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Soham Bandyopadhyay
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK.
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29
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Iwaloye O, Elekofehinti OO, Kikiowo B, Fadipe TM, Akinjiyan MO, Ariyo EO, Aiyeku OO, Adewumi NA. Discovery of Traditional Chinese Medicine Derived Compounds as Wild Type and Mutant Plasmodium falciparum Dihydrofolate Reductase Inhibitors: Induced Fit Docking and ADME Studies. Curr Drug Discov Technol 2021; 18:554-569. [PMID: 32729419 DOI: 10.2174/1570163817999200729122753] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND In a bid to come up with effective compounds as inhibitors for antimalarial treatment, we built a library of 2,000 traditional Chinese medicine(TCM)-derived compounds retrieved from TCM Database@Taiwan. METHODS The active sites of both the wild type and mutant Plasmodium falciparum dihydrofolatereductase (pfDHFR) were explored using computational tools. pfDHFR, one of the prime drug targets in the prevention of malaria infection induced by the female anopheles mosquito has continued to offer resistance to drugs (antifolates) due to mutation in some of the key amino acid residues crucial for its inhibition. RESULTS We utilized virtual throughput screening and glide XP docking to screen the compounds, and 8 compounds were found to have promising docking scores with both the wild type and mutant pfDHFR. They were further subjected to Induce Fit Docking (IFD) to affirm their inhibitory potency. The ADME properties and biological activity spectrum of the compounds were also considered. The inhibition profile of the compounds revealed that a number of compounds formed intermolecular interactions with ASP54, ILE14, LEU164, SER108/ASN108, ARG122 and ASP58. Most of the compounds can be considered as drug candidates due to their antiprotozoal activities and accordance with the Lipinski's Rule of Five (ROF). CONCLUSION The outcome of the present study should further be investigated to attest the efficacy of these compounds as better drug candidates than the antifolates.
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Affiliation(s)
- Opeyemi Iwaloye
- Department of Biochemistry, Bioinformatics and Molecular Biology Unit, Federal University of Technology Akure, Ondo State, Nigeria
| | - Olusola Olalekan Elekofehinti
- Department of Biochemistry, Bioinformatics and Molecular Biology Unit, Federal University of Technology Akure, Ondo State, Nigeria
| | - Babatomiwa Kikiowo
- Department of Biochemistry, Adekunle Ajasin University, Akungba Akoko, Ondo State, Nigeria
| | - Toyin Mary Fadipe
- Department of Bioscience, International Institute of Agriculture, Ibadan, Oyo State, Nigeria
| | - Moses Orimoloye Akinjiyan
- Department of Biochemistry, Bioinformatics and Molecular Biology Unit, Federal University of Technology Akure, Ondo State, Nigeria
| | - Esther Opeyemi Ariyo
- Department of Biochemistry, Bioinformatics and Molecular Biology Unit, Federal University of Technology Akure, Ondo State, Nigeria
| | - Olabisi Olapade Aiyeku
- Department of Biochemistry, Bioinformatics and Molecular Biology Unit, Federal University of Technology Akure, Ondo State, Nigeria
| | - Nicholas Adeyemi Adewumi
- Department of Biochemistry, Bioinformatics and Molecular Biology Unit, Federal University of Technology Akure, Ondo State, Nigeria
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30
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Critical elements in the design, development and use of medical devices. A systemic perspective of orthopedic devices landscape in low- and middle-income countries. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.100593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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31
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Fleming KA, Horton S, Wilson ML, Atun R, DeStigter K, Flanigan J, Sayed S, Adam P, Aguilar B, Andronikou S, Boehme C, Cherniak W, Cheung AN, Dahn B, Donoso-Bach L, Douglas T, Garcia P, Hussain S, Iyer HS, Kohli M, Labrique AB, Looi LM, Meara JG, Nkengasong J, Pai M, Pool KL, Ramaiya K, Schroeder L, Shah D, Sullivan R, Tan BS, Walia K. The Lancet Commission on diagnostics: transforming access to diagnostics. Lancet 2021; 398:1997-2050. [PMID: 34626542 PMCID: PMC8494468 DOI: 10.1016/s0140-6736(21)00673-5] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/26/2021] [Accepted: 03/12/2021] [Indexed: 12/30/2022]
Affiliation(s)
| | - Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
| | | | - Rifat Atun
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | | | | | - Bertha Aguilar
- Médicos e Investigadores de la Lucha Contra el Cáncer de Mama, Mexico City, Mexico
| | - Savvas Andronikou
- Perelman School of Medicine, University of Pennsylvania Philadelphia, Philadelphia, PA, USA
| | | | - William Cherniak
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Annie Ny Cheung
- The University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Lluis Donoso-Bach
- Department of Medical Imaging, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | | | - Sarwat Hussain
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Hari S Iyer
- Dana Farber Cancer Institute, Boston, MA, USA
| | - Mikashmi Kohli
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Alain B Labrique
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - John Nkengasong
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Madhukar Pai
- School of Population and Global Health, McGill University, Montreal, QC, Canada
| | | | | | - Lee Schroeder
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Devanshi Shah
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Kamini Walia
- Indian Council of Medical Research, Delhi, India
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Waran V, Thillainathan R, Karuppiah R, Pickard JD. Equitable Access to State-of-the-Art Medical Technology-a Malaysian Mini-Public-Private Partnership Case Study. World Neurosurg 2021; 157:135-142. [PMID: 34687934 DOI: 10.1016/j.wneu.2021.10.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The provision of equitable and affordable health care has become increasingly challenging as advanced technology is introduced, particularly in developing countries. We explored the hypothesis that focused, small-scale mini-public-private partnerships have a potential role in providing equitable and affordable access to advanced technology for the benefit of all patients in developing nations, particularly middle-income countries. METHODS A clinician-led financial plan was developed at the University of Malaya to create the Centre for Image Guidance and Minimally Invasive Therapy (CIGMIT) to provide an integrated platform for high-end care for Malaysian patients of all ages, both public and private, requiring complex neurosurgical and spinal procedures and stereotactic and intensity-modulated radiotherapy. The challenges faced during development of the plan were documented together with an audit of patient throughput and analyses of financial risk and return. RESULTS CIGMIT opened in 2015. Patient throughput, both public and private, progressively increased in all facilities. In 2015-2019, 37,724 patients used the Centre's facilities. CIGMIT has become progressively more profitable for the University of Malaya, the public and private hospitals, and the investor. CIGMIT has weathered the challenges posed by coronavirus disease 19. CONCLUSIONS Focused, small-scale mini-public-private partnerships have a potential role in providing advanced technology for the benefit of patients in developing nations, particularly middle-income countries, subject to an approach that balances equity of access between public and private health care systems with fair reward.
