Publications
133 results found
Meinert E, Alturkistani A, Foley K, et al., 2019, Examining cost measurements in production and delivery of three case studies using eLearning for Applied Health Sciences: a cross-case synthesis, Journal of Medical Internet Research, Vol: 21, ISSN: 1438-8871
The World Health Organization World Health Report conveys that a significant increase is needed in global healthcare resourcing to meet current and future demand for health professionals. eLearning presents a possible opportunity to change and optimize training by providing a scalable means for instruction, thus reducing the costs for training health professionals and providing patient education. Research literature often suggests that a benefit of eLearning is its cost-effectiveness compared with face-to-face instruction, yet there is limited evidence comparing design and production costs with other forms of instruction, or the establishment of standards for budgeting for these costs.
Carter AR, Meinert E, Brindley DA, 2019, Biotechnology Governance 2.0: A Proposal for Minimum Standards in Biotechnology Corporate Governance, REJUVENATION RESEARCH, Vol: 22, Pages: 254-260, ISSN: 1549-1684
Zeeshaan A, Alturkistani A, Brindley D, et al., 2019, Tools for the diagnosis of Herpes simplex virus 1/2: A systematic review of studies published between 2012-2018, JMIR Public Health and Surveillance, Vol: 5, ISSN: 2369-2960
Herpes simplex viruses (HSV) 1 and 2 are common infections affecting the global population. HSV 1 is the most common type estimated to affect 67% of the global population. HSV can have rare, but severe manifestations such as encephalitis and neonatal herpes necessitating the use of reliable and accurate diagnostic tools for the detection of the viruses. Currently used HSV diagnostic tools require highly specialized skills, availability of a laboratory setting and may lack sensitivity. More recent HSV diagnostic tools are numerous and need to be identified and compared in a systematic way to be able to make the best decision about which diagnostic tool to use. Diagnosis of HSV is essential for prompt treatment with antivirals. To select the best test for a patient, knowledge of the performance and limitations of each test are critical. This systematic review summarizes recent study articles evaluating HSV-1 and HSV-2 diagnostic tools.
Meinert E, Alturkistani A, Foley K, et al., 2019, Examining cost measurements in production and delivery of three case studies using eLearning for Applied Health Sciences: A cross-case synthesis (Preprint), Publisher: JMIR Publications
Background:The World Health Report (2006) by the World Health Organization conveys that a significant increase is needed in global health care resourcing to meet the current and future demand for health professionals. Electronic learning (e-Learning) presents a possible opportunity to change and optimize training by providing a scalable means for instruction, thus reducing the costs for training health professionals and providing patient education. Research literature often suggests that a benefit of e-Learning is its cost-effectiveness compared with face-to-face instruction, yet there is limited evidence with respect to the comparison of design and production costs with other forms of instruction or the establishment of standards pertaining to budgeting for these costs.Objective:To determine the potential cost favorability of e-Learning in contrast to other forms of learning, there must first be an understanding of the components and elements for building an e-Learning course. Without first taking this step, studies lack the essential financial accounting rigor for course planning and have an inconsistent basis for comparison. This study aimed to (1) establish standard ingredients for the cost of e-Learning course production and (2) determine the variance instructional design has on the production costs of e-Learning courses.Methods:This study made use of a cross-case method among 3 case studies using mixed methods, including horizontal budget variance calculation and qualitative interpretation of responses from course designers for budget variance using total quality management themes. The different implementation-specific aspects of these cases were used to establish common principles in the composition of budgets in the production and delivery of an applied health professional e-Learning course.Results:A total of 2 case studies reported significant negative budget variances caused by issues surrounding underreporting of personnel costs, inaccurate resource task
O'Donoghue O, Vazirani A, Brindley D, et al., 2019, Design choices and trade-offs in healthcare blockchain implementations: Systematic review, Journal of Medical Internet Research, Vol: 21, ISSN: 1438-8871
Background: A blockchain is a list of records that uses cryptography to make stored data immutable; their use has recently been proposed for electronic medical record (EMR) systems. This paper details a systematic review of trade-offs in blockchain technologies that are relevant to EMRs. Trade-offs are defined as “a compromise between two desirable but incompatible features.”Objective: This review’s primary research question was: “What are the trade-offs involved in different blockchain designs that are relevant to the creation of blockchain-based electronic medical records systems?”Methods: Seven databases were systematically searched for relevant articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Papers published from January 1, 2017 to June 15, 2018 were selected. Quality assessments of papers were performed using the Risk Of Bias In Non-randomized Studies—of Interventions (ROBINS-I) tool and the Critical Assessment Skills Programme (CASP) tool. Database searches identified 2885 articles, of which 15 were ultimately included for analysis.Results: A total of 17 trade-offs were identified impacting the design, development, and implementation of blockchain systems; these trade-offs are organized into themes, including business, application, data, and technology architecture.Conclusions: The key findings concluded the following: (1) multiple trade-offs can be managed adaptively to improve EMR utility; (2) multiple trade-offs involve improving the security of blockchain systems at the cost of other features, meaning EMR efficacy highly depends on data protection standards; and (3) multiple trade-offs result in improved blockchain scalability. Consideration of these trade-offs will be important to the specific environment in which electronic medical records are being developed. This review also uses its findings to suggest useful design choices for a hypothetical National Health Service bl
