1657 results found
Joshi M, Ashrafian H, Arora S, et al., A Systematic Review and Meta-Analysis of digital alerting and outcomes in patients with sepsis, JMIR mHealth and uHealth, ISSN: 2291-5222
Dawda S, Camara M, Pratt P, et al., 2019, Patient-specific simulation of pneumoperitoneum for laparoscopic surgical planning, Journal of Medical Systems, Vol: 43, ISSN: 0148-5598
Gas insufflation in laparoscopy deforms the abdomen and stretches the overlying skin. This limits the use of surgical image-guidance technologies and challenges the appropriate placement of trocars, which influences the operative ease and potential quality of laparoscopic surgery. This work describes the development of a platform that simulates pneumoperitoneum in a patient-specific manner, using preoperative CT scans as input data. This aims to provide a more realistic representation of the intraoperative scenario and guide trocar positioning to optimize the ergonomics of laparoscopic instrumentation. The simulation was developed by generating 3D reconstructions of insufflated and deflated porcine CT scans and simulating an artificial pneumoperitoneum on the deflated model. Simulation parameters were optimized by minimizing the discrepancy between the simulated pneumoperitoneum and the ground truth model extracted from insufflated porcine scans. Insufflation modeling in humans was investigated by correlating the simulation’s output to real post-insufflation measurements obtained from patients in theatre. The simulation returned an average error of 7.26 mm and 10.5 mm in the most and least accurate datasets respectively. In context of the initial discrepancy without simulation (23.8 mm and 19.6 mm), the methods proposed here provide a significantly improved picture of the intraoperative scenario. The framework was also demonstrated capable of simulating pneumoperitoneum in humans. This study proposes a method for realistically simulating pneumoperitoneum to achieve optimal ergonomics during laparoscopy. Although further studies to validate the simulation in humans are needed, there is the opportunity to provide a more realistic, interactive simulation platform for future image-guided minimally invasive surgery.
Garas G, Darzi A, Athanasiou T, 2019, Comment on: Relationship between surgeons and industry., Br J Surg, Vol: 106
Fontana G, Flott K, Dhingra-Kumar N, et al., 2019, Five reasons for optimism on World Patient Safety Day, LANCET, Vol: 394, Pages: 993-995, ISSN: 0140-6736
Symons J, Ashrafian H, Dunscombe R, et al., From EHR to PHR: Let’s get the UK record straight, BMJ Open, ISSN: 2044-6055
This article reflects on the changing nature of health information access and the transition of focus from electronic health records (EHRs) to personal health records (PHRs) along with the challenges and need for alignment of national initiatives for EHR and PHR in the National Health Service (NHS) of the United Kingdom (UK).The importance of implementing integrated EHRs as a route to enhance the quality of health delivery has been increasingly understood. EHRs however carry several limitations that include major fragmentation through multiple providers and protocols throughout the NHS. Questions over ownership and control of data further complicate the potential for fully utilising records. Analysing the previous initiatives and the current landscape, we identify that adopting a patient health record system can empower patients and allow better harmonisation of clinical data at a national level. We propose regional PHR “hubs” to provide a universal interface that integrates digital heath data at a regional level with further integration at a national level.We propose that these PHR “hubs” will reduce the complexity of connections, decrease governance challenges and interoperability issues while also providing a safe platform for high-quality scalable and sustainable digital solutions, including artificial intelligence (AI) across the UK NHS, serving as an exemplar for other countries which wish to realise the full value of healthcare records.