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Affiliation(s)
- Vicknes Waran
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | | | - Ravindran Karuppiah
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - John D Pickard
- Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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Baugh JN, Gielen GH, van Vuurden DG, Veldhuijzen van Zanten SEM, Hargrave D, Massimino M, Biassoni V, Morales la Madrid A, Karremann M, Wiese M, Thomale U, Janssens GO, von Bueren AO, Perwein T, Hoving EW, Pietsch T, Andreiuolo F, Kramm CM. Transitioning to molecular diagnostics in pediatric high-grade glioma: experiences with the 2016 WHO classification of CNS tumors. Neurooncol Adv 2021; 3:vdab113. [PMID: 34595479 PMCID: PMC8478775 DOI: 10.1093/noajnl/vdab113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Pediatric neuro-oncology was profoundly changed in the wake of the 2016 revision of the WHO Classification of Tumors of the Central Nervous System. Practitioners were challenged to quickly adapt to a system of tumor classification redefined by molecular diagnostics. Methods We designed a 22-question survey studying the impact of the revised WHO classification on pediatric high-grade glioma. The survey collected basic demographics, general attitudes, issues encountered, and opinions on pediatric subtypes. Participant answers were analyzed along socioeconomic lines utilizing the human development index (HDI) of the United Nations and membership in the group of seven (G7) world economic forum. Results Four hundred and sixty-five participants from 53 countries were included, 187 pediatric neurooncologists (40%), 160 neuropathologists (34%), and 118 other experts (26%). When asked about pediatric high-grade glioma entities, participants from very high development countries preferred treating a patient based on genetic findings. Participants from high and medium development countries indicated using traditional histology and tumor location as mainstays for therapeutic decisions. Non-G7 countries tended to regard the introduction of molecularly characterized tumor entities as a problem for daily routine due to lack of resources. Conclusions Our findings demonstrate an overall greater reliance and favorability to molecular diagnostics among very high development countries. A disparity in resources and access to molecular diagnostics has left some centers unable to classify pediatric high-grade glioma per the WHO classification. The forthcoming edition should strain to abate disparities in molecular diagnostic availability and work toward universal adaptation.
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Affiliation(s)
- Joshua N Baugh
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Gerrit H Gielen
- Institute of Neuropathology, Medical Center Bonn, Bonn, Germany
| | | | | | - Darren Hargrave
- Great Ormond Street Hospital for Children NHS Trust London, London, UK
| | - Maura Massimino
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
| | - Andres Morales la Madrid
- Pediatric Neuro-Oncology, Department of Pediatric Oncology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Michael Karremann
- Department of Pediatric and Adolescent Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Maria Wiese
- Division of Pediatric Hematology and Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Ulrich Thomale
- Pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - André O von Bueren
- Division of Pediatric Oncology and Hematology, Department of Women, Child and Adolescent, University Hospital of Geneva, Geneva, Switzerland.,CANSEARCH research platform in Pediatric Oncology and Hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland
| | - Thomas Perwein
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Eelco W Hoving
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Torsten Pietsch
- Institute of Neuropathology, Medical Center Bonn, Bonn, Germany
| | - Felipe Andreiuolo
- Institute of Neuropathology, Medical Center Bonn, Bonn, Germany.,Instituto Estadual Do Cérebro Paulo Niemeyer and the IDOR Institute, Rio de Janeiro, Brazil
| | - Christof M Kramm
- Division of Pediatric Hematology and Oncology, University Medical Center Goettingen, Goettingen, Germany
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Crump L, Maidane Y, Mauti S, Tschopp R, Ali SM, Abtidon R, Bourhy H, Keita Z, Doumbia S, Traore A, Bonfoh B, Tetchi M, Tiembré I, Kallo V, Paithankar V, Zinsstag J. From reverse innovation to global innovation in animal health: A review. Heliyon 2021; 7:e08044. [PMID: 34622053 PMCID: PMC8479615 DOI: 10.1016/j.heliyon.2021.e08044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 11/02/2022] Open
Abstract
Reverse innovation refers to learning from or diffusion of innovations developed in low income settings and further translated to industrialized countries. There is lack of consensus regarding terminology, but the idea that innovations in low-income countries are promising for adoption in high-income contexts is not new. However, in healthcare literature globally, the vast majority of publications referring to 'disruptive innovation' were published in the last ten years. To assess the potential of innovative developments and technologies for improving animal health, we initiated a literature review in 2020. We used a combined approach, incorporating targeted searching in PubMed using a key word algorithm with a snowball technique, to identify 120 relevant publications and extract data for qualitative coding. Heterogeneity of articles precluded meta-analysis, quality scoring and risk of bias analysis. We can distinguish technical innovations like new digital devices, diagnostic tests and procedures, and social innovations of intersectoral cooperation. We profile two case studies to describe potential global innovations: an integrated surveillance and response system in Somali Regional State, Ethiopia and a blockchain secured One Health intervention to optimally provide post-exposure prophylaxis for rabies exposed people in West Africa. Innovation follows no borders and can also occur in low-income settings, under constraints of cost, lack of services and infrastructure. Lower administrative and legal barriers may contribute to produce innovations that would not be possible under conditions of high density of regulation. We recommend using the term global innovation, which highlights those emanating from international partnership to solve problems of global implications.
