146 results found
HARRIS M, 2023, Decolonizing healthcare innovation low-cost solutions from low-income countries, Publisher: Routledge, ISBN: 9781032284958
This fascinating book offers a pathway for the NHS to adopt low-cost but effective innovations from areas of the world traditionally seen as beneficiaries rather than providers of help and support.
Teixeira CS, Fernandes TG, Dias MAB, et al., 2023, Correction to: Perinatal Health in Amazon Triple Border Region: Cross-Sectional Analysis Comparing Outcomes in the Brazilian, Peruvian and Colombian Population., Matern Child Health J
Lennox L, Antonacci G, Harris M, et al., 2023, ’Unpacking the ‘process of sustaining’—identifying threats to sustainability and the strategies used to address them: a longitudinal multiple case study, Implementation Science Communications, Vol: 4, Pages: 1-18, ISSN: 2662-2211
BackgroundAlthough sustainability remains a recognised challenge for Quality Improvement (QI) initiatives, most available research continues to investigate sustainability at the end of implementation. As a result, the learning and continuous adjustments that shape sustainability outcomes are lost. With little understanding of the actions and processes that influence sustainability within QI initiatives, there is limited practical guidance and direction on how to enhance the sustainability of QI initiatives. This study aims to unpack the ‘process of sustaining’, by exploring threats to sustainability encountered throughout the implementation of QI Initiatives and identifying strategies used by QI teams to address these threats over time.MethodsA longitudinal multiple case study design was employed to follow 4 QI initiatives over a 3-year period. A standardised sustainability tool was used quarterly to collect perceptions of sustainability threats and actions throughout implementation. Interviews (n=38), observations (32.5 h), documentary analysis, and a focus group (n=10) were conducted to enable a greater understanding of how the process of sustaining is supported in practice. Data were analysed using the Consolidated Framework for Sustainability (CFS) to conduct thematic analysis.ResultsAnalysis identified five common threats to sustainability: workforce stability, improvement timelines, organisational priorities, capacity for improvement, and stakeholder support. Each of these threats impacted multiple sustainability constructs demonstrating the complexity of the issues encountered. In response to threats, 12 strategies to support the process of sustaining were identified under three themes: engagement (five strategies that promoted the development of relationships), integration (three strategies that supported initiatives to become embedded within local systems), and adaptation (four strategies that enhanced understanding of, and response to, emergent
Teixeira CS, Fernandes TG, Dias MAB, et al., 2023, Perinatal health in Amazon triple border region: cross-sectional analysis comparing outcomes in the Brazilian, Peruvian and Colombian population, Maternal and Child Health Journal, ISSN: 1092-7875
ObjectiveTo investigate the perinatal outcomes in Brazilian, Peruvian, and Colombian women in a Brazilian reference maternity hospital based at Amazon triple border region.MethodA cross-sectional case study of data from 3242 live birth certificates issued at the Tabatinga public maternity hospital, in the countryside of Amazonas, in the period between January 2015 and December 2017. Maternal and perinatal independent variables were analysed based on central tendency and variability, and frequency distribution for categorical variables. The Pearson’s Chi-Square test and univariate analyses were performed to estimate probability ratios (Odds Ratio-OR).ResultsSignificant differences were found in the education level in the three population groups, as well as in the number of previous pregnancies, antenatal consultations, month of initial prenatal care, and type of delivery. Brazilian pregnant women had more prenatal consultations, caesarean sections, and premature births. Peruvian and Colombian women started antenatal care later, and those with high-risk pregnancies tended to deliver in their home country.Conclusion for PracticeOur findings show some singularities in the care of women and infants in the Amazonian triple border region. The Brazilian Unified Health Care System performs an important role in the guarantee of free access to health services, and ensures comprehensive care for women and infants, promoting human rights in border regions regardless of nationality.