Kurek N, Darzi A, 2019, The ageing surgeon, BMJ Quality and Safety, ISSN: 2044-5415
Garas G, Cingolani I, Patel V, et al., Evaluating the implications of Brexit for research collaboration and policy: A network analysis and simulation study, BMJ Open, ISSN: 2044-6055
Objective To evaluate the role of the European Union (EU) as a research collaborator in the United Kingdom (UK)’s success as a global leader in healthcare research and innovation and quantify the impact that Brexit may have. Design Network and regression analysis of scientific collaboration, followed by simulation models based on alternative scenarios. Setting International real world collaboration network among all countries involved in robotic surgical research and innovation.Participants 772 organisations from industry and academia nested within 56 countries and connected through 2,397 collaboration links.Main outcome measures Research impact measured through citations, innovation value measured through the innovation index, and an array of attributes of social networks to measure brokerage and geographical entropy at national and international levels.Results Globally, the UK ranks third in robotic surgical innovation, and the EU constitutes its prime collaborator. Brokerage opportunities and collaborators’ geographical diversity are associated with a country’s research impact (c=211.320 and 244.527, respectively;p-value<0·01) and innovation (c=18.819 and 30.850, respectively;p-value<0·01). Replacing EU collaborators with United States (US)’ ones is the only strategy that could benefit the UK, but on the condition that US collaborators are chosen among the top-performing ones, which is likely to be very difficult and costly, at least in the short term. Conclusions This study suggests what has long been argued, namely that the UK-EU research partnership has been mutually beneficial and that its continuation represents the best possible outcome for both negotiating parties. However, the uncertainties raised by Brexit necessitate looking beyond the EU for potential research partners. In the short-term, the UK’s best strategy might be to try and maintain its academic links with the EU. In the longer-term, strategic r
Miraldo M, Goiana-da-Silva F, Cruz-e-Silva D, et al., 2019, Disrupting the landscape: how the Portuguese National Health Service built an omnichannel communication platfor, Public Health Panorama, Vol: 5, Pages: 314-323, ISSN: 2412-544X
Noncommunicable diseases (NCDs) are the leading causes of death, disease and disability in the WHO European Region and are largely preventable. The private sector has long been using marketing to influence and change people’s lifestyles. In some cases, particularly the food sector, health-compromising content is prioritized over health-promoting content. However, this case study aims to illustrate how governments working on tight budgets can partner with private media companies to their own advantage in order to increase the impact of health messages and thus improve the health literacy of the population. The omnichannel communication platform and associated campaigns initiated by the Portuguese government and described in this case study serve as a practical example of a national health literacy initiative successfully reaching a wide audience. Indeed, the Portuguese National Health Service entered high on the list of the most impactful communication campaigns in Portugal.This might have implications for other countries as although further progress is required to analyse any impact of the campaigns, this example showcases the potential advantages of partnering with the media in that by using the same communication channels as multinational food and tobacco companies, governments may be able to level the playing field in terms of influence through marketing and communication, which might help to reverse unhealthy lifestyles among their populations.
Vlaev I, King D, Darzi A, et al., 2019, Changing health behaviors using financial incentives: a review from behavioral economics, BMC Public Health, Vol: 19, ISSN: 1471-2458
BackgroundIncentives are central to economics and are used across the public and private sectors to influence behavior. Recent interest has been shown in using financial incentives to promote desirable health behaviors and discourage unhealthy ones.Main textIf we are going to use incentive schemes to influence health behaviors, then it is important that we give them the best chance of working. Behavioral economics integrates insights from psychology with the laws of economics and provides a number of robust psychological phenomena that help to better explain human behavior. Individuals’ decisions in relation to incentives may be shaped by more subtle features – such as loss aversion, overweighting of small probabilities, hyperbolic discounting, increasing payoffs, reference points – many of which have been identified through research in behavioral economics. If incentives are shown to be a useful strategy to influence health behavior, a wider discussion will need to be had about the ethical dimensions of incentives before their wider implementation in different health programmes.ConclusionsPolicy makers across the world are increasingly taking note of lessons from behavioral economics and this paper explores how key principles could help public health practitioners design effective interventions both in relation to incentive designs and more widely.
Modi HN, Singh H, Fiorentino F, et al., 2019, Association of residents' neural signatures with stress resilience during surgery., JAMA Surgery, Pages: E1-E9, ISSN: 2168-6254
Importance: Intraoperative stressors may compound cognitive load, prompting performance decline and threatening patient safety. However, not all surgeons cope equally well with stress, and the disparity between performance stability and decline under high cognitive demand may be characterized by differences in activation within brain areas associated with attention and concentration such as the prefrontal cortex (PFC). Objective: To compare PFC activation between surgeons demonstrating stable performance under temporal stress with those exhibiting stress-related performance decline. Design, Setting, and Participants: Cohort study conducted from July 2015 to September 2016 at the Imperial College Healthcare National Health Service Trust, England. One hundred two surgical residents (postgraduate year 1 and greater) were invited to participate, of which 33 agreed to partake. Exposures: Participants performed a laparoscopic suturing task under 2 conditions: self-paced (SP; without time-per-knot restrictions), and time pressure (TP; 2-minute per knot time restriction). Main Outcomes and Measures: A composite deterioration score was computed based on between-condition differences in task performance metrics (task progression score [arbitrary units], error score [millimeters], leak volume [milliliters], and knot tensile strength [newtons]). Based on the composite score, quartiles were computed reflecting performance stability (quartile 1 [Q1]) and decline (quartile 4 [Q4]). Changes in PFC oxygenated hemoglobin concentration (HbO2) measured at 24 different locations using functional near-infrared spectroscopy were compared between Q1 and Q4. Secondary outcomes included subjective workload (Surgical Task Load Index) and heart rate. Results: Of the 33 participants, the median age was 33 years, the range was 29 to 56 years, and 27 were men (82%). The Q1 residents demonstrated task-induced increases in HbO2 across the bilateral ventrolateral PFC (VLPFC) and right dorsolateral P
