930 results found
Ahmed I, Ahmad NS, Ali S, et al., 2018, Medication Adherence Apps: Review and Content Analysis., JMIR Mhealth Uhealth, Vol: 6, ISSN: 2291-5222
BACKGROUND: Medication adherence is an expensive and damaging problem for patients and health care providers. Patients adhere to only 50% of drugs prescribed for chronic diseases in developed nations. Digital health has paved the way for innovative smartphone solutions to tackle this challenge. However, despite numerous apps available claiming to improve adherence, a thorough review of adherence apps has not been carried out to date. OBJECTIVE: The aims of this study were to (1) review medication adherence apps available in app repositories in terms of their evidence base, medical professional involvement in development, and strategies used to facilitate behavior change and improve adherence and (2) provide a system of classification for these apps. METHODS: In April 2015, relevant medication adherence apps were identified by searching the Apple App Store and the Google Play Store using a combination of relevant search terms. Data extracted included app store source, app price, documentation of health care professional (HCP) involvement during app development, and evidence base for each respective app. Free apps were downloaded to explore the strategies used to promote medication adherence. Testing involved a standardized medication regimen of three reminders over a 4-hour period. Nonadherence features designed to enhance user experience were also documented. RESULTS: The app repository search identified a total of 5881 apps. Of these, 805 fulfilled the inclusion criteria initially and were tested. Furthermore, 681 apps were further analyzed for data extraction. Of these, 420 apps were free for testing, 58 were inaccessible and 203 required payment. Of the 420 free apps, 57 apps were developed with HCP involvement and an evidence base was identified in only 4 apps. Of the paid apps, 9 apps had HCP involvement, 1 app had a documented evidence base, and 1 app had both. In addition, 18 inaccessible apps were produced with HCP involvement, whereas 2 apps had a documente
Ahmed K, Penney N, Darzi A, et al., 2018, Taste Changes after Bariatric Surgery: a Systematic Review., Obes Surg
BACKGROUND: Alterations in taste perception and preferences may contribute to dietary changes and subsequent weight loss following bariatric surgery. METHODS: A systematic search was performed to identify all articles investigating gustation, olfaction, and sensory perception in both animal and human studies following bariatric procedures. RESULTS: Two hundred fifty-five articles were identified after database searches, bibliography inclusions and deduplication. Sixty-one articles were included. These articles provide evidence supporting changes in taste perception and hedonic taste following bariatric procedures. Taste sensitivity to sweet and fatty stimuli appears to increase post-operatively. Additionally, patients also have a reduced hedonic response to these stimuli. CONCLUSIONS: Available evidence suggests that there is a change in taste perception following bariatric procedures, which may contribute to long-term maintenance of weight loss following surgery.
Alkandari A, Ashrafian H, Sathyapalan T, et al., 2018, Improved physiology and metabolic flux after Roux-en-Y gastric bypass is associated with temporal changes in the circulating microRNAome: a longitudinal study in humans., BMC Obes, Vol: 5, ISSN: 2052-9538
Background: The global pandemic of obesity and the metabolic syndrome are leading causes of mortality and morbidity. Bariatric surgery leads to sustained weight loss and improves obesity-associated morbidity including remission of type 2 diabetes. MicroRNAs are small, endogenous RNAs that regulate gene expression post-transcriptionally, controlling most of the human transcriptome and contributing to the regulation of systemic metabolism. This preliminary, longitudinal, repeat sampling study, in which subjects acted as their own control, aimed to assess the temporal effect of bariatric surgery on circulating microRNA expression profiles. Methods: We used Exiqon's optimized circulating microRNA panel (comprising 179 validated miRNAs) and miRCURY locked nucleic acid plasma/serum Polymerase Chain Reaction (PCR) to assess circulating microRNA expression. The microRNAome was determined for Roux-en-Y gastric bypass (RYGB) patients examined preoperatively and at 1 month, 3 months, 6 months, 9 months and 12 months postoperatively. Data was analysed using multivariate and univariate statistics. Results: Compared to the preoperative circulating microRNA expression profile, RYGB altered the circulating microRNAome in a time dependent manner and the expression of 48 circulating microRNAs were significantly different. Importantly, these latter microRNAs are associated with pathways involved in regulation and rescue from metabolic dysfunction and correlated with BMI, the percentage of excess weight loss and fasting blood glucose levels. Conclusions: The results of this pilot study show that RYGB fundamentally alters microRNA expression in circulation with a time-dependent progressive departure in profile from the preoperative baseline and indicate that microRNAs are potentially novel biomarkers for the benefits of bariatric surgery.