Antonacci G, Whitney J, Harris M, et al., 2023, How do healthcare providers use national audit data for improvement?, BMC Health Services Research, Vol: 23, Pages: 1-17, ISSN: 1472-6963
BackgroundSubstantial resources are invested by Health Departments worldwide in introducing National Clinical Audits (NCAs). Yet, there is variable evidence on the NCAs’ effectiveness and little is known on factors underlying the successful use of NCAs to improve local practice. This study will focus on a single NCA (the National Audit of Inpatient Falls -NAIF 2017) to explore: (i) participants’ perspectives on the NCA reports, local feedback characteristics and actions undertaken following the feedback underpinning the effective use of the NCA feedback to improve local practice; (ii) reported changes in local practice following the NCA feedback in England and Wales.MethodsFront-line staff perspectives were gathered through interviews. An inductive qualitative approach was used. Eighteen participants were purposefully sampled from 7 of the 85 participating hospitals in England and Wales. Analysis was guided by constant comparative techniques.ResultsRegarding the NAIF annual report, interviewees valued performance benchmarking with other hospitals, the use of visual representations and the inclusion of case studies and recommendations. Participants stated that feedback should target front-line healthcare professionals, be straightforward and focused, and be delivered through an encouraging and honest discussion. Interviewees highlighted the value of using other relevant data sources alongside NAIF feedback and the importance of continuous data monitoring. Participants reported that engagement of front-line staff in the NAIF and following improvement activities was critical. Leadership, ownership, management support and communication at different organisational levels were perceived as enablers, while staffing level and turnover, and poor quality improvement (QI) skills, were perceived as barriers to improvement. Reported changes in practice included increased awareness and attention to patient safety issues and greater involvement of patients and staff in
Banstola A, Pokhrel S, Hayhoe B, et al., 2023, Economic evaluations of interventional opportunities for the management of mental–physical multimorbidity: a systematic review, BMJ Open, Vol: 13, Pages: 1-10, ISSN: 2044-6055
Objectives Economic evaluations of interventions for people with mental–physical multimorbidity, including a depressive disorder, are sparse. This study examines whether such interventions in adults are cost-effective.Design A systematic review.Data sources MEDLINE, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Scopus, Web of Science and NHS EED databases were searched until 5 March 2022.Eligibility criteria We included studies involving people aged ≥18 with two or more chronic conditions (one being a depressive disorder). Economic evaluation studies that compared costs and outcomes of interventions were included, and those that assessed only costs or effects were excluded.Data extraction and synthesis Two authors independently assessed risk of bias in included studies using recommended checklists. A narrative analysis of the characteristics and results by type of intervention and levels of healthcare provision was conducted.Results A total of 19 studies, all undertaken in high-income countries, met inclusion criteria. Four intervention types were reported: collaborative care, self-management, telephone-based and antidepressant treatment. Most (14 of 19) interventions were implemented at the organisational level and were potentially cost-effective, particularly, the collaborative care for people with depressive disorder and diabetes, comorbid major depression and cancer and depression and multiple long-term conditions. Cost-effectiveness ranged from £206 per quality-adjusted life year (QALY) for collaborative care programmes for older adults with diabetes and depression at primary care clinics (USA) to £79 723 per QALY for combining collaborative care with improved opportunistic screening for adults with depressive disorder and diabetes (England). Conclusions on cost-effectiveness were constrained by methodological aspects of the included studies: choice of perspectives, time horizon and costing methods.Conclusions Economic evaluations of inte
Harris M, Lokugamage A, Chetwynd C, 2023, Biomedical research and global sustainability: throwing off the straight jacket of hierarchical thinking, making space for nomadic thinking, Decolonial Subversions, Vol: 3, Pages: 1-10
The biomedical paradigm, characterised by the separation of human from nature, of mind from body, and of ‘us’ from ‘them’, is encrusted with the jewels of western exploitation. Its legacy, one of many, has been to permit critical thinking to be infused with the domination of scientific knowledge over indigenous knowledge, of expert experience over patient experience, and of western knowledge over knowledge from other regions. Planetary sustainability has put us all into an uncomfortable liminal space where there is an urgent need to develop new ways of thinking to navigate the complexity and uncertainties of the Anthropocene. The decolonization/dismantling of the historically biased, epistemically rigid, hierarchical thinking that has led us to the brink of environmental collapse must re-centre a more ‘nomadic’ or ‘rhizomic’ type of thinking that works against the grain of traditional western categories and conventional methods, making breathing space for experiential person-centred, ecological wisdom to blossom. What might this look like for global health and academia? Practicing medicine using an ecological lens; a system with geographically diverse representation in the authorship of scientific literature; methodological diversity in the top journals, placing qualitative research, stories and art on an equal footing with Randomised Controlled Trials; and editorial boards composed in part of lay members. A more inclusive academe, through Cultural Safety, where works from patients, service users, indigenous community voices are published alongside and co-produced with expert/professional communities is a step in the right direction.