Arhi CS, Ziprin P, Bottle A, et al., 2019, Colorectal cancer patients under the age of 50 experience delays in primary care leading to emergency diagnoses: a population-based study, Colorectal Disease, ISSN: 1462-8910
AIM: The incidence of colorectal cancer in the under 50s is increasing. In this national population-based study we aim to show that missed opportunities for diagnosis in primary care are leading to referral delays and emergency diagnoses in young patients. METHOD: We compared the interval before diagnosis, presenting symptom(s) and the odds ratio (OR) of an emergency diagnosis for those under the age of 50 with older patients sourced from the cancer registry with linkage to a national database of primary-care records. RESULTS: The study included 7315 patients, of whom 508 (6.9%) were aged under 50 years, 1168 (16.0%) were aged 50-59, 2294 (31.4%) were aged 60-69 and 3345 (45.7%) were aged 70-79 years. Young patients were more likely to present with abdominal pain and via an emergency, and had the lowest percentage of early stage cancer. They experienced a longer interval between referral and diagnosis (12.5 days) than those aged 60-69, reflecting the higher proportion of referrals via the nonurgent pathway (33.3%). The OR of an emergency diagnosis did not differ with age if a red-flag symptom was noted at presentation, but increased significantly for young patients if the symptom was nonspecific. CONCLUSION: Young patients present to primary care with symptoms outside the national referral guidelines, increasing the likelihood of an emergency diagnosis.
Ghafur S, Kristensen S, honeyford K, et al., A retrospective impact analysis of the WannaCry cyber-attack on the NHS, npj Digital Medicine, ISSN: 2398-6352
A systematic analysis of Hospital Episodes Statistics (HES) data was done to determine the effects of the 2017 WannaCry attack on the National Health Service (NHS) by identifying the missed appointments, deaths, and fiscal costs attributable to the ransomware attack. The main outcomes measured were: outpatient appointments cancelled, elective and emergency admissions to hospitals, Accident & Emergency (A&E) attendances, and deaths in A&E. Compared with the baseline, there was no significant difference in the total activity across all trusts during the week of the WannaCry attack. Trusts had 1% more emergency admissions and 1% fewer A&E attendances per day during the WannaCry week compared with baseline. Hospitals directly infected with the ransomware, however, had significantly fewer emergency and elective admissions: a decrease of about 6% in total admissions per infected hospital per day was observed, with 4% fewer emergency admissions and 9% fewer elective admissions. No difference in mortality was noted. The total economic value of the lower activity at the infected trusts during this time was £5.9m including £4m in lost inpatient admissions, £0.6m from lost A&E activity, and £1.3m from cancelled outpatient appointments. Among hospitals infected with WannaCry ransomware, there was a significant decrease in the number of attendances and admissions, which corresponded to £5.9m in lost hospital activity. There was no increase in mortality reported, though this is a crude measure of patient harm. Further work is needed to appreciate the impact of a a cyber attack or IT failure on care delivery and patient safety.
Runciman M, Darzi A, Mylonas G, 2019, Soft robotics in minimally invasive surgery, Soft Robotics, Vol: 6, Pages: 423-443, ISSN: 2169-5172
Soft robotic devices have desirable traits for applications in minimally invasive surgery (MIS) but many interdisciplinary challenges remain unsolved. To understand current technologies, we carried out a keyword search using the Web of Science and Scopus databases, applied inclusion and exclusion criteria, and compared several characteristics of the soft robotic devices for MIS in the resulting articles. There was low diversity in the device designs and a wide-ranging level of detail regarding their capabilities. We propose a standardised comparison methodology to characterise soft robotics for various MIS applications, which will aid designers producing the next generation of devices.
Judah G, Markiewicz O, Lavelle M, et al., Threats to safe transitions from hospital to home: Consensus study in primary care, British Journal of General Practice, ISSN: 0960-1643
BackgroundTransitions between healthcare settings are vulnerable points for patients.Aim To identify key threats to safe patient transitions from hospital to primary care settings.Design Three-round web-based Delphi consensus process.Setting Clinical and non-clinical staff in 39 primary care practices. MethodRound 1: free-text idea-generating round. Rounds 2 and 3: consensus-obtaining rating rounds. Practices were encouraged to complete the questionnaires at team meetings. Aggregate ratings of perceived level of importance for each threat were calculated (1-3 not important, 4-6 somewhat important, 7-9 very important). Percentage of votes cast for each patient or medication group were recorded (consensus defined as 75%). Results 39 practices completed Round 1, 36/39 (92%) completed Round 2 and 30/36 (83%) completed Round 3. Round 1 identified nine threats encompassing problems involving communication, service organisation, medication provision and which patients were most at risk. “Poor quality of handover instructions from secondary to primary care teams” achieved the highest rating (M=8.43) and a 100% consensus that it was a “very important” threat. The elderly (97%) and patients with complex medical problems taking more than five medications (80%) were voted the most vulnerable. Anticoagulants (77%) were considered to pose the greatest risk to patients. Conclusions This study identified specific threats to safe patient transitions from hospital to primary care, providing policymakers and healthcare providers with targets for quality improvement strategies. Further work needs to identify factors underpinning these threats so that interventions can be tailored to the relevant behavioural and environmental contexts in which these threats arise.