Arshad Z, Alturkistani A, Brindley D, et al., 2019, Tools for the diagnosis of herpes simplex virus 1/2: systematic review of studies published between 2012 and 2018 (Preprint), Publisher: JMIR Publications
Background:Herpes simplex virus (HSV)-1 and HSV-2 are common infections affecting the global population, with HSV-1 estimated to affect 67% of the global population. HSV can have rare but severe manifestations, such as encephalitis and neonatal herpes, necessitating the use of reliable and accurate diagnostic tools for the detection of the viruses. Currently used HSV diagnostic tools require highly specialized skills and availability of a laboratory setting but may lack sensitivity. The numerous recently developed HSV diagnostic tools need to be identified and compared in a systematic way to make the best decision about which diagnostic tool to use. The diagnosis of HSV is essential for prompt treatment with antivirals. To select the best test for a patient, knowledge of the performance and limitations of each test is critical.Objective:This systematic review has summarized recent studies evaluating HSV-1 and HSV-2 diagnostic tools.Methods:Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, selection criteria, data extraction, and data analysis were determined before the commencement of the study. Studies assessing the specificity/sensitivity of HSV-1 or HSV-2 diagnostic tools published between 2012 and 2018 were included. Quality assessment of included studies was performed using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool.Results:Searches of the PubMed database yielded 264 studies; 11 studies included 11 molecular assays, and 8 studies included 19 different serological assays for the detection of HSV-1, HSV-2, or both. A greater proportion of molecular assay–based tools are being developed by commercial entities. Studies that tested molecular assays mostly focused on cutaneous and mucosal HSV infections (n=13); 2 studies focused on ocular disease, whereas only 1 study focused on the central nervous system manifestations. The Simplexa HSV 1 & 2 Direct is currently the only Food and Drug Ad
Alturkistani A, Majeed F, Car J, et al., 2019, Data collection approaches to enable evaluation of a Massive Open Online Course (MOOC) about data science for continuing education in healthcare: case study, JMIR Medical Education, Vol: 5, ISSN: 2369-3762
Background: This paper presents learner perceptions of a pilot Massive Open Online Course (MOOC). Objective: The aim of this study was to explore data collection approaches to help inform future MOOC evaluations on the use of semi-structured interviews and the Kirkpatrick evaluation model. Methods: 191 learners joined two course runs of a limited trial of the MOOC. Seven learners volunteered to be interviewed for the study. The study design drew on semi-structured interviews of 2 learners transcribed and analysed using Braun and Clark's method for thematic coding. This limited participant set was used to identify how the Kirkpatrick evaluation model could be used to evaluate further implementations of the course at scale. Results: The study identified several themes that could be used for further analysis. The themes and sub-themes include: Learner background (educational, professional, topic significance), MOOC learning (learning achievement, MOOC application) and MOOC features (MOOC positives, MOOC negatives, networking). There was not sufficient data points to perform a Kirkpatrick evaluation.Conclusions: Semi-structured interviews for MOOC evaluation can provide a valuable in-depth analysis of learners’ experience of the course. However, there must be sufficient data sources to complete a Kirkpatrick evaluation to provide for data triangulation. For example, data from pre-course and post-course surveys, quizzes and/or test results could be used to improve the evaluation methodology.
Foley K, Alturkistani A, Carter A, et al., 2019, Massive Open Online Courses (MOOC) evaluation methods: protocol for a systematic review, JMIR Research Protocols, Vol: 8, ISSN: 1929-0748
BACKGROUND: Massive open online courses (MOOCs) have increased in popularity in recent years. They target a wide variety of learners and use novel teaching approaches, yet often exhibit low completion rates (10%). It is important to evaluate MOOCs to determine their impact and effectiveness, but little is known at this point about the methodologies that should be used for evaluation. OBJECTIVE: The purpose of this paper is to provide a protocol for a systematic review on MOOC evaluation methods. METHODS: We will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines for reporting this protocol. We developed a population, intervention, comparator, and outcome (PICO) framework to guide the search strategy, based on the overarching question, "What methods have been used to evaluate MOOCs?" The review will follow six stages: 1) literature search, 2) article selection, 3) data extraction, 4) quality appraisal, 5) data analysis, and 6) data synthesis. RESULTS: The systematic review is ongoing. We completed the data searches and data abstraction in October and November 2018. We are now analyzing the data and expect to complete the systematic review by March 2019. CONCLUSIONS: This systematic review will provide a useful summary of the methods used for evaluation of MOOCs and the strengths and limitations of each approach. It will also identify gaps in the literature and areas for future work. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/12087.