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Affiliation(s)
- Lisa Crump
- Swiss Tropical and Public Health Institute, PO Box, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Yahya Maidane
- Swiss Tropical and Public Health Institute, PO Box, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003, Basel, Switzerland
- Jigjiga University, Jigjiga, Ethiopia
| | - Stephanie Mauti
- Swiss Tropical and Public Health Institute, PO Box, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Rea Tschopp
- Swiss Tropical and Public Health Institute, PO Box, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003, Basel, Switzerland
- Armauer Hansen Research Institute, PO Box 1005, Addis Ababa, Ethiopia
| | - Seid Mohammed Ali
- Swiss Tropical and Public Health Institute, PO Box, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003, Basel, Switzerland
- Jigjiga University, Jigjiga, Ethiopia
| | - Rahma Abtidon
- Swiss Tropical and Public Health Institute, PO Box, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003, Basel, Switzerland
- Jigjiga University, Jigjiga, Ethiopia
| | - Hervé Bourhy
- Institut Pasteur, 25-28 Rue du Dr Roux, 75015, Paris, France
| | - Zakaria Keita
- Université des Sciences, des Techniques et des Technologies de Bamako, BP, 1805, Bamako, Mali
| | - Seydou Doumbia
- Université des Sciences, des Techniques et des Technologies de Bamako, BP, 1805, Bamako, Mali
| | | | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, 01 BP, 1303, Abidjan, Cote d'Ivoire
| | - Mathilde Tetchi
- Institut National d'Hygiène Publique, 23 BP, 3838, Abidjan, Cote d'Ivoire
| | - Issaka Tiembré
- Institut National d'Hygiène Publique, 23 BP, 3838, Abidjan, Cote d'Ivoire
| | - Vessaly Kallo
- Ministère de Resources Animales et Halieutiques, Abidjan, Cote d'Ivoire
| | - Vega Paithankar
- Health Information Traceability Stiftung, Gotthardstrasse 26, Zug, Switzerland
| | - Jakob Zinsstag
- Swiss Tropical and Public Health Institute, PO Box, 4002, Basel, Switzerland
- University of Basel, Petersplatz 1, 4003, Basel, Switzerland
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Lin X, Lu L, Pan J. Hospital market competition and health technology diffusion: An empirical study of laparoscopic appendectomy in China. Soc Sci Med 2021; 286:114316. [PMID: 34416527 DOI: 10.1016/j.socscimed.2021.114316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/07/2021] [Accepted: 08/13/2021] [Indexed: 12/16/2022]
Abstract
The evidence about the role of hospital market competition on health technology diffusion in developing countries is scarce. In this study, we examined the association between hospital market competition and the diffusion of health technologies in China's healthcare system. Laparoscopic appendectomy, a minimally invasive surgery for patients with acute appendicitis, was selected as a representative of cost-effective health technology. The inpatient discharge dataset linked to the annually hospital administrative data and to the demographic and socioeconomic data were used. A total of 261,922 patients who were diagnosed with acute appendicitis and had received either open appendectomy or laparoscopic appendectomy at 820 hospitals in Sichuan, China between 2017 and 2019 were included in our analyses. Our outcome measure was the use of laparoscopic appendectomy during hospitalization. We accounted for the endogeneity of hospital competition measures using the Herfindahl-Hirschman Index calculated by predicted patient flows. Controlling for the observable patient, hospital and region characteristics, multivariate logistic regression was performed to model the association between hospital competition and the diffusion of laparoscopic appendectomy. The rapid diffusion of laparoscopic appendectomy over the study period and the substantial variation in use across regions and hospitals were observed. The regression results showed that laparoscopic appendectomy diffused faster in the markets where hospitals faced more competition. Our findings suggest that the diffusion of laparoscopic appendectomy is not only driven by medical factors but also nonmedical factors like hospital market competition. Our study provides new evidence on the association between market structure and technology diffusion in China's hospital market and offers the implications of appropriate technologies diffusion in health for policymakers.
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Affiliation(s)
- Xiaojun Lin
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, China.
| | - Liyong Lu
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, China.
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, China.