Fernandes Neves Soares AL, Poovendran D, Freise L, et al., Healthcare professionals’ perspectives on the secondary use of health records to improve quality and safety of care: a qualitative study in England, Journal of Medical Internet Research, ISSN: 1438-8871
Background: Healthcare professionals (HCP) are often patients’ first point of contact in what concerns the communication of the purposes, benefits, and risks of sharing electronic health records (EHR) for non-direct care purposes. Their engagement is fundamental to ensure patients’ buy-in and a successful implementation of healthcare data sharing schemes. However, their views on this subject are seldom evaluated. Objective: To explore HCP’ perspectives on the secondary uses of healthcare data in England. Specifically, we aimed to assess a) their knowledge on its purposes and b) the main concerns about data sharing processes.Methods: A total of 30 interviews were conducted between the 27th March and 7th April 2017 using an online interview platform, and following a topic guide with open-ended questions. The participants represented a variety of geographic locations across England (London, West Midlands, East of England, North East, Yorkshire and the Humber), covering both primary and secondary care services. The transcripts were compiled verbatim and systematically reviewed by two independent reviewers, using the framework analysis method to identify emerging themes.Results: HCP were knowledgeable about the possible secondary uses of data and highlighted its importance for 1) patient profiling and tailored care, 2) research, 3) quality assurance, 4) public health, and 5) service delivery planning purposes. Main concerns towards data sharing included 1) data accuracy, 2) patients’ willingness to share their records, 3) challenges on obtaining free and informed consent, 4) data security, 5) lack of adequacy / understanding of current policies, and 6) potential patient exposure and exploitation.Conclusions: These results suggest a high level of HCP understanding about the purposes of data sharing for secondary purposes, however, some concerns still remain. A better understanding of HCP’ knowledge and concerns could inform national communica
Goiana-Da-Silva K, Cruz-e-Silva D, Allen L, et al., Portugal’s voluntary food reformulation agreement and the WHO reformulation targets, Journal of Global Health, ISSN: 2047-2978
Espinosa-González AB, Delaney BC, Marti J, et al., 2019, The impact of governance in primary health care delivery: a systems thinking approach with a European panel, Health Research Policy and Systems, Vol: 17, Pages: 1-16, ISSN: 1478-4505
Enhancing primary health care (PHC) is considered a policy priority for health systems strengthening due to PHC’s ability to provide accessible and continuous care and manage multimorbidity. Research in PHC often focuses on the effects of specific interventions (e.g. physicians’ contracts) in health care outcomes. This informs narrowly designed policies that disregard the interactions between the health functions (e.g. financing and regulation) and actors involved (i.e. public, professional, private), and their impact in care delivery and outcomes. The purpose of this study is to analyse the interactions between PHC functions and their impact in PHC delivery, particularly in providers’ behaviour and practice organisation.
Goiana-da-Silva F, Cruz-E-Silva D, Allen L, et al., 2019, Modelling impacts of food industry co-regulation on noncommunicable disease mortality, Portugal, Bulletin of the World Health Organization, Vol: 97, Pages: 450-459, ISSN: 0042-9686
Objective: To model the reduction in premature deaths attributed to noncommunicable diseases if targets for reformulation of processed food agreed between the Portuguese health ministry and the food industry were met. Methods: The 2015 co-regulation agreement sets voluntary targets for reducing sugar, salt and trans-fatty acids in a range of products by 2021. We obtained government data on dietary intake in 2015-2016 and on population structure and deaths from four major noncommunicable diseases over 1990-2016. We used the Preventable Risk Integrated ModEl tool to estimate the deaths averted if reformulation targets were met in full. We projected future trends in noncommunicable disease deaths using regression modelling and assessed whether Portugal was on track to reduce baseline premature deaths from noncommunicable diseases in the year 2010 by 25% by 2025, and by 30% before 2030. Findings: If reformulation targets were met, we projected reductions in intake in 2015-2016 for salt from 7.6 g/day to 7.1 g/day; in total energy from 1911 kcal/day to 1897 kcal/day due to reduced sugar intake; and in total fat (% total energy) from 30.4% to 30.3% due to reduced trans-fat intake. This consumption profile would result in 248 fewer premature noncommunicable disease deaths (95% CI: 178 to 318) in 2016. We projected that full implementation of the industry agreement would reduce the risk of premature death from 11.0% in 2016 to 10.7% by 2021. Conclusion: The co-regulation agreement could save lives and reduce the risk of premature death in Portugal. Nevertheless, the projected impact on mortality was insufficient to meet international targets.