Vazirani A, ODonoghue O, Brindley D, et al., 2019, Implementing blockchains for efficient healthcare: a systematic review, Journal of Medical Internet Research, Vol: 21, ISSN: 1438-8871
Background: The decentralised nature of sensitive health information can bring about situations where timely information is unavailable, worsening health outcomes. Furthermore, as patient involvement in healthcare increases, there is a growing need for patients to access and control their data. Blockchain is a secure decentralised online ledger that could be used to manage electronic health records efficiently, therefore with the potential to improve health outcomes by creating a conduit for interoperability.Objective: To perform a systematic review to assess the feasibility of Blockchain as a method of managing healthcare records efficiently. Methods: Reviewers identified studies via systematic searches of databases including Pubmed, Medline, Scopus, Embase, Proquest and Cochrane Library. Suitability for inclusion of each was assessed independently. Results: Of 71 included studies, the majority discuss potential benefits and limitations without evaluation of their effectiveness, although some systems were tested on live data.Conclusions: Blockchain could create a mechanism to manage access to electronic health records stored on the cloud. Using a Blockchain can increase interoperability whilst maintaining privacy and security of data. It contains inherent integrity and conforms to strict legal regulations. Increased interoperability would be beneficial for health outcomes. Although this technology is currently unfamiliar to most, investments into creating a sufficiently user-friendly interface and educating users on how best to take advantage of it would lead to improved health outcomes.
Meinert E, Reeves S, Eerens J, et al., 2019, Exploring the cost of eLearning within the field of health professions education: key findings from a Systematic Scoping Review (Preprint), Publisher: JMIR Publications Inc.
Background:Existing research on the costs of delivering courses online courses is limited. The way in which these learning platforms compare in cost to face-to-face learning is also poorly understood. This lack of data has made it difficult to evaluate whether the investments spent by organisations on online learning are effective in comparison to face-to-face instruction.Objective:The key aim of this scoping literature review is to better understand the state of evidence about whether eLearning demonstrates cost advantages over face-to-face instruction and report the results of a research question centred on: What data exists to define cost calculations related to eLearning? Specifically, we investigate the extent to which the literature can provide details for calculation of the costs for eLearning design, development, and delivery.Methods:Scoping review using a search strategy of MeSH terms and related keywords centred on eLearning and cost calculation with a population scope of health professionals in all countries. The search was limited to English language studies. No restriction was placed on literature publication date.Results:In total, 7344 articles were returned from the original search of the literature. Of these, 232 were relevant to associated keywords or abstract references to cost following screening. Full-text review resulted in 168 studies being excluded, with 42 studies providing data and analysis of the impact of cost and value in health professions education. A further 22 studies provided details of costing approaches for the production and delivery of eLearning.Conclusions:There is an emerging body of studies capturing costs in eLearning. However, costs in these studies were collected inconsistently and in relation to a wide variety of factors or had an alternate study-related focus. Although there is a perception that eLearning is more cost-effective than face-to-face instruction, there is not yet sufficient evidence to assert this conclusively
Meinert E, Alturkistani A, Foley K, et al., 2019, Implementation of blockchains in healthcare: protocol for a systematic review, JMIR Research Protocols, Vol: 8, ISSN: 1929-0748
BackgroundA blockchain is a digitised, decentralised, distributed public ledger; a shared and synchronised database that records cryptocurrency transactions. Despite the shift towards digital platforms enabled by Electronic Medical Records (EMRs), demonstrating a will to reform the healthcare sector, health systems face issues including security, interoperability, data fragmentation, timely access to patient data and silos. Application of healthcare blockchains could enable data interoperability, enhancement of precision medicine and reduction in prescription frauds through implementing novel methods in access and patient consent. Objectives To summarise the evidence on the strategies and frameworks utilised to implement blockchains for patient data in healthcare to ensure privacy and improve interoperability and scalability. It is anticipated this review will assist in development of recommendations that will assist key stakeholders in healthcare blockchain implementation and we predict that the evidence generated will challenge the healthcare status quo, moving away from more traditional approaches and facilitating decision-making of patients, healthcare providers and researchers. ResultsDatabase searches will be initiated in September 2018. We expect to complete the review in December 2018. ConclusionsThis review will summarize the strategies and frameworks used to implement blockchains in healthcare to increase data privacy, interoperability and scalability. This review will also help clarify if the strategies and frameworks required for the operationalisation of blockchains in healthcare ensure the privacy of patient data whilst enabling efficiency, interoperability and scalability.