Dallera G, Alaa A, Kreindler J, et al., 2022, Evaluating the feasibility and acceptability of a safety protocol to mitigate SARS-CoV-2 transmission risks when participating in full-capacity live mass events: a cross-sectional survey and interview-based study, BMJ Open, Vol: 12, ISSN: 2044-6055
Objective: Investigate the feasibility and acceptability of a novel COVID-19 safety protocol combining professionally witnessed home-based videoed pre-event testing and a data-driven risk assessment model that was piloted at the Standon Calling Festival in July 2021.Design: Observational study using a sequential explanatory mixed-methods design involving a survey, personal interviews and group discussions with a cross section of participants.Setting: Standon Calling Festival, Hertfordshire, England.Participants: 4726 adults who attended Standon Calling and consented to participate in the study.Results: Nearly a quarter (23.1%; 1093) attendees (women 65%, men 35%) responded to the postevent survey. Eleven participants were interviewed before thematic saturation was reached. The majority (81.0%) of respondents found the at-home testing protocol convenient and of reasonable cost (73.6%). Confidence in the test result was enhanced due to professional-supported videoing (76.2%), whereas 72.6% had confidence in the security of the data. Videoed self-testing helped 45.0% of respondents to feel more confident in their lateral flow testing technique. The majority (85.5%) felt safer at the event and 93.7% agreed that the protocol did not interfere with their enjoyment of the event. Themes generated from interviews showed that the protocol could be applied to other disease areas and events, but there were concerns that over-reliance on test results alone could lead some people to have a false sense of security around the safety of the live event.Conclusions: Our study showed that a protocol that combines professionally witnessed home-based videoed pre-event testing is highly acceptable and feasible, and it can inform decision making and support the safe reopening of live mass events at full capacity. Although COVID-19 is now considered endemic in the UK, this protocol can be of value for other countries where the live events industry remains heavily impacted. Risk modelling sh
Harris P, Kirkland R, Masanja S, et al., 2022, Strengthening the primary care workforce to deliver high quality care for non-communicable diseases in refugee settings: lessons learnt from a UNHCR partnership, BMJ Global Health, Vol: 7, Pages: 1-10, ISSN: 2059-7908
Non-communicable disease (NCD) prevention and care in humanitarian contexts has been a long-neglected issue. Health care systems in humanitarian settings have focused heavily on communicable diseases and immediate life-saving health needs. NCDs are a significant cause of morbidity and mortality in refugee settings, however in many situations NCD care is not well integrated into primary health care services. Increased risk of poorer outcomes from Covid 19 for people living with NCDs has heightened the urgency of responding to NCDs and shone a spotlight on their relativeneglect in these settings. Partnering with the United Nations Refugee Agency (UNHCR) since 2014, Primary Care International (PCI) has provided clinical guidance and Training of Trainer (ToT) courses on NCDs to 649 health professionals working in primary care in refugee settings in 13 countries. Approximately 2,300 healthcare workers (HCW) have been reached through cascade trainings over the last six years. Our experience has shown that, despite fragile health services, high staff turnover and competing clinical priorities, it is possible to improve NCD knowledge, skills, and practice. ToT programmes are a feasible and practical format to deliver NCD trainingto mixed groups of healthcare workers (doctors, nurses, technical officers, pharmacy technicians and community health workers). Clinical guidance must be adapted to local settings whilst co-creating an enabling environment for health workers is essential to deliver accessible, high-quality continuity of care for NCDs. On-going support for non clinical systems change is equally critical for sustained impact. A shared responsibility for cascade training - and commitment from local health partners - is necessary to raise NCD awareness, influence local and national policy and to meet the UNHCR’sobjective of facilitating access to integrated prevention and control of NCDs.