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Balfour K, McCarthy A, Hey SY, Kousha O, Singano E, Mulwafu W, Walker DFDL, Blaikie A. Comparative evaluation of a low-cost solar powered otoscope with a traditional device among health care workers in Malawi. Laryngoscope Investig Otolaryngol 2021; 6:839-843. [PMID: 34401510 PMCID: PMC8356856 DOI: 10.1002/lio2.601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/29/2021] [Accepted: 05/28/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To comparatively evaluate a low-cost otoscope with a traditional device among health care workers in Malawi. METHODS The study is a prospective, comparative, qualitative observational survey of health care worker's opinions using 5-point Likert rating scales and tick box categories in a 10-item survey questionnaire. Twenty-five mixed cadre health care workers from the Ear, Nose, and Throat Department of the Queen Elizabeth Hospital, Blantyre in Malawi were recruited. Outcomes measures used were ease of speculum attachment, handling, insertion, stability, the quality of view, color, build, brightness, overall ease of use, and their suitability for local work. RESULTS The low-cost otoscope scored statistically higher in overall combined performance, as well as in the remaining four out of the nine attributes. Notably, 54.2% of users rated the low-cost device more suitable than the traditional device for use in low-middle income countries, 25% were equivocal, and 20.8% preferred the traditional device. CONCLUSION This study found the Arclight otoscope to be an appropriate and practical substitute for more expensive traditional otoscopes for the delivery of ENT services in low resource settings. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
| | - Amy McCarthy
- School of MedicineUniversity of St AndrewsSt AndrewsUK
| | - Shi Ying Hey
- Department of OtolaryngologyNHS LothianEdinburghUK
| | - Obaid Kousha
- School of MedicineUniversity of St AndrewsSt AndrewsUK
| | - Emmanuel Singano
- Department of OtolaryngologyQueen Elizabeth Central HospitalBlantyreMalawi
| | - Wakisa Mulwafu
- Department of OtolaryngologyQueen Elizabeth Central HospitalBlantyreMalawi
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Sabet Sarvestani A, Coulentianos M, Sienko KH. Defining and characterizing task-shifting medical devices. Global Health 2021; 17:60. [PMID: 34022920 PMCID: PMC8140413 DOI: 10.1186/s12992-021-00684-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/04/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Task shifting could help address limited human resources available for the delivery of quality health care services in low-resource settings. However, the role of medical devices in supporting task shifting is not fully understood. This study aimed to 1) define "task-shifting medical devices" and 2) identify product characteristics to guide the design and development of task-shifting medical devices. A three-part survey questionnaire comprising open-ended, rank-ordering, and multiple-choice questions was disseminated to healthcare professionals worldwide. The survey included questions to capture stakeholders' general understanding of and preferences for task shifting in medicine and public health, and questions to define task-shifting medical devices and identify desirable product characteristics of task-shifting medical devices. RESULTS Task-shifting medical devices were defined by respondents as "devices that can be used by a less specialized health worker". Aside from safe and effective, both essential characteristics for medical devices, easy to use was the most cited product characteristic for a task-shifting medical device. Responses also emphasized the importance of task-shifting medical devices to enable local agency, such as peer-to-peer training and local maintenance. Several additional frequently mentioned attributes included low cost, contextually appropriate, maintainable, capable of using an alternative power source, easy to understand, easy to learn, reusable, and easy to manage throughout its use cycle. CONCLUSION This study defines and characterizes task-shifting medical devices based on healthcare professionals' responses. Ease of use was identified as the most important characteristic that defines a task-shifting medical device, alongside safe and effective, and was strongly associated with enabling peer-to-peer training and maintainability. The findings from this study can be used to inform technology product profiles for medical devices used by lower-level cadres of healthcare workers in low-resource settings.
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Affiliation(s)
| | | | - Kathleen H. Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, USA
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Zuluaga G, Sarmiento I, Pimentel J, Correal C, Andersson N. [Cultivation and use of medicinal plants and association with reporting of childhood asthma: A case-control study in the Bogotá savanna]. Medwave 2021; 21:e8196. [PMID: 34037578 DOI: 10.5867/medwave.2021.04.8196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/13/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction The prevalence of childhood asthma has increased in recent years. The World Health Organization has called for conducting research exploring the role of traditional medicine and medicinal plants in respiratory disease control. Objective To identify the relationship between the prevalence of childhood asthma and traditional care of the respiratory system, including cultivation and use of medicinal plants. Methods We conducted an observational, analytic, case-control study that included children 2 to 14 years old who used official health services in eight municipalities near Bogota between 2014 and 2015. Cases were children diagnosed with asthma. We randomly selected the controls among the remaining patients of the same healthcare facilities. We applied an 18-question survey. The Mantel-Haenszel procedure identified significant associations using 95% confidence intervals. Results We surveyed the caretakers of 97 cases and 279 controls in eight municipalities. Some 23.4% (88/376) and 37.9% (142/375) reported using traditional remedies for fever control and common cold management, respectively. 8.8% (33/376) reported following traditional care during a common cold, 30.4% (114/375) reported growing medicinal plants at home, and 45% (166/369) reported using medicinal plants for health purposes in their household. Multivariate analysis showed that having and using medicinal plants at home is associated with a lower reporting of asthma (odds ratio 0.49; 95% confidence interval: 0.25 to 0.99). Conclusions Cultivating and using medicinal plants at home is associated with a lower reporting of childhood asthma. Researchers should consider the therapeutic, environmental, and cultural properties of medicinal plants to prevent respiratory diseases.