Martin G, Ghafur S, Cingolani I, et al., 2019, The effects and preventability of 2627 patient safety incidents related to health information technology failures: a retrospective analysis of 10 years of incident reporting in England and Wales, The Lancet Digital Health, Vol: 1, Pages: e127-e135, ISSN: 2589-7500
Martin G, Arora S, Shah N, et al., 2019, A regulatory perspective on the influence of health information technology on organisational quality and safety in England, Health Informatics Journal, ISSN: 1460-4582
Health information technology can transform and enhance the quality and safety of care, but it may also introduce new risks. This study analysed 130 healthcare regulator inspection reports and organisational digital maturity scores in order to characterise the impact of health information technology on quality and safety from a regulatory perspective. Although digital maturity and the positive use of health information technology are significantly associated with overall organisational quality, the negative effects of health information technology are frequently and more commonly identified by regulators. The poor usability of technology, lack of easy access to systems and data and the incorrect use of health information technology are the most commonly identified areas adversely affecting quality and safety. There is a need to understand the full risks and benefits of health information technology from the perspective of all stakeholders, including patients, end-users, providers and regulators in order to best inform future practice and regulation.
Aufegger L, Bicknell C, Soane E, et al., 2019, Understanding health management and safety decisions using signal processing and machine learning, BMC Medical Research Methodology, Vol: 19, ISSN: 1471-2288
BackgroundSmall group research in healthcare is important because it deals with interaction and decision-making processes that can help to identify and improve safer patient treatment and care. However, the number of studies is limited due to time- and resource-intensive data processing. The aim of this study was to examine the feasibility of using signal processing and machine learning techniques to understand teamwork and behaviour related to healthcare management and patient safety, and to contribute to literature and research of teamwork in healthcare.MethodsClinical and non-clinical healthcare professionals organised into 28 teams took part in a video- and audio-recorded role-play exercise that represented a fictional healthcare system, and included the opportunity to discuss and improve healthcare management and patient safety. Group interactions were analysed using the recurrence quantification analysis (RQA; Knight et al., 2016), a signal processing method that examines stability, determinism, and complexity of group interactions. Data were benchmarked against self-reported quality of team participation and social support. Transcripts of group conversations were explored using the topic modelling approach (Blei et al., 2003), a machine learning method that helps to identify emerging themes within large corpora of qualitative data.ResultsGroups exhibited stable group interactions that were positively correlated with perceived social support, and negatively correlated with predictive behaviour. Data processing of the qualitative data revealed conversations focused on: (1) the management of patient incidents; (2) the responsibilities among team members; (3) the importance of a good internal team environment; and (4) the hospital culture.ConclusionsThis study has shed new light on small group research using signal processing and machine learning methods. Future studies are encouraged to use these methods in the healthcare context, and to conduct further research
Dilley J, Camara M, Omar I, et al., 2019, Evaluating the impact of image guidance in the surgical setting: A systematic review, Surgical Endoscopy, ISSN: 0930-2794
BACKGROUND: Image guidance has been clinically available for over a period of 20 years. Although research increasingly has a translational emphasis, overall the clinical uptake of image guidance systems in surgery remains low. The objective of this review was to establish the metrics used to report on the impact of surgical image guidance systems used in a clinical setting. METHODS: A systematic review of the literature was carried out on all relevant publications between January 2000 and April 2016. Ovid MEDLINE and Embase databases were searched using a title strategy. Reported outcome metrics were grouped into clinically relevant domains and subsequent sub-categories for analysis. RESULTS: In total, 232 publications were eligible for inclusion. Analysis showed that clinical outcomes and system interaction were consistently reported. However, metrics focusing on surgeon, patient and economic impact were reported less often. No increase in the quality of reporting was observed during the study time period, associated with study design, or when the clinical setting involved a surgical specialty that had been using image guidance for longer. CONCLUSIONS: Publications reporting on the clinical use of image guidance systems are evaluating traditional surgical outcomes and neglecting important human and economic factors, which are pertinent to the uptake, diffusion and sustainability of image-guided surgery. A framework is proposed to assist researchers in providing comprehensive evaluation metrics, which should also be considered in the design phase. Use of these would help demonstrate the impact in the clinical setting leading to increased clinical integration of image guidance systems.