Dallera G, Skopec M, Barlow J, et al., 2022, Review of a frugal cooling mattress to induce therapeutic hypothermia for treatment of hypoxic-ischaemic encephalopathy in the UK NHS, Globalization and Health, Vol: 18, ISSN: 1744-8603
Hypoxic ischaemic encephalopathy (HIE) is a major cause of neonatal mortality and disability in the United Kingdom (UK) and has significant human and financial costs. Therapeutic hypothermia (TH), which consists of cooling down the newborn’s body temperature, is the current standard of treatment for moderate or severe cases of HIE. Timely initiation of treatment is critical to reduce risk of mortality and disability associated with HIE. Very expensive servo-controlled devices are currently used in high-income settings to induce TH, whereas low-income settings rely on the use of low-tech devices such as water bottles, ice packs or fans. Cooling mattresses made with phase change materials (PCMs) were recently developed as a safe, efficient, and affordable alternative to induce TH in low-income settings. This frugal innovation has the potential to become a reverse innovation for the National Health Service (NHS) by providing a simple, efficient, and cost-saving solution to initiate TH in geographically remote areas of the UK where cooling equipment might not be readily available, ensuring timely initiation of treatment while waiting for neonatal transport to the nearest cooling centre. The adoption of PCM cooling mattresses by the NHS may reduce geographical disparity in the availability of treatment for HIE in the UK, and it could benefit from improvements in coordination across all levels of neonatal care given challenges currently experienced by the NHS in terms of constraints on funding and shortage of staff. Trials evaluating the effectiveness and safety of PCM cooling mattresses in the NHS context are needed in support of the adoption of this frugal innovation. These findings may be relevant to other high-income settings that experience challenges with the provision of TH in geographically remote areas. The use of promising frugal innovations such as PCM cooling mattresses in high-income settings may also contribute to challenge the dominant narrative that
Price R, Skopec M, Mackenzie S, et al., 2022, A novel data solution to inform curriculum decolonisation: the case of the Imperial College London Masters of Public Health, Scientometrics: an international journal for all quantitative aspects of the science of science, communication in science and science policy, Vol: 127, Pages: 1021-1037, ISSN: 0138-9130
There is increasing interest within Higher Education Institutions (HEIs) to examine curricula for legacies of colonialism or empire that might result in a preponderance of references to research from the global north. Prior attempts to study reading lists for author geographies have employed resource-intensive audit and data collection methods based on manual searching and tagging individual reading list items by characteristics such as author country or place of publication. However, these manual methods are impractical for large reading lists with hundreds of citations that change over instances the course is taught. Laborious manual methods may explain why there is a lack of quantitative evidence to inform this debate and the understanding of geographic distribution of curricula. We describe a novel computational method applied to 568 articles, representing 3166 authors from the Imperial College London Masters in Public Health programme over two time periods (2017–18 and 2019–20). Described with summary statistics, we found a marginal shift away from global north-affiliated authors on the reading lists of one Masters course over two time periods and contextualise the role and limitations of the use of quantitative data in the decolonisation discourse. The method provides opportunities for educators to examine the distribution of course readings at pace and over time, serving as a useful point of departure to engage in decolonisation debates.