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Affiliation(s)
- Germán Zuluaga
- Grupo de Estudios en Sistemas Tradicionales de Salud, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia. Dirección: Calle 12 # 3A 21, Cota, Cundinamarca, Colombia. . ORCID: 0000-0001-5715-9133
| | - Iván Sarmiento
- Grupo de Estudios en Sistemas Tradicionales de Salud, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia. ORCID: 0000-0003-2871-1464
| | - Juan Pimentel
- Grupo de Estudios en Sistemas Tradicionales de Salud, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia. ORCID: 0000-0002-6842-3064
| | - Camilo Correal
- Universidad de La Sabana, Departamento de Medicina Familiar y Salud Pública, Chía, Colombia. ORCID: 0000-0002-4252-326X
| | - Neil Andersson
- CIET-PRAM, Departamento de Medicina Familiar, Universidad de McGill, Montreal, Quebec, Canadá. ORCID: 0000-0003-1121-6918
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Whitaker J, O'Donohoe N, Denning M, Poenaru D, Guadagno E, Leather AJM, Davies JI. Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments. BMJ Glob Health 2021; 6:e004324. [PMID: 33975885 PMCID: PMC8118008 DOI: 10.1136/bmjgh-2020-004324] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/07/2021] [Accepted: 02/04/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The large burden of injuries falls disproportionately on low/middle-income countries (LMICs). Health system interventions improve outcomes in high-income countries. Assessing LMIC trauma systems supports their improvement. Evaluating systems using a Three Delays framework, considering barriers to seeking (Delay 1), reaching (Delay 2) and receiving care (Delay 3), has aided maternal health gains. Rapid assessments allow timely appraisal within resource and logistically constrained settings. We systematically reviewed existing literature on the assessment of LMIC trauma systems, applying the Three Delays framework and rapid assessment principles. METHODS We conducted a systematic review and narrative synthesis of articles assessing LMIC trauma systems. We searched seven databases and grey literature for studies and reports published until October 2018. Inclusion criteria were an injury care focus and assessment of at least one defined system aspect. We mapped each study to the Three Delays framework and judged its suitability for rapid assessment. RESULTS Of 14 677 articles identified, 111 studies and 8 documents were included. Sub-Saharan Africa was the most commonly included region (44.1%). Delay 3, either alone or in combination, was most commonly assessed (79.3%) followed by Delay 2 (46.8%) and Delay 1 (10.8%). Facility assessment was the most common method of assessment (36.0%). Only 2.7% of studies assessed all Three Delays. We judged 62.6% of study methodologies potentially suitable for rapid assessment. CONCLUSIONS Whole health system injury research is needed as facility capacity assessments dominate. Future studies should consider novel or combined methods to study Delays 1 and 2, alongside care processes and outcomes.
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Affiliation(s)
- John Whitaker
- King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | | | - Max Denning
- Department of Surgery and Cancer, Imperial College London, London, UK
- Stanford Graduate School of Business, Stanford University, Stanford, California, USA
| | - Dan Poenaru
- Harvey E Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Andrew J M Leather
- King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, Western Cape, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Uwamariya J, Mazimpaka C, May L, Nshimyiryo A, Feldman HA, Sayinzoga F, Umutesi S, Gadgil A, Rapp VH, Nahimana E, Hansen A. Safety and effectiveness of a non-electric infant warmer for hypothermia in Rwanda: A cluster-randomized stepped-wedge trial. EClinicalMedicine 2021; 34:100842. [PMID: 33997734 PMCID: PMC8102718 DOI: 10.1016/j.eclinm.2021.100842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Neonatal hypothermia is a common source of morbidity and mortality in low resource settings. We developed the Dream Warmer, a low cost, re-usable non-electric infant warmer to prevent and treat hypothermia. METHODS We conducted a cluster-randomized stepped-wedge trial. The primary aim was to assess the effect on overall euthermia rates of introducing the warmer compared to standard of care in rural Rwandan hospitals. The secondary aims were to assess effects of warmer introduction on mortality, as well as the safety and feasibility of the warmer. Ten district hospitals participated in the study from November 19th 2019 to July 15th 2020. Patients were eligible to use the warmer if they were 1) hypothermic (temp < 36·5 °C) or 2) or at risk of hypothermia (weight < 2·5 kg or estimated post menstrual age < 35 weeks) when Kangaroo Mother Care was not available. An encounter was defined as the data from an individual infant on a single day. Trial of a Non Electric Infant Warmer for Prevention and Treatment of Hypothermia in Rwanda [NCT03890211]. FINDINGS Over the study period, 3179 patients were enrolled across the ten neonatal wards, yielding 12,748 encounters; 464 unique infants used the warmer 892 times, 79% eligible due to hypothermia. Because of limited study nurse resources, the warmer was used in only 18% of eligible encounters. Despite this low rate of warmer use, the rate of euthermia rose from 51% (95% CI 50-52%) of encounters pre-intervention to 67% (66-68%) post-intervention; p < 0·0001. Among the encounters in which the warmer was used, only 11% (9-13%) remained hypothermic. While mortality rates pre- and post-intervention did not change, mortality rate among those who used the warmer was significantly lower than among those who did not (0·9% vs 2·8%, p = 0·01). Use of the warmer did not affect hyperthermia rates. There were no safety concerns or instances of incorrect warmer use. INTERPRETATION Introduction of the warmer increased rates of euthermia with no associated safety concerns.
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Affiliation(s)
- Josee Uwamariya
- Partners In Health/Inshuti Mu Buzima (PIH/IMB), KG9 Avenue, No. 46, Nyarutarama Cell, Remera Sector, Kigali, Gasabo, Rwanda
| | - Christian Mazimpaka
- Partners In Health/Inshuti Mu Buzima (PIH/IMB), KG9 Avenue, No. 46, Nyarutarama Cell, Remera Sector, Kigali, Gasabo, Rwanda
| | - Leana May
- Children's Hospital of Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States
- University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, United States
| | - Alphonse Nshimyiryo
- Partners In Health/Inshuti Mu Buzima (PIH/IMB), KG9 Avenue, No. 46, Nyarutarama Cell, Remera Sector, Kigali, Gasabo, Rwanda
| | - Henry A. Feldman
- Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | | | | | - Ashok Gadgil
- University of California, 760 Davis Hall, Berkeley, CA 94720, United States
- Lawrence Berkeley Laboratory, MS 90R2121, 1 Cyclotron Road, Berkeley, CA 94720, United States
| | - Vi H. Rapp
- Lawrence Berkeley Laboratory, MS 90R2121, 1 Cyclotron Road, Berkeley, CA 94720, United States
| | - Evrard Nahimana
- Partners In Health/Inshuti Mu Buzima (PIH/IMB), KG9 Avenue, No. 46, Nyarutarama Cell, Remera Sector, Kigali, Gasabo, Rwanda
| | - Anne Hansen
- Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
- Corresponding author at: Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States.