Meinert E, Alturkistani A, Osama T, et al., 2019, Digital technology in somatic and gene therapy trials of paediatric patients with ocular diseases: a systematic scoping review protocol, JMIR Research Protocols, Vol: 8, ISSN: 1929-0748
BackgroundPharmacogenomics suggests that diseases with similar symptomatic presentations often have varying genetic causes, affecting an individual patient’s response to a specific therapeutic strategy. Gene therapies and somatic cell therapies offer unique therapeutic pathways for ocular diseases and often depend on increased understanding of the genotype-phenotype relationship in disease presentation and progression. While demand for personalised medicine is increasing and the required molecular tools are available, its adoption within paediatric ophthalmology remains to be maximised in the post-genomic era. To address the individual hurdles encountered in the field of genomic-related clinical trials and facilitate the uptake of personalised medicine, we propose to conduct a review that will examine and identify the digital technologies used to facilitate data analysis in somatic and gene therapy trials in paediatric patients with ocular diseases.Objectives To present an outline of HIT/ICT resources used in somatic and gene therapy clinical trials in children with ocular diseases. This review will enable authors to identify challenges and provide recommendations facilitating the uptake of genetic and somatic therapies as therapeutic tools in paediatric ophthalmology. The review will also determine whether conducting a systematic review will be beneficial.ResultsDatabase searches will be initiated in September 2018. We expect to complete the review in December 2018. ConclusionsBased on review findings, the authors will summarise methods used for facilitating IT integration in personalised medicine. Additionally, it will identify further research gaps and determine whether conduction of further reviews will be beneficial.
Meinert E, Alturkistani A, Foley KA, et al., 2019, Blockchain implementation in health care: Protocol for a systematic review, JMIR Research Protocols, Vol: 8, Pages: 153-159, ISSN: 1929-0748
Background: A blockchain is a digitized, decentralized, distributed public ledger that acts as a shared and synchronized database that records cryptocurrency transactions. Despite the shift toward digital platforms enabled by electronic medical records, demonstrating a will to reform the health care sector, health systems face issues including security, interoperability, data fragmentation, timely access to patient data, and silos. The application of health care blockchains could enable data interoperability, enhancement of precision medicine, and reduction in prescription frauds through implementing novel methods in access and patient consent.Objective: To summarize the evidence on the strategies and frameworks utilized to implement blockchains for patient data in health care to ensure privacy and improve interoperability and scalability. It is anticipated this review will assist in the development of recommendations that will assist key stakeholders in health care blockchain implementation, and we predict that the evidence generated will challenge the health care status quo, moving away from more traditional approaches and facilitating decision making of patients, health care providers, and researchers.Methods: A systematic search of MEDLINE/PubMed, Embase, Scopus, ProQuest Technology Collection and Engineering Index will be conducted. Two experienced independent reviewers will conduct titles and abstract screening followed by full-text reading to determine study eligibility. Data will then be extracted onto data extraction forms before using the Cochrane Collaboration Risk of Bias Tool to appraise the quality of included randomized studies and the Risk of Bias in nonrandomized studies of Interventions to assess the quality of nonrandomized studies. Data will then be analyzed and synthesized.Results: Database searches will be initiated in September 2018. We expect to complete the review in January 2019.Conclusions: This review will summarize the strategies and fra
Fawcett E, Van Velthoven MH, Meinert E, 2019, Long-Term Weight Management Using Wearable Technology in Overweight and Obese Adults: Systematic Review (Preprint)
<sec> <title>BACKGROUND</title> <p>Although there are many wearable devices available to help people lose weight and decrease the rising prevalence of obesity, the effectiveness of these devices in long-term weight management has not been established.</p> </sec> <sec> <title>OBJECTIVE</title> <p>This study aimed to systematically review the literature on using wearable technology for long-term weight loss in overweight and obese adults.</p> </sec> <sec> <title>METHODS</title> <p>We searched the following databases: Medical Literature Analysis and Retrieval System Online, EMBASE, Compendex, ScienceDirect, Cochrane Central, and Scopus. The inclusion criteria were studies that took measurements for a period of ≥1 year (long-term) and had adult participants with a BMI &gt;24. A total of 2 reviewers screened titles and abstracts and assessed the selected full-text papers for eligibility. The risk of bias assessment was performed using the following tools appropriate for different study types: the Cochrane risk of bias tool, Risk Of Bias In Nonrandomized Studies-of Interventions, A MeaSurement Tool to Assess systematic Reviews, and 6 questions to trigger critical thinking. The results of the studies have been provided in a narrative summary.</p> </sec> <sec> <title>RESULTS</title> <p>We included five intervention studies: four randomized controlled trials and one nonrandomized study. In addition, we used insights from six systematic reviews, four commentary papers, and a dissertation. The interventions delivered by wearable devices
Meinert E, Alturkistani A, Luo D, et al., 2019, Current status and future direction of companion diagnostics, Companion and Complementary Diagnostics: From Biomarker Discovery to Clinical Implementation, Pages: 455-472, ISBN: 9780128135402
This chapter will introduce companion diagnostics (CDxes), its current status, economic and regulatory aspects of CDx, and its future potential while discussing specific disease areas as well as the analytical technologies that are likely to dominate. It will first start by providing an overview of CDx, its definition, and some of the mechanisms that underlie its development. The chapter will then discuss the current status of CDx, its uses in medicine, and critical aspects of its development demonstrated in the discussion about codevelopment, with factors contributing to a market size exceeding 2 billion US dollars. An overview of the present economic and regulatory issues will also be discussed. Specific disease areas such as oncology, aging-related diseases, and other diseases will be considered concerning their future aspects in the use of CDx and the analytical technologies that will underlie their development.