Patel VM, Panzarasa P, Ashrafian H, et al., 2019, Collaborative patterns, authorship practices and scientific success in biomedical research: a network analysis., Journal of the Royal Society of Medicine, Vol: 112, Pages: 245-257, ISSN: 1758-1095
OBJECTIVE: To investigate the relationship between biomedical researchers' collaborative and authorship practices and scientific success. DESIGN: Longitudinal quantitative analysis of individual researchers' careers over a nine-year period. SETTING: A leading biomedical research institution in the United Kingdom. PARTICIPANTS: Five hundred and twenty-five biomedical researchers who were in employment on 31 December 2009. MAIN OUTCOME MEASURES: We constructed the co-authorship network in which nodes are the researchers, and links are established between any two researchers if they co-authored one or more articles. For each researcher, we recorded the position held in the co-authorship network and in the bylines of all articles published in each three-year interval and calculated the number of citations these articles accrued until January 2013. We estimated maximum likelihood negative binomial panel regression models. RESULTS: Our analysis suggests that collaboration sustained success, yet excessive co-authorship did not. Last positions in non-alphabetised bylines were beneficial for higher academic ranks but not for junior ones. A professor could witness a 20.57% increase in the expected citation count if last-listed non-alphabetically in one additional publication; yet, a lecturer suffered from a 13.04% reduction. First positions in alphabetised bylines were positively associated with performance for junior academics only. A lecturer could experience a 8.78% increase in the expected citation count if first-listed alphabetically in one additional publication. While junior researchers amplified success when brokering among otherwise disconnected collaborators, senior researchers prospered from socially cohesive networks, rich in third-party relationships. CONCLUSIONS: These results help biomedical scientists shape successful careers and research institutions develop effective assessment and recruitment policies that will ultimately sustain the quality of biomedical r
Qiu S, Nikolaou S, Fiorentino F, et al., 2019, Exploratory analysis of plasma neurotensin as a novel biomarker for early detection of colorectal polyp and cancer, Hormones and Cancer, Vol: 10, Pages: 128-135, ISSN: 1868-8500
Earlier detection of colorectal cancer (CRC) results in improved survival. Existing non-invasive biomarkers have suboptimal accuracy. Neurotensin (NTS) is involved in CRC carcinogenesis. This study evaluated the diagnostic potential of plasma NTS for colorectal polyps and cancers. Participants were selected based on national CRC referral guidelines. All subjects underwent colonoscopy. Average plasma concentrations were compared across different diagnostic groups. Predictors for detecting colorectal neoplasia were identified. Receiver operator characteristic (ROC) curve analysis assessed the diagnostic accuracy of NTS. An independent biobank was used as validation group. Of 165 participants, 46 had polyps or CRC. Significantly higher plasma NTS was found in the colonic neoplasia group (603.6 pg/ml vs. 407.2 pg/ml, p < 0.01). Risk factors for colonic polyps or cancers included Loge (plasma NTS concentration) (OR, 2.73; 95% CI, 1.33–5.59, p < 0.01), loge (Age) (OR, 15.49; 95% CI, 2.67–89.66, p < 0.01) and cigarette smoking (OR, 3.49; 95% CI, 1.31–9.26, p = 0.01). Plasma NTS had an optimal sensitivity of 60.4% and specificity of 71.6% for the diagnosis of colorectal polyps and cancers. Similar diagnostic accuracy was obtained in the validation group. Plasma NTS has the potential to be a non-invasive biomarker for colorectal neoplasia. It appears to be more accurate than existing blood markers and is unique in being able to detect precancerous polyps.
Cohen D, Vlaev I, Heitmueller A, et al., 2019, Validation of behavioral simulations: a case study on enhancing collaboration between partnership organizations, Journal of Public Health, Vol: 27, Pages: 367-378, ISSN: 1741-3842
AimThe current article provides a detailed account of a behavioral simulation called Lateral Play. Lateral Play aimed to enhance collaborations and optimize shared decision-making across organizations within a newly formed partnership. The current article aims to enhance appreciation of the behavioral simulation methodology and encourage its use.Subjects and MethodsHealth service leaders from different organizations within a newly formed partnership gathered in the simulated community and took up roles similar to their real-life positions. The simulation presented participants with problems and opportunities similar to those that they would experience in real life, such as the need to consolidate services and create new care pathways. To evaluate Lateral Play’s effectiveness, self-reported and observational data were collected. These data include information about participants’ reactions, learning and behavior, and the newly formed partnership’s organizational results.ResultsLateral Play allowed health leaders to better understand how they could enhance collaborations and optimize shared decision-making across their newly formed partnership. The data suggest that simulations can promote effective collaborations.ConclusionsUse of behavioral simulations should be encouraged to promote policy awareness and understanding, refine implementation strategies and improve outcomes in newly formed partnerships.
