Objectives Validation and testing of a microneedle device capable of continuously monitoring lactate concentrations in healthy pregnant volunteers. Setting Clinical research facility in a Liverpool hospital in the UK. Participants Seven healthy pregnant women over 18 years old, with no previously diagnosed medical conditions and no reported pregnancy complications, were able to exercise gently for 30 min and do similar exercise routinely. Results A healthy volunteer proof-of-concept study was carried out measuring lactate continuously during a period of rest and gentle exercise in pregnant women. Women wore a microneedle device during 30 min of gentle exercise in order to monitor their interstitial lactate levels continuously along with having blood draws at regular intervals. Participants completed a questionnaire about their experience (average pain score 0.43/10, average discomfort score 0.14/10). Interstitial lactate mirrored trends in venous lactate in response to exercise. Conclusions In maternity care, lactate levels are used to support decision-making, especially around evolving sepsis during labour or post-partum haemorrhage management. Little is known about lactate levels during labour; they are presumed to rise due to anaerobic respiration brought about by physical exertion. However, whether in labour or not, if lactate levels rise above 2 mM intervention is triggered in the form of broad-spectrum antibiotics for treatment or prevention of sepsis. Lactate concentration provides a snapshot of a woman’s current clinical condition, which may alter rapidly. The device has possible application during labour and childbirth, where it could have a significant impact by triggering timely interventions while reducing exposure to unnecessary antibiotics. Trial registration number West of Scotland Research Ethics Committee 4 and prospectively registered ( ISRCTN38095366 ).

Digital and AI-driven technologies hold significant potential to enhance health system efficiency, equity and quality. One emerging area of interest is the use of AI-enabled virtual humans—interactive, avatar-based agents capable of providing health-related guidance through human-like conversations. On 22 October 2024, the WHO Health Promotion team, in collaboration with BMJ, convened a virtual roundtable to explore the role of AI-enabled virtual humans, exemplified by the WHO prototype tool, Smart AI Resource Assistant for Health (S.A.R.A.H.), in advancing public health goals. This meeting report summarises key discussions, challenges and strategies proposed by experts from diverse sectors and geographies to expand the impact of these tools in global health promotion.

IntroductionNHS 111 Wales is a free phone, nonemergency number that helps people get the right advice and treatment when needed. Clinicians, such as nurses and paramedics, work alongside health advisors to assess, advice and signpost patients.For various reasons, Welsh Ambulance Services NHS Trust (WAST) had to rapidly replace its ageing call handling and clinical assessment systems. This early-stage innovation report describes the development of the newly created and implemented Call Prioritisation Streaming System (CPSS), now in use in NHS 111 Wales for call handling. It will outline the approach taken to creating, in partnership, CPSS from the existing intellectual property of WAST and describe some of its key benefits.MethodsThe CPSS development process was adapted from various established processes. It included group preparation, engine preparation, protocol selection, alias creation, question topic, category, keyword creation, question rationale creation, full review, external peer-review process, engine testing and International Academies of Emergency Dispatch adoption and approval before implementation.ConclusionThis early-stage innovation report has outlined the creation of CPSS, which has already managed over 530 000 cases to date. The creation of such systems does not happen frequently, and the authors hope that in sharing this journey, learning might be adapted and taken into the creation of other systems or the evolution of existing protocols and systems.Learning will occur immediately, with data from outcomes, user feedback, patient experience reports and feedback from wider system partners all being considered, and early evaluation will be undertaken.

The clinical entrepreneur programme (CEP) plays a role in supporting, reatining and empowering NHS staff by fostering innovation within the healthcare system. Established to address systemic barriers that often lead clinicans to leave the NHS to pursue entrepreneurial endeavours, the CEP enables staff to develop and implement transformative healthcare solutions while remaining within the NHS workforce. This not only benefits the innovators but strengthens the NHS by promoting a culture of continuous improvement and adaptation to emerging medical technologies.A strength of the CEP is its inclusivity of a diverse range of clinical and non-clinical staff and students. Student Selected Component (SSC) projects have also been supported cultivating digital health competencies, quality improvement awareness, research skills and translational capabilities.Beyond individual development, the CEP contributes to broader NHS transformation through initiatives such as NHS InSites and collaboration with Health Innovation Networks (HINs) and NHS Trusts, aiming to contribute to real-world adoption of solutions.With over 1000 alumni and growing, the CEP has retained and reintegrated healthcare professionals within the NHS, while supporting new innovations to reach patients. This reinforces a progressive NHS ecosystem that values and integrates clinical innovation and entrepreneurship.

IntroductionDuring a public health emergency like the COVID-19 pandemic, emergency department (ED) clinicians may be able to save more lives if they rapidly identify and implement innovations that are safe and effective. However, there is little research examining clinician decision-making around innovation implementation during public health emergencies and when evidence-based information is limited.ObjectiveThe goals of this study were to understand how ED clinicians decided to implement innovations and to describe the facilitators and challenges they faced during implementation.MethodsWe conducted 3 pilot interviews and 13 focus group discussions with clinicians from eight hospital-based EDs across the USA. Seventeen physicians, seven advanced practice providers, 18 nurses and seven respiratory therapists participated. We used inductive and deductive techniques to perform content and thematic analysis of focus group transcripts.ResultsParticipants cited social media, clinician autonomy, limited resources, organisational culture, supportive leadership and outside experiences as facilitators of trying innovations. Challenges in trying new innovations included limited evidence-based information, evolving guidelines, fear, moral distress and clinician pushback. Facilitators of using innovations in practice included leadership advocating for continued use, signs of patient improvement, ease of adoption and adequate resources. Challenges were the lack of familiarity, no established protocol and limited information dissemination about best practices.ConclusionOur study highlights factors that influenced innovation adoption and implementation in EDs during the COVID-19 pandemic, including how fear and moral distress affected decision-making. Organisations can support the implementation of promising innovations by selecting strong leaders, ensuring clinician psychological safety, providing protocols and resources and highlighting successes.