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Abstract
Introduction: Global surgical care is increasingly recognized in the global health agenda and requires multidisciplinary engagement. Despite high interest among medical students, residents and other learners, many surgical faculty and health experts remain uniformed about global surgical care. Methods: We have operated an interdisciplinary graduate-level course in Global Surgical Care based on didactics and interactive group learning. Students completed a pre- and post-course survey regarding their learning experiences and results were analyzed using the Wilcoxon signed-rank test. Results: Fourteen students completed the pre-course survey, and 11 completed the post-course survey. Eleven students (79%) were enrolled in a Master’s degree program in global health, with eight students (57%) planning to attend medical school. The median ranking of surgery on the global health agenda was fifth at the beginning of the course and third at the conclusion (p = 0.11). Non-infectious disease priorities tended to stay the same or increase in rank from pre- to post-course. Infectious disease priorities tended to decrease in rank (HIV/AIDS, p = 0.07; malaria, p = 0.02; neglected infectious disease, p = 0.3). Students reported that their understanding of global health (p = 0.03), global surgery (p = 0.001) and challenges faced by the underserved (p = 0.03) improved during the course. When asked if surgery was an indispensable part of healthcare, before the course 64% of students strongly agreed, while after the course 91% of students strongly agreed (p = 0.3). Students reported that the interactive nature of the course strengthened their skills in collaborative problem-solving. Conclusions: We describe an interdisciplinary global surgery course that integrates didactics with team-based projects. Students appeared to learn core topics and held a different view of global surgery after the course. Similar courses in global surgery can educate clinicians and other stakeholders about strategies for building healthy surgical systems worldwide.
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Valentim RADM, Lima TS, Cortez LR, Barros DMDS, Silva RDD, Paiva JCD, Coutinho KD, Morais PSGD, Lacerda JDS, André FRD. The relevance a technology ecosystem in the Brazilian National Health Service's Covid-19 response: the case of Rio Grande do Norte, Brazil. CIENCIA & SAUDE COLETIVA 2021; 26:2035-2052. [PMID: 34231717 DOI: 10.1590/1413-81232021266.44122020] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/15/2021] [Indexed: 11/22/2022] Open
Abstract
Technological advances play an undeniable role in strengthening health systems. With regard to digital technologies, information systems and the analysis of health data are playing a growing role in health surveillance and preparing for and responding to disease outbreaks, the theme addressed by this article within the context of the Covid-19 pandemic in the State of Rio Grande do Norte. This study departs from the assumption that digital health interventions can increase Covid-19 response capacity. We developed a technology ecosystem that integrates different information systems to meet the needs outlined in international regulations governing the response to the pandemic. In addition to the main elements of the ecosystem, this article describes the application of this instrument by different institutional actors. The main decision making tool used in the state government's Covid-19 response, the ecosystem is a model for digital health interventions in Brazil's national health service. This experience in Rio Grande do Norte brings together elements that can contribute to studies investigating the resilience of health systems and analyzing health policies in emergency situations.
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Affiliation(s)
- Ricardo Alexsandro de Medeiros Valentim
- Laboratório de Inovação Tecnológica em Saúde (LAIS), Universidade Federal do Rio Grande do Norte (UFRN). Av. Nilo Peçanha 620, Petrópolis. 59012-300 Natal RN Brasil
| | | | | | - Daniele Montenegro da Silva Barros
- Laboratório de Inovação Tecnológica em Saúde (LAIS), Universidade Federal do Rio Grande do Norte (UFRN). Av. Nilo Peçanha 620, Petrópolis. 59012-300 Natal RN Brasil
| | - Rodrigo Dantas da Silva
- Laboratório de Inovação Tecnológica em Saúde (LAIS), Universidade Federal do Rio Grande do Norte (UFRN). Av. Nilo Peçanha 620, Petrópolis. 59012-300 Natal RN Brasil
| | | | - Karilany Dantas Coutinho
- Laboratório de Inovação Tecnológica em Saúde (LAIS), Universidade Federal do Rio Grande do Norte (UFRN). Av. Nilo Peçanha 620, Petrópolis. 59012-300 Natal RN Brasil
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Joshi A, Kaur M, Arora S, Bhatt A, Sharma P, Kaur H, Kumar K, Arora M, Malhotra B, Anshuman A. A pilot evaluation of Swasthya Pahal program using SMAART informatics framework to support NCD self-management. Mhealth 2021; 7:55. [PMID: 34805386 PMCID: PMC8572753 DOI: 10.21037/mhealth-20-110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 01/17/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Empirical research acknowledges the capability of mHealth and eHealth interventions for ensuring high-quality and tailored healthcare to individuals. People living with various health conditions get access to a wide range of healthcare services through digital interventions. The aim of the study is to examine the usefulness of Swasthya Pahal, a community-based Health for all program, aimed to enhance screening and self-management of diabetes, hypertension, and obesity among police personnel. METHODS A convenient sample of 64 individuals aged 18 years and above present at the Police Sanchar Training Centre, Dehradun, Uttarakhand were enrolled over 2 days in January 2020. The Swasthya Pahal pilot program was approved by the Uttarakhand State Police authorities. Individuals' health data was recorded using an interactive, bi-lingual, touch screen, computer-based program. Subjective data was collected and self-reported information was gathered about (I) socio-demographics, (II) health behaviors, (III) clinical status, and (IV) Knowledge, Attitudes, and Practices (KAP). Objective data assessments included measurements such as weight, blood pressure, and blood sugar levels using a series of physiological sensors. Additional information gathered at 1 month follow up included modifications that individuals made in their self-management of diabetes and hypertension, diet, physical activity, alcohol consumption, and smoking. Information was gathered related to individuals' interest in receiving SMS based health messages. RESULTS The average age of study participants was 37 (SD =8) years, 88% were males, and 42% had graduate education. Hypertension (31%) was found to be the most common family history. Thirty-six percent of individuals were presently smokers or consumed alcohol. Sixty-two percent of them self-reported doing some form of exercise. Walking, jogging and yoga were the most common exercise types. Eighty-seven percent of them were not receiving any treatment to self-manage hypertension. Based on the JNC 8 criteria, 37% of the individuals were hypertensive. Fifty of the 64 individuals expressed interest to receive SMS message, 64% of them expressed keenness to receive weekly SMS messages. Messages related to diet, physical activity, sleep, and smoking and alcohol consumption were perceived as important. CONCLUSIONS The Swasthya Pahal program using the SMAART informatics framework is a useful tool to enhance screening and self-management of non-communicable diseases (NCDs) among police personnel.