Meinert E, Eerens J, Banks C, et al., 2019, A CASE STUDY EXAMINING THE COST MEASUREMENTS IN PRODUCTION AND DELIVERY OF A SMALL PRIVATE ONLINE COURSE (SPOC) FOR TEACHING ADMINISTRATIVE STAFF TO ENGAGE WITH YOUNG PATIENTS, 11th International Conference on Education and New Learning Technologies (EDULEARN), Publisher: IATED-INT ASSOC TECHNOLOGY EDUCATION & DEVELOPMENT, Pages: 6458-6466, ISSN: 2340-1117
Lam C, Meinert E, Alturkistani A, et al., 2018, Decision support tools for regenerative medicine: systematic review, Journal of Medical Internet Research, Vol: 20, Pages: 1-18, ISSN: 1438-8871
Background:Decisional tools have demonstrated their importance in informing manufacturing and commercial decisions in the monoclonal antibody domain. Recent approved therapies in regenerative medicine have shown great clinical benefits to patients.Objective:The objective of this review was to investigate what decisional tools are available and what issues and gaps have been raised for their use in regenerative medicine.Methods:We systematically searched MEDLINE to identify articles on decision support tools relevant to tissue engineering, and cell and gene therapy, with the aim of identifying gaps for future decisional tool development. We included published studies in English including a description of decisional tools in regenerative medicines. We extracted data using a predesigned Excel table and assessed the data both quantitatively and qualitatively.Results:We identified 9 articles addressing key decisions in manufacturing and product development challenges in cell therapies. The decision objectives, parameters, assumptions, and solution methods were analyzed in detail. We found that all decisional tools focused on cell therapies, and 6 of the 9 reviews focused on allogeneic cell therapy products. We identified no available tools on tissue-engineering and gene therapy products. These studies addressed key decisions in manufacturing and product development challenges in cell therapies, such as choice of technology, through modeling.Conclusions:Our review identified a limited number of decisional tools. While the monoclonal antibodies and biologics decisional tool domain has been well developed and has shown great importance in driving more cost-effective manufacturing processes and better investment decisions, there is a lot to be learned in the regenerative medicine domain. There is ample space for expansion, especially with regard to autologous cell therapies, tissue engineering, and gene therapies. To consider the problem more comprehensively, the full needle
Lam C, Meinert E, Alturkistani A, et al., 2018, A systematic review of decision-support tools for regenerative medicine, Journal of Medical Internet Research, Vol: 20, Pages: 1-18, ISSN: 1438-8871
Decisional tools have demonstrated their importance in informing manufacturing and commercial decisions in the monoclonal antibody domain (mAb). Recent approved therapies in regenerative medicine have shown great clinical benefits to patients. This study investigates what are the decisional tools available and what issues and gaps have been raised for their use in regenerative medicine. We systematically searched the literature to identify publications on decision-support tools relevant to tissue engineering, cell and gene therapy, with the aim of identifying gaps for future decisional tool development. Identified papers have addressed key decisions in manufacturing and product development challenges in cell therapies. Our review has identified a limited number of decisional tools. There is ample space for expansion especially with regard to autologous cell therapies, tissue engineering and gene therapies.
