Involvement of frontline clinicians in healthcare technology development: Lessons learned from a ventilator project.

Co-development of healthcare technology with users helps produce user-friendly products, ensuring safe device usage and meeting patients' needs. For developers considering healthcare innovations, engaging user experience can reduce production time and cost while maximizing device application. The purpose of this paper is to report lessons learned from the development of a 3D printed origami ventilator prototype in response to the rise of ventilator demand due to the Coronavirus disease (COVID-19) pandemic. We conducted focus groups with frontline clinicians working in an Intensive Care Unit of a large urban hospital in Vancouver, British Columbia, Canada. In the interdisciplinary focus groups, we identified challenges, practical tips about product development, the human needs of technology, and cross-discipline peer learning. The focus group discussions provide useful insight into the technology development for complex clinical contexts. Based on our experiences, we articulate five practical tips for co-development of healthcare technology - AGILE: Analyse users' needs first, Gain insights into complex context, Involve users early and frequently, Lead with a prototype, and Educate and support. Through sharing the tips and lessons learned, we wish to emphasize the necessity of meaningful multi-disciplinary collaboration during healthcare technology development and promote the inclusion of frontline clinicians during these initiatives. Supplementary Information: The online version contains supplementary material available at 10.1007/s12553-022-00655-w.

Involvement of frontline clinicians in healthcare technology development: Lessons learned from a ventilator project

Co-development of healthcare technology with users helps produce user-friendly products, ensuring safe device usage and meeting patients’ needs. For developers considering healthcare innovations, engaging user experience can reduce production time and cost while maximizing device application. The purpose of this paper is to report lessons learned from the development of a 3D printed origami ventilator prototype in response to the rise of ventilator demand due to the Coronavirus disease (COVID-19) pandemic. We conducted focus groups with frontline clinicians working in an Intensive Care Unit of a large urban hospital in Vancouver, British Columbia, Canada. In the interdisciplinary focus groups, we identified challenges, practical tips about product development, the human needs of technology, and cross-discipline peer learning. The focus group discussions provide useful insight into the technology development for complex clinical contexts. Based on our experiences, we articulate five practical tips for co-development of healthcare technology - AGILE: Analyse users’ needs first, Gain insights into complex context, Involve users early and frequently, Lead with a prototype, and Educate and support. Through sharing the tips and lessons learned, we wish to emphasize the necessity of meaningful multi-disciplinary collaboration during healthcare technology development and promote the inclusion of frontline clinicians during these initiatives. Supplementary Information The online version contains supplementary material available at 10.1007/s12553-022-00655-w.

Pneumonia-targeted lopinavir/ritonavir-based treatment for patients with COVID-19: an early-period retrospective single center observational study.

BACKGROUND: Robust evidenced treatment strategy for Coronavirus disease 2019 (COVID-19) has not been established yet. Early, targeted, comprehensive management approach can be essential. METHODS: A lopinavir/ritonavir (LPV/r)-based antiviral treatment was administered to the patients with computed tomography (CT)-documented pneumonia. Medical records of patients with COVID-19, previously discharged or hospitalized for ≥ 21 days at the Seoul Medical Center from January 29 to April 15, 2020 were reviewed to analyze clinical and virological outcomes. Patients were divided into two groups (PCR-Negative conversion group vs. Non-negative conversion group and requiring oxygen group vs. Non-requiring oxygen group). RESULTS: In total, 136 patients with a mean age of 41.8 ± 18.2 years were included with median 3-day delay of hospitalization after illness. Thirteen (9.56%) were initially asymptomatic, and 5 (3.67%) were persistently asymptomatic. Eighty-five (62.5%) had CT-documented pneumonia, 94% of whom received LPV/r treatments. A total of 53 patients (38.97%) had negative polymerase chain reaction (PCR) results within 28 days. Eight (9.4%) out of 85 pneumonic patients received oxygen supplementation. Patients with initial lower respiratory symptoms showed significant delay in PCR negative conversion (> 28 days) (odds ratio [OR] 0.166; 95% confidence interval [CI] 0.067-0.477; P < 0.001). However, antiviral treatment for pneumonic patients was significantly related with early conversion within 28 days (OR 3.049; 95% CI 1.128-8.243; P = 0.028). Increasing age increased the likelihood of oxygen supplementation requirement in the pneumonic patient group (OR 1.108; 95% CI 1.021-1.202; P = 0.014). CONCLUSIONS: Early, pneumonia targeted LPV/r-based antiviral therapy resulted in a significantly higher probability of negative conversion of PCR within 28 days compared to symptomatic treatment.

Clinical Experience with Use of Remdesivir in the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2: a Case Series.

BACKGROUND: A novel antiviral agent, remdesivir (RDV), is a promising candidate treatment for coronavirus disease 2019 (COVID-19) in the absence of any proven therapy. MATERIALS AND METHODS: This retrospective case series included 10 patients with a clinically and laboratory confirmed diagnosis of severe COVID-19 pneumonia who had received RDV for 5 days (n = 5) or 10 days (n = 5) in the Phase III clinical trial of RDV (GS-US-540-5773) conducted by Gilead Sciences. The clinical and laboratory data for these patients were extracted. RESULTS: One patient in the 10-day group received RDV for only 5 days because of nausea and elevated liver transaminases. No patient had respiratory comorbidity. Seven patients had bilateral lesions and three had unilateral lesions on imaging. All patients had received other medications for COVID-19, including lopinavir/ritonavir and hydroxychloroquine, before administration of RDV. Five patients required supplemental oxygen and one required mechanical ventilation. All patients showed clinical and laboratory evidence of improvement. Half of the patients developed elevated liver transaminases and three had nausea. There were no adverse events exceeding grade 2. CONCLUSION: Our experience indicates that RDV could be a therapeutic option for COVID-19. A well-designed randomized controlled clinical trial is now needed to confirm the efficacy of RDV in patients with COVID-19.

Clinical Experience with Use of Remdesivir in the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2: a Case Series

BACKGROUND: A novel antiviral agent, remdesivir (RDV), is a promising candidate treatment for coronavirus disease 2019 (COVID-19) in the absence of any proven therapy. MATERIALS AND METHODS: This retrospective case series included 10 patients with a clinically and laboratory confirmed diagnosis of severe COVID-19 pneumonia who had received RDV for 5 days (n = 5) or 10 days (n = 5) in the Phase III clinical trial of RDV (GS-US-540-5773) conducted by Gilead Sciences. The clinical and laboratory data for these patients were extracted. RESULTS: One patient in the 10-day group received RDV for only 5 days because of nausea and elevated liver transaminases. No patient had respiratory comorbidity. Seven patients had bilateral lesions and three had unilateral lesions on imaging. All patients had received other medications for COVID-19, including lopinavir/ritonavir and hydroxychloroquine, before administration of RDV. Five patients required supplemental oxygen and one required mechanical ventilation. All patients showed clinical and laboratory evidence of improvement. Half of the patients developed elevated liver transaminases and three had nausea. There were no adverse events exceeding grade 2. CONCLUSION: Our experience indicates that RDV could be a therapeutic option for COVID-19. A well-designed randomized controlled clinical trial is now needed to confirm the efficacy of RDV in patients with COVID-19.