Appelbaum N, Clarke J, Maconochie I, et al., 2018, Paediatric weight estimation by age in the digital era: optimising a necessary evil, RESUSCITATION, Vol: 122, Pages: 29-35, ISSN: 0300-9572
Appelbaum N, Clarke J, Maconochie I, et al., 2018, A model for habitus-adjusted paediatric weight estimation by age and data concerning the validation of this method on a large dataset of English children., Data Brief, Vol: 16, Pages: 771-774, ISSN: 2352-3409
It is often not possible to weigh children upon arrival at an emergency room before commencing the provision of emergency care. Because drugs for children are prescribed on the basis of age and body weight, estimations of weight are necessitated. Age-based equations have been one of the most commonly used weight estimation strategies historically. Due to the variability of weight for age in children, and variations in body habitus, these methods are inaccurate by design (Young and Korotzer, 2016) .
Archer S, Pinto A, Vuik S, et al., 2018, Surgery, Complications, and Quality of Life: A Longitudinal Cohort Study Exploring the Role of Psychosocial Factors., Ann Surg
OBJECTIVE: To determine whether psychosocial factors moderate the relationship between surgical complications and quality of life (QoL). BACKGROUND: Patients who experience surgical complications have significantly worse postoperative QoL than patients with an uncomplicated recovery. Psychosocial factors, such as coping style and level of social support influence how people deal with stressful events, but it is unclear whether they affect QoL following a surgical complication. These findings can inform the development of appropriate interventions that support patients postoperatively. METHODS: This is a longitudinal cohort study; data were collected pre-op, 1 month post-op, 4 months post-op, and 12 months post-op. A total of 785 patients undergoing major elective gastrointestinal, vascular, or cardiothoracic surgery who were recruited from 28 National Health Service sites in England and Scotland took part in the study. RESULTS: Patients who experience major surgical complications report significantly reduced levels of physical and mental QoL (P < 0.05) but they make a full recovery over time. Findings indicate that a range of psychosocial factors such as the use of humor as a coping style and the level of health care professional support may moderate the impact of surgical complications on QoL. CONCLUSIONS: Surgical complications alongside other sociodemographic and psychosocial factors contribute to changes in QoL; the results from this exploratory study suggest that interventions that increase the availability of healthcare professional support and promote more effective coping strategies before surgery may be useful, particularly in the earlier stages of recovery where QoL is most severely compromised. However, these relationships should be further explored in longitudinal studies that include other types of surgery and employ rigorous recruitment and follow-up procedures.
Ashraf H, Sodergren MH, Merali N, et al., 2018, Eye-tracking technology in medical education: A systematic review, MEDICAL TEACHER, Vol: 40, Pages: 62-69, ISSN: 0142-159X
Clift AK, Pawa N, Osmani H, et al., 2018, Appropriate Surgical Strategy in Appendiceal Neuroendocrine Tumors: Is Right Hemicolectomy Oncologically Justified or Overtreatment?, 15th Annual ENETS Conference for the Diagnosis and Treatment of Neuroendocrine Tumor Disease, Publisher: KARGER, Pages: 269-269, ISSN: 0028-3835
Darzi A, 2018, A British Perspective on the American College of Surgeons Conversation About Firearm Safety, ANNALS OF SURGERY, Vol: 267, Pages: 430-431, ISSN: 0003-4932
Dewa LH, Cecil E, Eastwood L, et al., 2018, Indicators of deterioration in young adults with serious mental illness: a systematic review protocol., Syst Rev, Vol: 7
BACKGROUND: The first signs of serious mental illnesses (SMIs) including schizophrenia, bipolar disorder and major depression are likely to occur before the age of 25. The combination of high prevalence of severe mental health symptoms, inability to recognise mental health deterioration and increased likelihood of comorbidity in a complex transitional young group makes detecting deterioration paramount. Whilst studies have examined physical and mental health deterioration in adults, no systematic review has examined the indicators of mental and physical deterioration in young adults with SMI. The study aim is to systematically review the existing evidence from observational studies that examine the indicators of mental and physical deterioration in young adults with SMI and highlight gaps in knowledge to inform future research. METHODS: Seven databases including CINHAL, MEDLINE, Embase, PsycINFO, Health Management Information Consortium, Cochrane databases and Web of Science will be searched against five main facets (age, serious mental illness, sign, deterioration and patient) and a subsequent comprehensive list of search terms. Searches will be run individually in each database to reflect each unique set of relevant subject headings and appropriate MeSH terms. Inclusion and exclusion criteria were developed and refined by the research team. Two reviewers will participate in each search stage including abstract/title and full text screening, data extraction and appraisal, to ensure reliability. A narrative synthesis of the data will also be conducted. DISCUSSION: This systematic review will likely make a significant contribution to the field of mental health and help inform future research pertaining to interventions that help highlight deteriorating patients. This may vary depending on the patient group, mental illness or deterioration type. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017075755.