Meinert E, Van Velthoven M, Brindley D, et al., 2018, The internet of things in health care in Oxford: protocol for proof-of-concept projects, JMIR Research Protocols, Vol: 7, Pages: 1-12, ISSN: 1929-0748
Background:Demands on health services across are increasing because of the combined challenges of an expanding and aging population, alongside complex comorbidities that transcend the classical boundaries of modern health care. Continuing to provide and coordinate care in the current manner is not a viable route to sustain the improvements in health outcomes observed in recent history. To ensure that there continues to be improvement in patient care, prevention of disease, and reduced burden on health systems, it is essential that we adapt our models of delivery. Providers of health and social care are evolving to face these pressures by changing the way they think about the care system and, importantly, how to involve patients in the planning and delivery of services.Objective:The objective of this paper is to provide (1) an overview of the current state of Internet of Things (IoT) and key implementation considerations, (2) key use cases demonstrating technology capabilities, (3) an overview of the landscape for health care IoT use in Oxford, and (4) recommendations for promoting the IoT via collaborations between higher education institutions and industry proof-of-concept (PoC) projects.Methods:This study describes the PoC projects that will be created to explore cost-effectiveness, clinical efficacy, and user adoption of Internet of Medical Things systems. The projects will focus on 3 areas: (1) bring your own device integration, (2) chronic disease management, and (3) personal health records.Results:This study is funded by Research England’s Connecting Capability Fund. The study started in March 2018, and results are expected by the end of 2019.Conclusions:Embracing digital solutions to support the evolution and transformation of health services is essential. Importantly, this should not simply be undertaken by providers in isolation. It must embrace and exploit the advances being seen in the consumer devices, national rollout of high-speed broadband servi
Meinert E, Van Velthoven M, Brindley D, et al., 2018, The internet of things in healthcare: proof of concept opportunities in Oxford, JMIR Research Protocols, Vol: 7, ISSN: 1929-0748
BackgroundDemands on health services across the globe are increasing due to the combined challenges of an expanding and ageing population, alongside complex comorbidities that transcend the classical boundaries of modern healthcare. To meet these challenges, we must increase the quality of care, and the efficiency with which it is delivered. Continuing to provide and coordinate care in the current manner is not a viable route to sustaining the improvements in health outcomes observed in recent history. To ensure that there continues to be improvement in patient care, prevention of disease and reduced burden on healthcare systems, it is essential that we adapt our models of delivery. Providers of health and social care are evolving to face these pressures by changing the way they think about the care system and importantly how to involve patients in the planning and delivery of services.ObjectivesThe objective of this paper is to provide: 1. An overview of the current state of IoT and key implementation considerations2. Key use cases demonstrating technology capabilities3. Overview of the landscape for healthcare Internet of Things use in Oxford4. Recommendations for PITCH-In proof of concept projectsMethodsThis paper describes the proof-of-concept (PoC) projects that will be created to explore both cost effectiveness, clinical efficacy and user adoption of IoMT systems. The projects will focus on three areas: 1) Bring your own device (BYOD) Integration, 2) Chronic Disease Management and 3) Personal Health Records. ResultsThis project is funded by Research England’s Connecting Capability (CCF) fund. The project started on March 2018 and results are expected by the end of 2019. ConclusionsEmbracing digital solutions to support the evolution and transformation of health services is essential. Importantly, this should not simply be undertaken by providers in isolation. It must embrace and exploit the advances being seen in the consumer devices, national rollout o
Lam C, Meinert E, Alturkistani A, et al., 2018, Decision support tools for regenerative medicine: systematic review (Preprint), Publisher: JMIR Publications
Background:Decisional tools have demonstrated their importance in informing manufacturing and commercial decisions in the monoclonal antibody domain. Recent approved therapies in regenerative medicine have shown great clinical benefits to patients.Objective:The objective of this review was to investigate what decisional tools are available and what issues and gaps have been raised for their use in regenerative medicine.Methods:We systematically searched MEDLINE to identify articles on decision support tools relevant to tissue engineering, and cell and gene therapy, with the aim of identifying gaps for future decisional tool development. We included published studies in English including a description of decisional tools in regenerative medicines. We extracted data using a predesigned Excel table and assessed the data both quantitatively and qualitatively.Results:We identified 9 articles addressing key decisions in manufacturing and product development challenges in cell therapies. The decision objectives, parameters, assumptions, and solution methods were analyzed in detail. We found that all decisional tools focused on cell therapies, and 6 of the 9 reviews focused on allogeneic cell therapy products. We identified no available tools on tissue-engineering and gene therapy products. These studies addressed key decisions in manufacturing and product development challenges in cell therapies, such as choice of technology, through modeling.Conclusions:Our review identified a limited number of decisional tools. While the monoclonal antibodies and biologics decisional tool domain has been well developed and has shown great importance in driving more cost-effective manufacturing processes and better investment decisions, there is a lot to be learned in the regenerative medicine domain. There is ample space for expansion, especially with regard to autologous cell therapies, tissue engineering, and gene therapies. To consider the problem more comprehensively, the full needle
Meinert E, Alturkistani A, Brindley D, et al., 2018, Weighing benefits and risks in aspects of security, privacy and adoption of technology in a value-based healthcare system, BMC Medical Informatics and Decision Making, Vol: 18, ISSN: 1472-6947
Technology can potentially enable the implementation of a value-based healthcare system, where the impact of quality of care is offered at optimised cost for maximised patient benefit. Technology can deliver value by aiding in data collection to evaluate outcomes and measure costs on a patient and population level. Healthcare organisations, however, face several challenges and risks that result almost exclusively from the use of these technologies.