Moussa OM, Erridge S, Chidambaram S, et al., 2019, Mortality of the severely obese: a population study, Annals of Surgery, Vol: 269, Pages: 1087-1091, ISSN: 0003-4932
OBJECTIVE: This study aimed to analyze the Clinical Practice Research Datalink to identify the prognostic factors of all-cause mortality in the severely obese. BACKGROUND: Patients who are severely obese [body mass index (BMI) ≥35 kg/m] are at increased risk of all-cause mortality as a result of metabolic sequelae including hyperlipidemia, hypertension, and diabetes. Bariatric surgery has been shown to reduce the severity of the metabolic complications of obesity. METHOD: A case-controlled analysis was carried out of patients with a BMI of 35 kg/m or more from the Clinical Practice Research Datalink, a UK database of primary care clinics. Clinicopathological characteristics at baseline diagnosis were extracted. Cases of all-cause mortality were identified as a clinical endpoint. A Cox proportional hazard model was used to calculate hazard ratios (HRs) for different patient factors. A P value less than 0.050 was defined as significant. RESULTS: A total of 187,061 records were identified for analysis. Median follow-up time was 98.0 months (range: 3.0-1095.0). A total of 8655(4.6%) were identified as having died during the study period. The median time from baseline obesity diagnosis until death was 137.0 months (range: 3.0-628.7). Multivariate analysis found bariatric surgery to be associated with reduced risk of all-cause mortality (HR: 0.487; P < 0.001). The following were associated with increased risk of death: male sex (HR: 1.805; P < 0.001), BMI of 60 or greater (HR: 2.541; P < 0.001), hypertension (HR: 2.108; P < 0.001), diabetes (HR: 2.766; P < 0.001), and hyperlipidemia (HR: 1.641; P < 0.001). CONCLUSIONS: Factors such as high BMI, diabetes, hyperlipidemia, and hypertension at first diagnosis of severe obesity were each independently associated with an increased risk of death. Bariatric surgery was shown to be associated with reduced risk of all-cause mortality. Improving access to bariatric surgery and public health campaigns can improve
Moussa OM, Ardissino M, Kulatilake P, et al., 2019, Effect of body mass index on depression in a UK cohort of 363 037 obese patients: A longitudinal analysis of transition, Clinical Obesity, Vol: 9, ISSN: 1758-8103
With obesity levels increasing, it is important to consider the mental health risks associated with this condition to optimize patient care. Links between depression and obesity have been explored, but few studies focus on the risk profiles of patients across stratified body mass index (BMI) classes above 30 kg/m2 . This study aims to determine the impact of BMI on depression risk in patients with obesity and to investigate trends of depression in a large cohort of British patients with BMI > 30 kg/m2 . A nationwide primary care database, the Clinical Practice Research Datalink (CPRD), was analysed for diagnoses of obesity (BMI > 30 kg/m2 ). Obese patients were then sub-classified into seven BMI categories. Primary health care-based records of patients entered in the CPRD were analysed. A total of 363 037 patients had a BMI ≥ 30 kg/m2 ; of these patients 97 392 (26.8%) also had a diagnosis of depression. Absolute event rates over time and hazard risk of depression were analysed by BMI category. On Cox regression analysis of time to development of depression, the cumulative hazard increased significantly and linearly across BMI groups (P < 0.001). Compared to those with BMI 30 to 35 kg/m2 , patients with BMI 35 to 40 kg/m2 had a 20% higher risk of depression (hazard ratio [HR] 1.206, confidence interval [CI] 1.170-1.424), and those with BMI > 60 kg/m2 had a 98% higher risk (HR 1.988, CI 1.513-2.612). This study identified the prevalence and time course of depression in a cohort of obese patients in the United Kingdom. Findings suggest the risk of depression is directly proportional to BMI above 30 kg/m2 . Therefore, clinicians should note higher BMI levels confer increased risk of depression.