Dewa LH, Murray K, Thibaut B, et al., 2018, Identifying research priorities for patient safety in mental health: an international expert Delphi study, BMJ OPEN, Vol: 8, ISSN: 2044-6055
Dilley JWR, Hughes-Hallett A, Pratt PJ, et al., 2018, Perfect Registration Leads to Imperfect Performance: A Randomized Trial of Multimodal Intraoperative Image Guidance., Ann Surg
OBJECTIVE: To compare surgical safety and efficiency of 2 image guidance modalities, perfect augmented reality (AR) and side-by-side unregistered image guidance (IG), against a no guidance control (NG), when performing a simulated laparoscopic cholecystectomy (LC). BACKGROUND: Image guidance using AR offers the potential to improve understanding of subsurface anatomy, with positive ramifications for surgical safety and efficiency. No intra-abdominal study has demonstrated any advantage for the technology. Perfect AR cannot be provided in the operative setting in a patient; however, it can be generated in the simulated setting. METHODS: Thirty-six experienced surgeons performed a baseline LC using the LapMentor simulator before randomization to 1 of 3 study arms: AR, IG, or NG. Each performed 3 further LC. Safety and efficiency-related simulator metrics, and task workload (SURG-TLX) were collected. RESULTS: The IG group had a shorter total instrument path length and fewer movements than NG and AR groups. Both IG and NG took a significantly shorter time than AR to complete dissection of Calot triangle. Use of IG and AR resulted in significantly fewer perforations and serious complications than the NG group. IG had significantly fewer perforations and serious complications than the AR group. Compared with IG, AR guidance was found to be significantly more distracting. CONCLUSION: Side-by-side unregistered image guidance (IG) improved safety and surgical efficiency in a simulated setting when compared with AR or NG. IG provides a more tangible opportunity for integrating image guidance into existing surgical workflow as well as delivering the safety and efficiency benefits desired.
Erridge S, Ashraf H, Purkayastha S, et al., 2018, Comparison of gaze behaviour of trainee and experienced surgeons during laparoscopic gastric bypass, BRITISH JOURNAL OF SURGERY, Vol: 105, Pages: 287-294, ISSN: 0007-1323
Erridge S, Moussa OM, Ziprin P, et al., 2018, Risk of GERD-Related Disorders in Obese Patients on PPI Therapy: a Population Analysis, OBESITY SURGERY, Vol: 28, Pages: 2796-2803, ISSN: 0960-8923
Flott K, Darzi A, Gancarczyk S, et al., 2018, Improving the Usefulness and Use of Patient Survey Programs: National Health Service Interview Study, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 20, ISSN: 1438-8871
Flott K, Darzi A, Mayer E, 2018, Care pathway and organisational features driving patient experience: statistical analysis of large NHS datasets., BMJ Open, Vol: 8
OBJECTIVE: The aim of this study was to identify the care pathway and organisational factors that predict patient experience. DESIGN: Statistical analysis of large National Health Service (NHS) datasets. SETTING ANDPARTICIPANTS: England; acute NHS organisational-level data. PRIMARY AND SECONDARY OUTCOME MEASURES: The relationship of care pathway and organisational variables to organisation-level patient experience. RESULTS: A framework of 18 care pathway and organisational variables were created based on the existing literature. 11 of these correlated to patient experience in univariate analyses. Multicollinearity tests resulted in 1 of the 11 variables holding a correlation to another variable larger than r=0.70. A significant multilinear regression equation, including the final 10 variables, was found (F(10,108)=6.214, p<0.00), with an [Formula: see text] of 0.365. Two variables were significant in predicting better in patient experience: Amount of support to clinical staff (beta=0.2, p=0.02) and the proportion of staff who would recommend the trust as a place to work or receive treatment (beta=0.26, p=0.01). Two variables were significant in predicting a negative impact on the patient's rating of their experience: Number of patients spending over 4 hours from decision to admit to admission (beta=-1.99, p=0.03) and the percentage of estates and hotel services contracted out (beta=-0.23, p=0.01). CONCLUSIONS: These results indicate that augmenting clinical support and investing in the mechanisms that facilitate positive staff experience is essential to delivering appropriate, informative and patient-centric care. Reducing wait times and the extent of external contracting within hospitals is also likely to improve patient ratings of experience. Understanding the relationship between patient experience and objective, measurable organisational features promote a more patient-centric interpretation of quality and compel a better use of patient experience feedback to
Flott K, Durkin M, Darzi A, 2018, The Tokyo Declaration on patient safety, BMJ-BRITISH MEDICAL JOURNAL, Vol: 362, ISSN: 1756-1833