Hu R, van Velthoven MH, Meinert E, 2018, Perspectives of People Who Are Overweight and Obese on Using Wearable Technology for Weight Management: Systematic Review (Preprint)
<sec> <title>BACKGROUND</title> <p>Obesity is a large contributor to preventable chronic diseases and health care costs. The efficacy of wearable devices for weight management has been researched; however, there is limited knowledge on how these devices are perceived by users.</p> </sec> <sec> <title>OBJECTIVE</title> <p>This study aimed to review user perspectives on wearable technology for weight management in people who are overweight and obese.</p> </sec> <sec> <title>METHODS</title> <p>We searched the online databases Pubmed, Scopus, Embase, and the Cochrane library for literature published from 2008 onward. We included all types of studies using a wearable device for delivering weight-loss interventions in adults who are overweight or obese, and qualitative data were collected about participants' perspectives on the device. We performed a quality assessment using criteria relevant to different study types. The Cochrane risk of bias tool was used for randomized controlled trials. The Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) was used for nonrandomized studies. The Oxman and Guyatt Criteria were used for systematic reviews. We used the critical appraisal checklist for qualitative studies. Data were extracted into a data extraction sheet and thematically analyzed.</p> </sec> <sec> <title>RESULTS</title> <p>We included 19 studies: 5 randomized controlled trials, 6 nonrandomized studies, 5 qualitative studies, and 3 reviews. Mixed perceptions existed for different constructs of wearable technologies, which re
Vazirani AA, O'Donoghue O, Brindley D, et al., 2018, Implementing Blockchains for Efficient Health Care: Systematic Review (Preprint)
<sec> <title>BACKGROUND</title> <p>The decentralized nature of sensitive health information can bring about situations where timely information is unavailable, worsening health outcomes. Furthermore, as patient involvement in health care increases, there is a growing need for patients to access and control their data. Blockchain is a secure, decentralized online ledger that could be used to manage electronic health records (EHRs) efficiently, therefore with the potential to improve health outcomes by creating a conduit for interoperability.</p> </sec> <sec> <title>OBJECTIVE</title> <p>This study aimed to perform a systematic review to assess the feasibility of blockchain as a method of managing health care records efficiently.</p> </sec> <sec> <title>METHODS</title> <p>Reviewers identified studies via systematic searches of databases including PubMed, MEDLINE, Scopus, EMBASE, ProQuest, and Cochrane Library. Suitability for inclusion of each was assessed independently.</p> </sec> <sec> <title>RESULTS</title> <p>Of the 71 included studies, the majority discuss potential benefits and limitations without evaluation of their effectiveness, although some systems were tested on live data.</p> </sec> <sec> <title>CONCLUSIONS</title> <p>Blockchain could create a mechanism to manage access to EHRs stored on the cloud. Using a blockchain can increase interoperability while maintaining privacy and security of data. It contains
O'Donoghue O, Vazirani AA, Brindley D, et al., 2018, Design Choices and Trade-Offs in Health Care Blockchain Implementations: Systematic Review (Preprint)
<sec> <title>BACKGROUND</title> <p>A blockchain is a list of records that uses cryptography to make stored data immutable; their use has recently been proposed for electronic medical record (EMR) systems. This paper details a systematic review of trade-offs in blockchain technologies that are relevant to EMRs. Trade-offs are defined as “a compromise between two desirable but incompatible features.”</p> </sec> <sec> <title>OBJECTIVE</title> <p>This review’s primary research question was: “What are the trade-offs involved in different blockchain designs that are relevant to the creation of blockchain-based electronic medical records systems?”</p> </sec> <sec> <title>METHODS</title> <p>Seven databases were systematically searched for relevant articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Papers published from January 1, 2017 to June 15, 2018 were selected. Quality assessments of papers were performed using the Risk Of Bias In Non-randomized Studies—of Interventions (ROBINS-I) tool and the Critical Assessment Skills Programme (CASP) tool. Database searches identified 2885 articles, of which 15 were ultimately included for analysis.</p> </sec> <sec> <title>RESULTS</title> <p>A total of 17 trade-offs were identified impacting the design, development, and implementation of blockchain systems; these trade-offs are organized into themes, including business, application, data, and technology architecture.</p> </sec>
Alturkistani A, Majeed F, Car J, et al., 2018, Health information technology uses for primary prevention in preventive medicine: A scoping review protocol, BMJ Open, Vol: 8, ISSN: 2044-6055
Introduction The use of health information technologies (HITs) has been associated with positive benefits such as improved health outcomes and improved health services. Results from empirical studies reported potential benefits of HITs in preventive medicine measures such as primary prevention. This review will examine the broad range of HITs and their uses and effectiveness in primary prevention.Methods and analysis We will conduct searches in relevant databases (MEDLINE, EMBASE, the Cochrane Methodology Register, Cochrane Database of Systematic Reviews, CINAHL, SCOPUS and Web of Science) using Arksey and O’Malley’s scoping review methodology. The scoping review will include all study designs to identify the literature on HIT uses. Two reviewers will independently screen the literature following our screening criteria and using a data abstraction form. Findings will be summarised quantitatively (using numerical counts of HITs) and qualitatively (using narrative synthesis).Ethics and dissemination The study will synthesise data from published literature and will not require an ethical approval. The results of the review will be disseminated through a peer-reviewed journal.