Downey LE, Harris M, Jan S, et al., 2021, Global health system resilience is in everyone's interest., BMJ, Vol: 375, Pages: 1-2, ISSN: 1759-2151
Donnat C, Bunbury F, Liu D, et al., 2021, Predicting COVID-19 transmission to inform the management of mass events: a model-based approach, JMIR Public Health and Surveillance, Vol: 7, ISSN: 2369-2960
Background:Modelling COVID-19 transmission at live events and public gatherings is essential to control the probability of subsequent outbreaks and communicate to participants their personalised risk. Yet, despite the fast-growing body of literature on COVID transmission dynamics, current risk models either neglect contextual information on vaccination rates or disease prevalence or do not attempt to quantitatively model transmission.Objective:This paper attempts to bridge this gap by providing informative risk metrics for live public events, along with a measure of their uncertainty.Methods:Building upon existing models, our approach ties together three main components: (a) reliable modelling of the number of infectious cases at the time of the event, (b) evaluation of the efficiency of pre-event screening, and (c) modelling of the event’s transmission dynamics and their uncertainty along using Monte Carlo simulations.Results:We illustrate the application of our pipeline for a concert at the Royal Albert Hall and highlight the risk’s dependency on factors such as prevalence, mask wearing, or event duration. We demonstrate how this event held on three different dates (August 20th 2020, January 20th 2021, and March 20th 2021) would likely lead to transmission events that are similar to community transmission rates (0.06 vs 0.07, 2.38 vs 2.39, and 0.67 vs 0.60, respectively). However, differences between event and background transmissions substantially widen in the upper tails of the distribution of number of infections (as denoted by their respective 99th quantiles: 1 vs 1, 19 vs 8, and 6 vs 3 for our three dates), further demonstrating that sole reliance on vaccination and antigen testing to gain entry would likely significantly underestimate the tail risk of the event.Conclusions:Despite the unknowns surrounding COVID-19 transmission, our estimation pipeline opens the discussion on contextualized risk assessment by combining the best tools at hand to as
Harris M, Kreindler J, Donnat C, et al., 2021, Rapid response to BMJ: Are vaccine passports and covid passes a valid alternative to lockdown?, BMJ: British Medical Journal, Vol: 375, ISSN: 0959-535X
Issa H, Townsend W, Harris M, 2021, Benefiting the NHS through innovation: how to ensure international health partnerships are genuinely reciprocal Comment, BMJ Global Health, Vol: 6, Pages: 1-3, ISSN: 2059-7908
Shimizu H, Pacheco Santos L, Sanchez M, et al., 2021, Challenges facing the more doctors program (Programa Mais Médicos) in vulnerable and peri-urban areas in Greater Brasilia, Brazil, Human Resources for Health, Vol: 19, Pages: 1-8, ISSN: 1478-4491
BackgroundA shortage of physicians, especially in vulnerable and peri-urban areas, is a global phenomenon that has serious implications for health systems, demanding policies to assure the provision and retention of health workers. The aim of this study was to analyze the strategies employed by the More Doctors Program (Programa Mais Médicos) to provide primary care physicians in vulnerable and peri-urban parts of Greater Brasilia.MethodsThe study used a qualitative approach based on the precepts of social constructivism. Forty-nine semi-structured interviews were conducted: 24 with physicians employed as part of the More Doctors program, five with program medical supervisors, seven with secondary care physicians, twelve with primary care coordinators, and one federal administrator. The interviews occurred between March and September 2019. The transcripts of the interviews were submitted to thematic content analysis.ResultsThe partnership between the Ministry of Health and local authorities was essential for the provision of doctors—especially foreign doctors, most from Cuba, to assist vulnerable population groups previously without access to the health system. There was a notable presence of doctors with experience working with socioeconomically disadvantaged populations, which was important for gaining a better understanding of the effects of the endemic urban violence in the region. The incentives and other institutional support, such as enhanced salaries, training, and housing, transportation, and food allowances, were factors that helped provide a satisfactory working environment. However, the poor state of the infrastructure at some of the primary care units and limitations of the health service as a whole were factors that hampered the provision of comprehensive care, constituting a cause of dissatisfaction.ConclusionsMore Doctors introduced a range of novel strategies that helped ensure a supply of primary care doctors in vulnerable and peri-urb
Stefani G, Skopec M, Battersby C, et al., 2021, Why is Kangaroo Mother Care not yet scaled in the UK? A systematic review and realist synthesis of a frugal innovation for newborn care, BMJ Innovations, Vol: 8, Pages: 9-20, ISSN: 2055-642X
Objective: Kangaroo Mother Care (KMC) is a frugal innovation improving newborn health at a reduced cost compared with incubator use. KMC is widely recommended; however, in the UK, poor evidence exists on KMC, and its implementation remains inconsistent.Design: This Systematic Review and Realist Synthesis explores the barriers and facilitators in the implementation of KMC in the UK.Data source: OVID databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and Google Scholar were searched.Eligibility criteria: Studies were UK based, in maternity/neonatal units, for full-term/preterm children. First screening included studies on (1) KMC, Kangaroo Care (KC) or skin-to-skin contact (SSC) or (2) Baby Friendly Initiative, Small Wonders Change Program or family-centred care if in relation to KMC/KC/SSC. Full texts were reviewed for evidence regarding KMC/KC/SSC implementation.Results: The paucity of KMC research in the UK did not permit a realist review. However, expanded review of available published studies on KC and SSC, used as a proxy to understand KMC implementation, demonstrated that the main barriers are the lack of training, knowledge, confidence and clear guidelines.Conclusion: The lack of KMC implementation research in the UK stands in contrast to the already well-proven benefits of KMC for stable babies in low-income contexts and highlights the need for further research, especially in sick and small newborn population. Implementation of, and research into, KC/SSC is inconsistent and of low quality. Improvements are needed to enhance staff training and parental support, and to develop guidelines to properly implement KC/SSC. It should be used as an opportunity to emphasise the focus on KMC as a potential cost-effective alternative to reduce the need for incubator use in the UK.