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Affiliation(s)
- Ashish Joshi
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Mahima Kaur
- Foundation of Healthcare Technologies Society, New Delhi, India
| | - Srishti Arora
- Foundation of Healthcare Technologies Society, New Delhi, India
| | - Ashruti Bhatt
- Foundation of Healthcare Technologies Society, New Delhi, India
| | - Priya Sharma
- Foundation of Healthcare Technologies Society, New Delhi, India
| | - Harpreet Kaur
- Foundation of Healthcare Technologies Society, New Delhi, India
| | - Kanishk Kumar
- Foundation of Healthcare Technologies Society, New Delhi, India
| | - Mohit Arora
- Foundation of Healthcare Technologies Society, New Delhi, India
| | - Bhavya Malhotra
- Foundation of Healthcare Technologies Society, New Delhi, India
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Naal H, El Koussa M, El Hamouch M, Hneiny L, Saleh S. Evaluation of global health capacity building initiatives in low-and middle-income countries: A systematic review. J Glob Health 2020; 10:020412. [PMID: 33110574 PMCID: PMC7568934 DOI: 10.7189/jogh.10.020412] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) are in dire need to improve their health outcomes. Although Global Health Capacity Building (GHCB) initiatives are recommended approaches, they risk being ineffective in the absence of standardized evaluation methods. This study systematically reviews evaluation approaches for GHCB initiatives in LMICs. METHODS We searched the Medline (OVID), PubMed, Scopus, and Embase.com databases for studies reporting evaluation of a GHCB initiative in a LMIC from January 1, 2009 until August 15, 2019. To differentiate them from intervention, prevention, and awareness initiatives, included articles reported at least one approach to evaluate their learning modality. We excluded cross-sectional studies, reviews, and book chapters that only assessed the effect of interventions. Data identifying the learning modality, and evaluation method, level, time interval, and approach were extracted from articles as primary outcomes. RESULTS Of 8324 identified studies, 63 articles were eligible for analysis. Most studies stemmed from Africa and Asia (69.8%), were delivered and evaluated face-to-face (74.6% and 76.2%), mainly to professionals (57.1%) and community workers (20.6%). Although the use of online and blended modalities showed an increase over the past 4 years, only face-to-face initiatives were evaluated long-term beyond individual-level. GHCB evaluations in general lacked standardization especially regarding the tools. CONCLUSION This is an important resource for evaluating GHCB initiatives in LMICs. It synthesizes evaluation approaches, offers recommendations for improvement, and calls for the standardization of evaluations, especially for long-term and wider impact assessment of online and blended modalities.
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Affiliation(s)
- Hady Naal
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Maria El Koussa
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Melissa El Hamouch
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Layal Hneiny
- Saab Medical Library at the American University of Beirut, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
- Faculty of Health Sciences at the American University of Beirut, Beirut, Lebanon
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The Evaluation of the Effect of ICT in HIV Prevention in the General Population in China Based on an Information-Motivation-Behavioral Skill Model. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8786467. [PMID: 33178835 PMCID: PMC7644314 DOI: 10.1155/2020/8786467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/26/2020] [Accepted: 10/09/2020] [Indexed: 11/18/2022]
Abstract
Objectives With an increase in human immunodeficiency virus (HIV) infection, the application of information and communication technology (ICT) is considered as a helpful solution. The aim of this study is to evaluate the effect of ICT in HIV prevention in the general population based on an information-motivation-behavioral skill (IMB) model. Methods A national follow-up study on the evaluation of ICT on HIV health education effects before and after large sample intervention was conducted in 16 provinces of China. ICT was used to carry out a six-month educational program on the prevention of HIV for participants using the WeChat platform. The research group conducted a second questionnaire for participants to collect data and built the IMB model using Mplus 7.0 analysis software. Results A total of 997 questionnaires were sent, and 957 effective questionnaires were recovered, a recovery rate of 96.0%. Before the ICT intervention, the scores of information was 15.68 ± 3.28, of motivation was 14.47 ± 4.26, of behavior skills was 2.26 ± 1.08, and of condom use was 2.19 ± 1.15. After the ICT intervention, the scores for information (18.54 ± 2.48), motivation (16.06 ± 4.11), behavior skills (4.74 ± 1.04), and condom use (2.64 ± 1.15) improved significantly. ICT use had a significant regression effect on motivation (β = 0.237, P < 0.001), behavior skills (β = 0.997, P < 0.001), and information (β = 0.441, P < 0.001), while motivation (β = 0.196, P < 0.001), behavior skills (β = 0.207, P < 0.001), and information (β = 0.092, P < 0.001) had a significant regression effect on condom use. Conclusions The ICT intervention can not only improve information about HIV prevention, motivation, and behavior skills but also promote the use of condoms, so as to achieve the result of promoting behaviors that act to prevent AIDS within the general population.