Modi H, Singh H, Fiorentino F, et al., Neural signatures of resident resilience, JAMA Surgery, ISSN: 2168-6254
Importance: Intraoperative stressors may compound cognitive load, prompting performance decline and threatening patient safety. However, not all surgeons cope equally well with stress, and the disparity between performance stability and decline under high cognitive demand may be characterized by differences in activation within brain areas associated with attention and concentration such as the prefrontal cortex (PFC).Objective: To compare PFC activation between surgeons demonstrating stable performance under temporal stress with those exhibiting stress-related performance decline. The a priori hypothesis being that under temporal demand sustained prefrontal “activation(s)” reflect performance stability, whereas performance decline is manifest as “deactivation(s)”.Design: Cohort study conducted from July 2015 to September 2016. Setting: Single center (Imperial College Healthcare NHS Trust, United Kingdom). Participants: 102 surgical residents (PGY1 and above) were invited to participate, of which 33 agreed to partake (median age [range]: 33 [29-56] years, 27 [82%] males).Exposure: Subjects performed a laparoscopic suturing task under two conditions: ‘self-paced’ (SP; without time per knot restrictions), and ‘time pressure’ (TP; two-minute per knot time restriction). Main Outcomes and Measures: A composite deterioration score was computed based on between-condition differences in task performance metrics [(task progression score (au), error score (mm), leak volume (ml) and knot tensile strength (N)]. Based on the composite score, quartiles were computed reflecting performance stability (Q1) and decline (Q4). Changes in PFC oxygenated haemoglobin concentration (HbO2) measured at 24 different locations using functional near-infrared spectroscopy were compared between Q1 and Q4. Secondary outcomes included subjective workload (Surgical Task Load Index) and heart rate. Results: Q1 residents demonstrated task-induced incr
Gooderham N, Alkandari A, Ashrafian H, et al., 2019, Bariatric surgery modulates urinary levels of microRNAs involved in the regulation of renal function, Frontiers in Endocrinology, Vol: 10, ISSN: 1664-2392
Background: Obesity and diabetes cause chronic kidney disease with a common pathophysiology that is characterized by the accumulation of collagen in the extracellular matrix. Recent evidence has implicated the epithelial-to-mesenchymal transition (EMT) as a key step in this pathology with regulation by microRNAs. Weight loss leads to improvements in renal function; therefore, this study hypothesized that bariatric-surgery aided weight loss would lead to changes in urinary microRNAs involved in the regulation of renal function.Materials and methods: Twenty-four bariatric patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy donated urine pre-operatively and at 2–6 months and 1–2 years post-operatively. Urine samples were also obtained from 10 healthy weight and 7 morbidly obese non-surgical controls. Expression levels of kidney microRNAs were assessed in urine and the function of microRNAs was assessed through the in vitro transfection of HK-2 cells, a kidney proximal tubule cell line.Results: Levels of miR 192, miR 200a, and miR 200b were upregulated in urine following bariatric surgery. This increase was consistent across surgical type and diabetes status and was maintained and enhanced with time. Bariatric surgery alters urinary miR 192 expression from levels seen in morbidly obese patients to levels seen in healthy weight control patients. In mechanistic studies, the transfection of miR 192 in HK-2 cells increased miR 200a expression and decreased ZEB2, a key transcriptional promoter of kidney fibrosis.Conclusions: Bariatric surgery increased miR 192 and miR 200 urinary levels, key anti-fibrotic microRNAs that could contribute to a renal-protective mechanism and may be of value as urinary biomarkers following surgery. These findings suggest that urinary microRNAs may represent potential novel biomarkers for obesity-associated renal function.
Martin G, Clarke J, Liew F, et al., 2019, Evaluating the impact of organisational digital maturity on clinical outcomes in secondary care in England, npj Digital Medicine, Vol: 2, ISSN: 2398-6352
All healthcare systems are increasingly reliant on health information technology to support the delivery of high-quality, efficient and safe care. Data on its effectiveness are however limited. We therefore sought to examine the impact of organisational digital maturity on clinical outcomes in secondary care within the English National Health Service. We conducted a retrospective analysis of routinely collected administrative data for 13,105,996 admissions across 136 hospitals in England from 2015 to 2016. Data from the 2016 NHS Clinical Digital Maturity Index were used to characterise organisational digital maturity. A multivariable regression model including 12 institutional covariates was utilised to examine the relationship between one measure of organisational digital maturity and five key clinical outcome measures. There was no significant relationship between organisational digital maturity and risk-adjusted 30-day mortality, 28-day readmission rates or complications of care. In multivariable analysis risk-adjusted long length of stay and harm-free care were significantly related to aspects of organisational digital maturity; digitally mature hospitals may not only deliver more harm-free care episodes but also may have a significantly increased risk of patients experiencing a long length of stay. Organisational digital maturity is to some extent related to selected clinical outcomes in secondary care in England. Digital maturity is, however, also strongly linked to other institutional factors that likely play a greater role in influencing clinical outcomes. There is a need to better understand how health IT impacts care delivery and supports other drivers of hospital quality.
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