Doing more with less - How frugal innovations can contribute to improving healthcare systems

Synchronous PIV measurements of a self-powered blood turbine and pump couple for right ventricle support

A blood turbine-pump system (iATVA), resembling a turbocharger was proposed as a mechanical right-heart assist device without external drive power. In this study, the iATVA system is investigated with particular emphasis on the blood turbine flow dynamics. A time-resolved 2D particle image velocimetry (PIV) set-up equipped with a beam splitter and two high speed cameras, allowed simultaneous recordings from both the turbine and pump impellers at 7 different phased-locked instances. The iATVA prototype is 3D printed using an optically clear resin following our earlier PIV protocols. Results showed that magnetically coupled impellers operated synchronously. As the turbine flow rate increased from 1.6 to 2.4 LPM, the rotational speed and relative inlet flow angle increase from 630 to 900 rpm, and 38 to 55% respectively. At the trailing edges, backflow region spanned 3/5 of the total passage outlet flow, and an extra leakage flow was observed at the leading edge. For this early turbine design, approximately, 75% of the turbine blade passage was not contributing to the impulse operation mode. The maximum non-wall shear rate was ~ 2288 s-1 near to the inlet exit, which is significantly lower than the commercial blood pumps, encouraging further research and blood experiments of this novel concept. Experimental results will improve the hydrodynamic design of the turbine impeller and volute regions and will be useful in computational fluid dynamics validation studies of similar passive devices.

The ties that bind: innovation configurations in low- and middle-income healthcare delivery settings

PURPOSE

This study examines innovation configurations (i.e. sets of product/service, social and business model innovations) and configuration linkages (i.e. factors that help to combine innovations) across six organizations as contingent upon organizational structure.

DESIGN/METHODOLOGY/APPROACH

Using semi-structured interviews and available public information, qualitative data were collected and examined using content analysis to characterize innovation configurations and linkages in three local/private organizations and three foreign-led/public-private partnerships in Repiblik Ayiti (Haiti).

FINDINGS

Organizations tend to combine product/service, social, and business model innovations simultaneously in locally founded private organizations and sequentially in foreign-based public-private partnerships. Linkages for simultaneous combination include limited external support, determined autonomy and shifting from a "beneficiary mindset," and financial need identification. Sequential combination linkages include social need identification, community connections and flexibility.

RESEARCH LIMITATIONS/IMPLICATIONS

The generalizability of our findings for this qualitative study is subject to additional quantitative studies to empirically test the suggested factors and to examine other health care organizations and countries.

PRACTICAL IMPLICATIONS

Locally led private organizations in low- and middle-income settings may benefit from considering how their innovations are in service to one another as they may have limited resources. Foreign based public-private partnerships may benefit from pacing their efforts alongside a broader set of stakeholders and ecosystem partners.

ORIGINALITY/VALUE

This study is the first, to our knowledge, to examine how organizations combine sets of innovations, i.e. innovation configurations, in a healthcare setting and the first of any setting to examine innovation configuration linkages.

Global health reciprocal innovation: ethical, legal and regulatory considerations

Global health reciprocal innovation (GHRI) is a recent and more formalised approach to conducting research that recognises and develops innovations (eg, medicines, devices, methodologies) from low- and middle-income countries (LMICs). At present, studies using GHRI most commonly adapt innovations from LMICs for use in high-income countries (HICs), although some develop innovations in LMICs and HICs. In this paper, we propose that GHRI implicitly makes two ethical commitments: (1) to promote health innovations from LMICs, especially in HICs, and (2) to conduct studies on health innovations from LMICs in equitable partnerships between investigators in LMICs and HICs. We argue that these commitments take a significant step towards a more equal global health research enterprise while helping to ensure that populations and investigators in LMICs receive equitable benefits from studies using GHRI. However, studies using GHRI can raise potential ethical concerns and face legal and regulatory barriers. We propose ethical, legal and regulatory considerations to help address these concerns and barriers. We hope our recommendations will allow GHRI to move the global health research enterprise forward into an era where all people are treated equally as knowers and learners, while populations in both LMICs and HICs benefit equitably from studies using GHRI.

Learning from socially driven frugal innovation to design the future of healthcare: A case of mobile Primary Health Center

Background and Aim

Despite their flaws, the low-cost but powerful economical solutions can ensure everyone has access to health. The main aim of this study is to extract characteristics of frugal innovation (FI) and social innovation (SI) for Primary Health Centers (PHCs) in low resource settings (LRS) for sustainable development. We will use the gained insights to design the mobile primary healthcare infrastructure using FI and SI strategies. There is a lack of methodology to design sustainable healthcare infrastructure for LRS. There is a gap in the literature about building sustainable infrastructure to provide basic healthcare facilities essential to the community. This article studies several factors necessary for designing sustainable infrastructure from the lens of FI, SI, and sustainability to develop a mobile healthcare infrastructure for last-mile people.

Methods

Started with purposive sampled case studies to find out factors and criteria that most affect the success for an innovation to be frugal, social, and sustainable. The established criteria were used to design, develop, and deploy the mobile Primary Health Center (mPHC). Moving forward, we tested the system designed with stakeholders to gather insights. At this stage we found the feedback loop from the stakeholders and the role of interdisciplinary discussions between experts, medical officers, nurses, patient, and other staff of PHCs during the design, development, deployment, and test stage to be useful in taking design decisions efficiently.

Results

The designed healthcare infrastructure of mPHC through the aspects of FI and SI proves to be efficient in providing key healthcare services to LRS.

Conclusion

Focusing on essential capabilities and optimizing performance with technology, methodologies, and processes reduces costs in an innovation. Focus on socially inclusive and rebalancing power disparities, overcome societal challenges and improve human capabilities will create a sustainable and novel solution.