Meinert E, Van Velthoven M, Brindley D, et al., 2018, The internet of things in health care in Oxford: protocol for proof-of-concept projects (Preprint), Publisher: JMIR Publications
Background:Demands on health services across are increasing because of the combined challenges of an expanding and aging population, alongside complex comorbidities that transcend the classical boundaries of modern health care. Continuing to provide and coordinate care in the current manner is not a viable route to sustain the improvements in health outcomes observed in recent history. To ensure that there continues to be improvement in patient care, prevention of disease, and reduced burden on health systems, it is essential that we adapt our models of delivery. Providers of health and social care are evolving to face these pressures by changing the way they think about the care system and, importantly, how to involve patients in the planning and delivery of services.Objective:The objective of this paper is to provide (1) an overview of the current state of Internet of Things (IoT) and key implementation considerations, (2) key use cases demonstrating technology capabilities, (3) an overview of the landscape for health care IoT use in Oxford, and (4) recommendations for promoting the IoT via collaborations between higher education institutions and industry proof-of-concept (PoC) projects.Methods:This study describes the PoC projects that will be created to explore cost-effectiveness, clinical efficacy, and user adoption of Internet of Medical Things systems. The projects will focus on 3 areas: (1) bring your own device integration, (2) chronic disease management, and (3) personal health records.Results:This study is funded by Research England’s Connecting Capability Fund. The study started in March 2018, and results are expected by the end of 2019.Conclusions:Embracing digital solutions to support the evolution and transformation of health services is essential. Importantly, this should not simply be undertaken by providers in isolation. It must embrace and exploit the advances being seen in the consumer devices, national rollout of high-speed broadband servi
Meinert E, Alturkistani A, Car J, et al., 2018, Real-world evidence for postgraduate students and professionals in healthcare: protocol for the design of a blended massive open online course, BMJ Open, Vol: 8, Pages: 1-5, ISSN: 2044-6055
Introduction:There is an increased need for improving data science skills of healthcare professionals. MassiveOpen Online Courses (MOOCs) provide the opportunity to train professionals in a sustainable andcost-effective way. We present a protocol for the design and development of a blended MOOC onRWE aimed at improving RWE data science skills. The primary objective is to provide the opportunityto understand the fundamentals of RWE data science and to implement methods for analysing RWD.The blended format of the MOOC will combine the expertise of healthcare professionals joining thecourse online with the students on-campus. We expect learners to take skills taught in the MOOCand use them to seek new employment or start to initiatives in these domains.Methods and Analysis:The proposed MOOC will be developed through a blended format using the ADDIE (Analysis, Design,Development, Implementation and Evaluation) instructional design model and following theconnectivist-heutagogical learning theories (as a hybrid MOOC). The target learners will includepostgraduate students and professionals working in the health-related roles with interest in datascience. An evaluation of the MOOC will be performed to assess the MOOCs success in meeting itsintended outcomes and to improve future iterations of the course.Ethics and dissemination:The education course design protocol was approved by EIT Health (Grant 18654) as part of the EITHealth CAMPUS Deferred Call for Innovative Education 2018. Results will be published in a peerreviewedjournal.
van Velthoven MH, Wyatt JC, Meinert E, et al., 2018, How standards and user involvement can improve app quality: A lifecycle approach, INTERNATIONAL JOURNAL OF MEDICAL INFORMATICS, Vol: 118, Pages: 54-57, ISSN: 1386-5056
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Foley K, Alturkistani A, Carter A, et al., 2018, Massive Open Online Courses (MOOC) evaluation methods: protocol for a systematic review (preprint), Publisher: JMIR Publications
Background: Massive open online courses (MOOCs) have increased in popularity in recent years. They target a wide variety of learners and use novel teaching approaches, yet often exhibit low completion rates (10%). It is important to evaluate MOOCs to determine their impact and effectiveness, but little is known at this point about the methodologies that should be used for evaluation.Objective: The purpose of this paper is to provide a protocol for a systematic review on MOOC evaluation methods.Methods: We will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines for reporting this protocol. We developed a population, intervention, comparator, and outcome (PICO) framework to guide the search strategy, based on the overarching question, “What methods have been used to evaluate MOOCs?” The review will follow six stages: 1) literature search, 2) article selection, 3) data extraction, 4) quality appraisal, 5) data analysis, and 6) data synthesis.Results: The systematic review is ongoing. We completed the data searches and data abstraction in October and November 2018. We are now analyzing the data and expect to complete the systematic review by March 2019.Conclusions: This systematic review will provide a useful summary of the methods used for evaluation of MOOCs and the strengths and limitations of each approach. It will also identify gaps in the literature and areas for future work.
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