Garas G, Markar SR, Malietzis G, et al., 2018, Induced Bias Due to Crossover Within Randomized Controlled Trials in Surgical Oncology: A Meta-regression Analysis of Minimally Invasive versus Open Surgery for the Treatment of Gastrointestinal Cancer, ANNALS OF SURGICAL ONCOLOGY, Vol: 25, Pages: 221-230, ISSN: 1068-9265
Gohil S, Vuik S, Darzi A, 2018, Sentiment Analysis of Health Care Tweets: Review of the Methods Used, JMIR Public Health and Surveillance, Vol: 4, Pages: e43-e43
Gohil S, Vuik S, Darzi A, 2018, Sentiment Analysis of Health Care Tweets: Review of the Methods Used., JMIR Public Health Surveill, Vol: 4, ISSN: 2369-2960
BACKGROUND: Twitter is a microblogging service where users can send and read short 140-character messages called "tweets." There are several unstructured, free-text tweets relating to health care being shared on Twitter, which is becoming a popular area for health care research. Sentiment is a metric commonly used to investigate the positive or negative opinion within these messages. Exploring the methods used for sentiment analysis in Twitter health care research may allow us to better understand the options available for future research in this growing field. OBJECTIVE: The first objective of this study was to understand which tools would be available for sentiment analysis of Twitter health care research, by reviewing existing studies in this area and the methods they used. The second objective was to determine which method would work best in the health care settings, by analyzing how the methods were used to answer specific health care questions, their production, and how their accuracy was analyzed. METHODS: A review of the literature was conducted pertaining to Twitter and health care research, which used a quantitative method of sentiment analysis for the free-text messages (tweets). The study compared the types of tools used in each case and examined methods for tool production, tool training, and analysis of accuracy. RESULTS: A total of 12 papers studying the quantitative measurement of sentiment in the health care setting were found. More than half of these studies produced tools specifically for their research, 4 used open source tools available freely, and 2 used commercially available software. Moreover, 4 out of the 12 tools were trained using a smaller sample of the study's final data. The sentiment method was trained against, on an average, 0.45% (2816/627,024) of the total sample data. One of the 12 papers commented on the analysis of accuracy of the tool used. CONCLUSIONS: Multiple methods are used for sentiment analysis of tweets in the
Hassen Y, Singh P, Pucher PH, et al., 2018, Identifying quality markers of a safe surgical ward: An interview study of patients, clinical staff, and administrators, SURGERY, Vol: 163, Pages: 1226-1233, ISSN: 0039-6060
Hassen YAM, Johnston MJ, Singh P, et al., 2018, Key Components of the Safe Surgical Ward: International Delphi Consensus Study to Identify Factors for Quality Assessment and Service Improvement., Ann Surg
OBJECTIVE: The aim of this study was to prioritize key factors contributing to safety on the surgical ward BACKGROUND:: There is a variation in the quality and safety of postoperative care between institutions. These variations may be attributed to a combination of process-related issues and structural factors. The aim of this study is to reach a consensus, by means of Delphi methodology, on the most influential of these components that may determine safety in this environment. METHODS: The Delphi questionnaire was delivered via an online questionnaire platform. The panel were blinded. An international panel of safety experts, both clinical and nonclinical, and safety advocates participated. Individuals were selected according to their expertise and extent of involvement in patient safety research, regulation, or patient advocacy. RESULTS: Experts in patient safety from the UK, Europe, North America, and Australia participated. The panel identified the response to a deteriorating patient and the care of outlier patients as error-prone processes. Prioritized structural factors included organizational and environmental considerations such as use of temporary staff, out-of-hours reduction in services, ward cleanliness, and features of layout. The latter includes dedicated areas for medication preparation and adequate space around the patient for care delivery. Potential quality markers for safe care that achieved the highest consensus include leadership, visibility between patients and nurses, and nursing team skill mix and staffing levels. CONCLUSION: International consensus was achieved for a number of factors across process-related and structural themes that may influence safety in the postoperative environment. These should be championed and prioritized for future improvements in patient safety at the ward-level.