Frugal innovation (FI), which has gained traction in various sectors, is loosely defined as developing quality solutions in a resource-constrained environment that are affordable to low-income consumers. However, with its popularity, multiple and diverse definitions have emerged that often lack a theoretical foundation. This has led to a convoluted conceptualisation that hinders research and adoption in practice. Despite this plethora of perspectives and definitions, scholars do agree that there is a need for a unified definition. This critical review across the management, entrepreneurship, business and organisation studies literatures explores the multiple definitions of FI that have appeared in the last two decades and seeks to examine the commonalities and differences. One definition is supported by a theoretical underpinning, and main themes include affordability, adaptability, resource scarcity, accessibility and sustainability, however, there remains significant ambiguity around what constitutes an FI. Defining FI as a concept should not deter from focusing on its core aim and identifying an FI may be best achieved by comparing it to an incumbent alternative, rather than against an ill-defined concept. There is merit in developing a common understanding of FI to support strategies for its successful acceptance and diffusion globally.
Harris M, 2021, Book Review: Inflamed: Deep Medicine and the Anatomy of Injustice by Rupa Marya and Raj Patel, Publisher: BMJ Publishing Group, ISBN: 9780374602512
Sharma D, Harris M, Agrawal V, et al., 2021, Plea for standardised reporting of frugal innovations, BMJ Innovations, Vol: 7, Pages: 642-646, ISSN: 2055-8074
Skopec M, Fyfe M, Issa H, et al., 2021, Decolonization in a higher education STEMM institution – is ‘epistemic fragility’ a barrier?, London Review of Education, Vol: 19, Pages: 1-21, ISSN: 1474-8460
Central to the decolonial debate is how high-income countries (HICs) have systematically negated ways of knowing from low- and middle-income countries (LMICs), and yet the paucity of empirical decolonization studies leaves educators relatively unsupported as to whether, and how, to address privilege in higher education. Particularly in science, technology, engineering, mathematics and medicine (STEMM) institutions, there are few published examples of attempts to engage faculty in these debates. In 2018–19, we invited faculty on a master’s in public health course to engage with the decolonization debate by providing: (1) descriptive reading list analyses to all 16 module leads in the master’s programme to invite discussion about the geographic representation of readings; (2) an implicit association test adapted to examine bias towards or against research from LMICs; (3) faculty workshops exploring geographic bias in the curriculum; and (4) interviews to discuss decolonization of curricula and current debates. These initiatives stimulated debate and reflection around the source of readings for the master’s course, a programme with a strong STEMM focus, and the possibility of systemic barriers to the inclusion of literature from universities in LMICs. We propose the notion of epistemic fragility, invoking DiAngelo’s (2011) ‘white fragility’, because some of the responses appeared to result from the challenge to perceived meritocracy, centrality, authority, individuality and objectivity of the HIC episteme that this initiative invites. We posit that the effortful reinstatement of a status quo regarding knowledge hierarchies in the global context, although not a representative reaction, can lead to a significant impact on the initiative in general. Efforts to decolonize curricula require actions at both the individual and organizational levels and, in particular, a managed process of careful engagement so that fragility reactions
Harris M, Kreindler J, El-Osta A, et al., 2021, Safe management of full-capacity live/mass events in COVID19 will require mathematical, epidemiological and economic modelling, Journal of the Royal Society of Medicine, Vol: 114, Pages: 290-294, ISSN: 0141-0768
Donnat C, Bunbury F, Kreindler J, et al., 2021, A Predictive Modelling Framework for COVID-19 Transmission to Inform the Management of Mass Events, Journal of Medical Internet Research, ISSN: 1438-8871
Price R, Skopec M, Mackenzie S, et al., 2021, A novel data solution to analyse curriculum decolonisation – the case of Imperial College London Masters in Public Health