Advancing Cardiovascular Health Equity Globally Through Digital Technologies

Cardiovascular diseases (CVDs) remain the leading cause of death and disability worldwide. Digital health technologies are important public health interventions for addressing the burden of cardiovascular disease. In this article, we discuss the importance of translating digital innovations in research-funded projects to low-resource settings globally to advance global cardiovascular health equity. We also discuss current global cardiovascular health inequities and the digital health divide within and between countries. We present various considerations for translating digital innovations across different settings across the globe, including reciprocal innovation, a "bidirectional, co-constituted, and iterative exchange of ideas, resources, and innovations to address shared health challenges across diverse global settings." In this case, afferent reciprocal innovations may flow from high-income countries toward low- and middle-income countries, and efferent reciprocal innovations may be exported to high-income countries from low- and middle-income countries with adaptation. Finally, we discuss opportunities for bidirectional learning between local and global institutions and highlight examples of projects funded through the American Heart Association Health and Innovation Strategically Funded Research Network that have been adapted to lower-resource settings or have the potential to be adapted to lower-resource settings.

A Comprehensive, Valid, and Reliable Tool to Assess the Degree of Responsibility of Digital Health Solutions That Operate With or Without Artificial Intelligence: 3-Phase Mixed Methods Study

BACKGROUND

Clinicians' scope of responsibilities is being steadily transformed by digital health solutions that operate with or without artificial intelligence (DAI solutions). Most tools developed to foster ethical practices lack rigor and do not concurrently capture the health, social, economic, and environmental issues that such solutions raise.

OBJECTIVE

To support clinical leadership in this field, we aimed to develop a comprehensive, valid, and reliable tool that measures the responsibility of DAI solutions by adapting the multidimensional and already validated Responsible Innovation in Health Tool.

METHODS

We conducted a 3-phase mixed methods study. Relying on a scoping review of available tools, phase 1 (concept mapping) led to a preliminary version of the Responsible DAI solutions Assessment Tool. In phase 2, an international 2-round e-Delphi expert panel rated on a 5-level scale the importance, clarity, and appropriateness of the tool's components. In phase 3, a total of 2 raters independently applied the revised tool to a sample of DAI solutions (n=25), interrater reliability was measured, and final minor changes were made to the tool.

RESULTS

The mapping process identified a comprehensive set of responsibility premises, screening criteria, and assessment attributes specific to DAI solutions. e-Delphi experts critically assessed these new components and provided comments to increase content validity (n=293), and after round 2, consensus was reached on 85% (22/26) of the items surveyed. Interrater agreement was substantial for a subcriterion and almost perfect for all other criteria and assessment attributes.

CONCLUSIONS

The Responsible DAI solutions Assessment Tool offers a comprehensive, valid, and reliable means of assessing the degree of responsibility of DAI solutions in health. As regulation remains limited, this forward-looking tool has the potential to change practice toward more equitable as well as economically and environmentally sustainable digital health care.

Cost analysis of severe burn victims in Southwest China: A 7-year retrospective study

Background

Severe burn injury can be a life-threatening experience and can also lead to financial issues for suffers. The purpose of the current study was to analyze the direct hospitalization costs of severe burn inpatients in Southwest China.

Methods

Data related to all inpatients admitted with severe burns [total body surface area (TBSA) ≥30%] pooled from 2015 to 2021 were reviewed retrospectively at the Institute of Burn Research of Army Medical University. Demographic parameters, medical economics, and clinical data were obtained from medical records.

Results

A total of 668 cases were identified. The average age was 37.49 ± 21.00 years, and 72.3% were men. The average TBSA was 51.35 ± 19.49%. The median length of stay of inpatients in the burn intensive care unit was 14 [interquartile range (IQR): 5.0-34.8] days, and the median length of stay (LOS) was 41 (IQR: 22.0-73.8) days. The mortality rate was 1.6%. The median total cost was 212,755.45 CNY (IQR: 83,908.80-551,621.57 CNY) per patient varying from 3,521.30 to 4,822,357.19 CNY. The direct cost of scald burns was dramatically lower compared with that of other types of burns, with 11,213.43 to 2,819,019.14 CNY. Medical consumables presented the largest portion of total costs, with a median cost of 65,942.64 CNY (IQR: 18,771.86-171,197.97 CNY). The crucial risk factors for medical cost in our study were TBSA, surgical frequency, LOS, depth of burn, and outcome.

Conclusion

We conclude that an effective burn prevention program, shorter hospital stays, and facilitating the healing of wounds should be focused on with tailored precautionary protocols to reduce the medical costs of inpatients with severe burns.

Frugal innovation in wound care: a critical discussion of what we can learn from low-resource settings

Frugal innovation is a common philosophy in low-income settings due to limited access to resources. However, with both the increasing prevalence and clinical acuity of patients with wounds in the UK, it is essential that alongside innovation such as harnessing cutting-edge new technologies, frugal innovation is also pursued. This may improve both economic efficiency and patient outcomes. Frugal innovations were adopted throughout the COVID-19 pandemic and included opportunistic solutions such as video-conferencing services to run clinics. However, there are many more opportunities for frugal innovation in wound care, including the use of smartphone technology, which is already accessible to 99.5% of UK clinicians caring for wounds, or the simplification of wound-assessment processes using pulse oximeters as an alternative to dopplers, as in the Lanarkshire Oximetry Index. This article explores what frugal innovation is and how it could improve UK wound services. The authors invite clinicians working in wound care to consider their access to existing resources that may not be considered useful for wound-care processes and explore how these could be used to improve clinical outcomes.