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Point of Care Diagnostics in Resource-Limited Settings: A Review of the Present and Future of PoC in Its Most Needed Environment. BIOSENSORS-BASEL 2020; 10:bios10100133. [PMID: 32987809 PMCID: PMC7598644 DOI: 10.3390/bios10100133] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022]
Abstract
Point of care (PoC) diagnostics are at the focus of government initiatives, NGOs and fundamental research alike. In high-income countries, the hope is to streamline the diagnostic procedure, minimize costs and make healthcare processes more efficient and faster, which, in some cases, can be more a matter of convenience than necessity. However, in resource-limited settings such as low-income countries, PoC-diagnostics might be the only viable route, when the next laboratory is hours away. Therefore, it is especially important to focus research into novel diagnostics for these countries in order to alleviate suffering due to infectious disease. In this review, the current research describing the use of PoC diagnostics in resource-limited settings and the potential bottlenecks along the value chain that prevent their widespread application is summarized. To this end, we will look at literature that investigates different parts of the value chain, such as fundamental research and market economics, as well as actual use at healthcare providers. We aim to create an integrated picture of potential PoC barriers, from the first start of research at universities to patient treatment in the field. Results from the literature will be discussed with the aim to bring all important steps and aspects together in order to illustrate how effectively PoC is being used in low-income countries. In addition, we discuss what is needed to improve the situation further, in order to use this technology to its fullest advantage and avoid “leaks in the pipeline”, when a promising device fails to take the next step of the valorization pathway and is abandoned.
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How scientific research reacts to international public health emergencies: a global analysis of response patterns. Scientometrics 2020; 124:747-773. [PMID: 32836522 PMCID: PMC7282204 DOI: 10.1007/s11192-020-03531-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/27/2022]
Abstract
As of the middle of April 2020, the unprecedented COVID-19 pandemic has claimed more than 137,000 lives (https://coronavirus.jhu.edu/map.html). Because of its extremely fast spreading, the attention of the global scientific community is now focusing on slowing down, containing and finally stopping the spread of this disease. This requires the concerted action of researchers and practitioners of many related fields, raising, as always in such situations the question, of what kind of research has to be conducted, what are the priorities, how has research to be coordinated and who needs to be involved. In other words, what are the characteristics of the response of the global research community on the challenge? In the present paper, we attempt to characterise, quantify and measure the response of academia to international public health emergencies in a comparative bibliometric study of multiple outbreaks. In addition, we provide a preliminary review of the global research effort regarding the defeat of the COVID-19 pandemic. From our analysis of six infectious disease outbreaks since 2000, including COVID-19, we find that academia always responded quickly to public health emergencies with a sharp increase in the number of publications immediately following the declaration of an outbreak by the WHO. In general, countries/regions place emphasis on epidemics in their own region, but Europe and North America are also concerned with outbreaks in other, developed and less developed areas through conducting intensive collaborative research with the core countries/regions of the outbreak, such as in the case of Ebola in Africa. Researches in the fields of virology, infectious diseases and immunology are the most active, and we identified two characteristic patterns in global science distinguishing research in Europe and America that is more focused on public health from that conducted in China and Japan with more emphasis on biomedical research and clinical pharmacy, respectively. Universities contribute slightly less than half to the global research output, and the vast majority of research funding originates from the public sector. Our findings on how academia responds to emergencies could be beneficial to decision-makers in research and health policy in creating and adjusting anti-epidemic/-pandemic strategies.
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Laflamme L, Wallis LA. Seven pillars for ethics in digital diagnostic assistance among clinicians: Take-homes from a multi-stakeholder and multi-country workshop. J Glob Health 2020; 10:010326. [PMID: 32509282 PMCID: PMC7244932 DOI: 10.7189/jogh.10.010326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Lucie Laflamme
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,University of South Africa, Institute for Social and Health Sciences, Johannesburg, South Africa
| | - Lee Alan Wallis
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Bellville, South Africa.,Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Choudhry V, Weiner B, Karkhanis P, Avinandan V, Shah N, Bahl N, Wadhwa R, Sridhar P, Chandurkar D. Determinants of technology use for a mobile health intervention across public health facilities in rural India: Protocol for implementation research. Gates Open Res 2020. [DOI: 10.12688/gatesopenres.13128.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This paper presents a research protocol for implementation research (IR) to investigate contextual factors influencing the implementation of ASMAN mobile health intervention and their association with maternal, newborn, and child health outcomes. The IR will cover roughly 16-20 public health facilities across the states of Rajasthan and Madhya Pradesh in India. These facilities will be a sub-sample of 49 facilities covered separately under the outcome evaluation. The study employs a longitudinal mixed-methods multiple case study design with sequential data collection using constructs under the Consolidated Framework for Implementation Research (CFIR) across two phases. The first phase will be exploratory and use qualitative inquiry to contextualize the CFIR constructs. The second phase will employ a mixed-methods explanatory design with both validated and contextualized CFIR constructs and standard quantitative measures collected through outcome evaluation. Findings from this study will provide insights into factors that facilitate or impede the implementation of mobile health interventions and their association with MNCH outcomes in public health facilities in India.
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