Analyses of reading lists by some UK Higher Education institutions in attempt to identify bias in curricula have found a prevalence of articles from the global north. However, previous studies have employed resource-intensive audit and data collection methods such as the authors or volunteers manually searching for and tagging individual reading list items by characteristic such as author country or place of publication. This can be prohibitive to repeating the study at different time periods or on large reading list data sets, which leads to a gap in evidence-based data to support and inform curriculum decolonisation. We describe a novel computational method applied to 568 articles, representing 3,166 authors from the Imperial College London Masters in Public Health (MPH) programme over two time periods (2017-18 and 2019-20). Using summary statistics, we found a shift in composite geographic distribution of reading lists sources across the two time periods studied and relate this to interventions to decolonise the curriculum at Imperial. Our approach to applying a computational method to produce data as evidence in decolonisation toolkits is discussed.
Harris M, Saddi F, Parreira F, et al., 2021, Exploring front liners’ knowledge, participation and evaluation in the implementation of a pay for performance program (PMAQ) in primary health care in Brazil, Journal of Health, Organization and Management, ISSN: 0268-9235
Selhorst S, OToole RV, Slobogean GP, et al., 2021, Is a low-cost drill cover system non-inferior to conventional surgical drills for skeletal traction pin placement?, Journal of Orthopaedic Trauma, Vol: 35, Pages: e433-e436, ISSN: 0890-5339
The Drill Cover system was developed as a low-cost alternative to conventional surgical drills with specific applicability to low- and middle-income countries. However, the system may also be useful for the sterile placement of traction pins in the emergency department of high-income country hospitals. In September 2019, a US-based Level-1 trauma center began using the Drill Cover system to apply skeletal traction pins in patients with femoral shaft fractures. With these data, we performed a retrospective interrupted time series study to determine if the Drill Cover system was non-inferior to conventional surgical drills in terms of infections at the traction pin site. The study included 205 adult patients with femoral shaft fractures initially placed in skeletal traction using a conventional surgical drill (n=150, pre-intervention group) or the Drill Cover system (n=55, post-intervention group). The primary outcome was an infection at the site of skeletal traction pin placement that required surgery or antibiotics was compared between groups using a non-inferiority test with a one-sided alpha of 0.05 and a non-inferiority margin of 3%. No infections at the site of skeletal traction pin placement were found in either the pre-intervention or the post-intervention group (difference 0%, 95% CI: 0.0 to 1.4%, non-inferiority p-value<0.01). The results suggest that the Drill Cover system was non-inferior to conventional surgical drills regarding infections at the site of skeletal traction pins. The Drill Cover system may be a safe alternative to the more expensive surgical drills for skeletal traction pin placement in the emergency room environment.
Skopec M, Grillo A, Kureshi A, et al., 2020, Double standards in healthcare innovations: the case of mosquito net mesh for hernia repair, BMJ Innovations, Vol: 7, Pages: 482-490, ISSN: 2055-642X
With over two decades of evidence available including from randomised clinical trials, we explore whether the use of low-cost mosquito net mesh for inguinal hernia repair, common practice only in low-income and middle-income countries, represents a double standard in surgical care. We explore the clinical evidence, biomechanical properties and sterilisation requirements for mosquito net mesh for hernia repair and discuss the rationale for its use routinely in all settings, including in high-income settings. Considering that mosquito net mesh is as effective and safe as commercial mesh, and also with features that more closely resemble normal abdominal wall tissue, there is a strong case for its use in all settings, not just low-income and middle-income countries. In the healthcare sector specifically, either innovations should be acceptable for all contexts, or none at all. If such a double standard exists and worse, persists, it raises serious questions about the ethics of promoting healthcare innovations in some but not all contexts in terms of risks to health outcomes, equitable access, and barriers to learning.