BackgroundNational guidelines recommend that waist circumference (WC) be measured in patients with a body mass index (BMI) 27–35 kg/m2. Unfortunately, perhaps due to logistical reasons, WC is seldom measured in clinical settings. Herein, we describe the performance of a self-operated waist measurement device (SOWMD) as a potential means to overcome barriers to measuring WC.Materials and methodsTen volunteers underwent WC measures by professionals and SOWMD on 5 separate days to assess the reproducibility and accuracy. We then compared SOWMD measures with CT-derived fat content by recruiting 81 patients scheduled for a diagnostic abdominal CT scan.ResultsThere was no difference between professionally measured and SOWMD-measured WC; the intraindividual coefficient of variation over the 5 days was between 0.4% and 2.2%. The WC measured manually, by SOWMD and CT scan were highly correlated (r=0.90–0.92, all p<0.001). The minimal WC measured by SOWMD was a better predictor (r=0.81 for all patients, r=0.87 for men, both p<0.001) of CT-measured visceral adipose tissue volume than other approaches. The minimal WC measured by SOWMD was correlated with fasting plasma glucose (r=0.40, p<0.05), triglyceride (r=0.41, p<0.01) and high-density cholesterol (r=−0.49, p<0.001) concentrations.ConclusionSOWMD is a reproducible, accurate and convenient way to measure WC that can provide added value for health care providers when combined with BMI information.

Technological advancements are vital for improving the capacity of the health system to deliver health and well-being benefits to individuals. Despite significant financial investments in technological innovations in healthcare, patients reported benefiting from only 30%–60% of new healthcare technologies. We argue that failed adoption can be attributed to the underprioritisation of the human aspect of innovation development and uptake. In this paper, we elaborate on the psychological experience of being introduced to new technology at work through the perspective of a healthcare employee. We then present a psychology-based practical framework called ‘Tech-ISM’ for healthcare decision-makers to encourage more human-centric technology implementation processes, resources and leadership. The framework identifies the key individuals and relationships within a healthcare delivery context that can influence individual attitudes towards adoption, before offering recommendations for how decision-makers can socialise new technology into the workplace (ie, types of organisational resources and processes to provide), and manage these social dynamics over time (ie, types of work cultures to cultivate through leadership). While Tech-ISM is written for a healthcare decision-maker, any individuals involved with healthcare technology implementation can benefit from a holistic understanding of how social and organisational factors of a workplace inter-relate with the human experience of novelty and change.

The Social Innovation in Health Initiative (SIHI) piloted a community engagement self-monitoring (CE-SM) strategy, where communities were actively engaged in monitoring the implementation and performance of their social innovations to ensure that their objectives were achieved. This strategy aims to empower communities to document processes, understand the factors involved and measure outcomes by developing a community-grounded self-monitoring tool and implementing their own approach.Two community comanaged social innovations were selected. For one innovation, the communities implemented the CE-SM independent of external intervention. For the second, the communities were provided with minimal assistance by SIHI. These communities identified their monitoring indicators and selected local monitors to collect data to assess performance outcomes and document the entire process.Communities chose indicators based on their perceived importance and practicality, while monitors were chosen based on their familiarity with the community. Community leaders’ proactive leadership and community members’ participation contributed significantly to its success. The important role of regular feedback sessions was also emphasised, not only as a means of monitoring progress but also for boosting their morale. The level of external support needed by a community was determined by the scope of the project and the community’s grasp of the strategy.CE-SM has been demonstrated to be a viable strategy when communities realise their capacity to monitor their own projects using an approach they deem fit. It has also enhanced their sense of ownership which could improve the chances of sustaining these initiatives and contribute to more accessible healthcare and services.

IntroductionCurrent medical education prepares doctors to diagnose, assess and treat individual patients yet lacks the expectation to be responsible for the care of the wider community. Learning the skills to recognise and redress the social determinants of health are increasingly being recognised as an essential part of medical education.ObjectivesThe goal of this research was (1) to investigate how medical education can be leveraged to reduce health inequalities through the role and practice of doctors and (2) to elucidate how key innovations in medical education are a necessity that can support doctors as ‘change agents.’MethodsTwo international multidisciplinary roundtable focus groups with 23 healthcare leaders from various backgrounds were facilitated. The discussions were audiorecorded, transcribed and then thematically analysed with the qualitative analysis software QDA Miner.ResultsEight themes emerged: (1) Social innovation training in medical education; (2) Linking community working with social innovation; (3) Future curricula development; (4) Settings, context, environment and leaving the classroom; (5) Developing links with third sector organisations and community, including low-income and middle-income countries; (6) Including learners’ perspectives and lived experience; (7) Medical roles are political and need political support and (8) The need to address power imbalances and impact of discrimination.ConclusionsMedical education needs to fundamentally widen its focus from the individual doctor–patient relationship to the doctor–community relationship. Doctors’ training needs to help them become social innovators who can balance interventions with prevention, promote good health on a community and societal scale and tailor their treatments to the individuals’ contexts.