Cash-Gibson L, Harris M, Guerra G, et al., 2020, A novel conceptual model and heuristic tool to strengthen understanding and capacities for health inequalities research, Health Research Policy and Systems, Vol: 18, Pages: 1-12, ISSN: 1478-4505
BackgroundDespite increasing evidence on health inequalities over the past decades, further efforts to strengthen capacities to produce research on this topic are still urgently needed to inform effective interventions aiming to address these inequalities. To strengthen these research capacities, an initial comprehensive understanding of the health inequalities research production process is vital. However, most existing research and models are focused on understanding the relationship between health inequalities research and policy, with less focus on the health inequalities research production process itself. Existing conceptual frameworks provide valuable, yet limited, advancements on this topic; for example, they lack the capacity to comprehensively explain the health (and more specifically the health inequalities) research production process at the local level, including the potential pathways, components and determinants as well as the dynamics that might be involved. This therefore reduces their ability to be empirically tested and to provide practical guidance on how to strengthen the health inequalities research process and research capacities in different settings. Several scholars have also highlighted the need for further understanding and guidance in this area to inform effective action.MethodsThrough a critical review, we developed a novel conceptual model that integrates the social determinants of health and political economy perspectives to provide a comprehensive understanding of how health inequalities research and the related research capacities are likely to be produced (or inhibited) at local level.ResultsOur model represents a global hypothesis on the fundamental processes involved, and can serve as a heuristic tool to guide local level assessments of the determinants, dynamics and relations that might be relevant to better understand the health inequalities research production process and the related research capacities.ConclusionsThis type of
Shimizu HE, Santos LMP, Sanchez MN, et al., 2020, Percepções acerca do Programa Mais Médicos e do Processo de Supervisão Acadêmica [Perceptions about the “Mais Médicos” Program and the Academic Supervision Process], Revista Brasileira de Educação Médica, Vol: 44, ISSN: 0100-5502
Abstract: Introduction: This study aims to analyze the perceptions of the involved actors about the “Mais Médicos” Program (PMM) and the academic supervision process, its strengths and weaknesses aiming to improve Primary Heath Care practices. Method: Qualitative study carried out through 05 in-depth interviews with PMM supervising doctors, and 24 interviews with unit managers, 12 Primary Heath Care coordinators, and 07 Secondary Health Care doctors. Results: Three thematic axes emerged from de analysis: benefits of the program for the municipalities and for the population; the challenges of the supervisory process and the difficulties of the fragmented health system. Conclusions: The actors’ perception of the “Mais Médicos” Program are positive, especially because it brought doctors to municipalities with vulnerable areas, where doctors did not go to and where they did not stay. Supervision is an important support for continuing in-service training; however, it requires a better articulation with the different levels of the health system management. The precariousness of the service network limits the performance of both doctors and supervisors, demonstrating that it is necessary to invest in a solid and effective care network. Moreover, it was once again evident that the population will face a shortage of doctors due to changes in health policies. It is necessary to build more comprehensive policies, that will not only result in sporadic provision of medical care. There is a need for continuous actions, better integrated to the healthcare networks, aiming at an efficient and effective healthcare system.
Harris M, Bourquin B, Ettehad D, 2020, International crisis-led healthcare innovation in response to the COVID-19 pandemic, London, UK, Publisher: NHS Confederation
The COVID-19 pandemic and associated lockdown measures have permeated close to all aspects of daily life, with immediate and profound effects on population health and its wider determinants. Across the globe there has been an explosion of innovation in response to the crisis, enabled by a sense of common purpose, the unfreezing of rigid organisational structures, processes and regulations, and huge increases in public expenditure.This report outlines some of the crisis-led innovations that have helped countries to cope during the first wave of COVID-19 infections and that may shape the ‘new normal’ in the years to come.It collates a number of innovations into six domains (stuff, staff, space, systems, surveillance and society), an adapted version of Farmer’s 4 S’s, which distils the elements that ‘make all the difference in saving lives during an outbreak’.This paper was written by external authors between June and September 2020. As such, it does not necessarily represent the views of the NHS Confederation or its members.
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