Johnston MJ, Arora S, King D, et al., 2018, Improving the Quality of Ward-based Surgical Care With a Human Factors Intervention Bundle, ANNALS OF SURGERY, Vol: 267, Pages: 73-80, ISSN: 0003-4932
Judah G, Darzi A, Vlaev I, et al., 2018, Financial disincentives? A three-armed randomised controlled trial of the effect of financial Incentives in Diabetic Eye Assessment by Screening (IDEAS) trial., Br J Ophthalmol, Vol: 102, Pages: 1014-1020
OBJECTIVE: Conflicting evidence exists regarding the impact of financial incentives on encouraging attendance at medical screening appointments. The primary aim was to determine whether financial incentives increase attendance at diabetic eye screening in persistent non-attenders. METHODS AND ANALYSIS: A three-armed randomised controlled trial was conducted in London in 2015. 1051 participants aged over 16 years, who had not attended eye screening appointments for 2 years or more, were randomised (1.4:1:1 randomisation ratio) to receive the usual invitation letter (control), an offer of £10 cash for attending screening (fixed incentive) or a 1 in 100 chance of winning £1000 (lottery incentive) if they attend. The primary outcome was the proportion of invitees attending screening, and a comparative analysis was performed to assess group differences. Pairwise comparisons of attendance rates were performed, using a conservative Bonferroni correction for independent comparisons. RESULTS: 34/435 (7.8%) of control, 17/312 (5.5%) of fixed incentive and 10/304 (3.3%) of lottery incentive groups attended. Participants who received any incentive were significantly less likely to attend their appointment compared with controls (risk ratio (RR)=0.56; 95% CI 0.34 to 0.92). Those in the probabilistic incentive group (RR=0.42; 95% CI 0.18 to 0.98), but not the fixed incentive group (RR=1.66; 95% CI 0.65 to 4.21), were significantly less likely to attend than those in the control group. CONCLUSION: Financial incentives, particularly lottery-based incentives, attract fewer patients to diabetic eye screening than standard invites in this population. Financial incentives should not be used to promote screening unless tested in context, as they may negatively affect attendance rates.
Kwasnicki RM, Cross GW, Geoghegan L, et al., 2018, A lightweight sensing platform for monitoring sleep quality and posture: a simulated validation study, EUROPEAN JOURNAL OF MEDICAL RESEARCH, Vol: 23, ISSN: 0949-2321
Lami M, Singh H, Dilley JH, et al., 2018, Gaze patterns hold key to unlocking successful search strategies and increasing polyp detection rate in colonoscopy, ENDOSCOPY, Vol: 50, Pages: 701-707, ISSN: 0013-726X
Maa J, Darzi A, 2018, Firearm Injuries and Violence Prevention - The Potential Power of a Surgeon General's Report, NEW ENGLAND JOURNAL OF MEDICINE, Vol: 379, Pages: 408-410, ISSN: 0028-4793
Malik HT, Marti J, Darzi A, et al., 2018, Savings from reducing low-value general surgical interventions, BRITISH JOURNAL OF SURGERY, Vol: 105, Pages: 13-25, ISSN: 0007-1323
Markar SR, Arhi C, Leusink A, et al., 2018, The Influence of Antireflux Surgery on Esophageal Cancer Risk in England: National Population-based Cohort Study., Ann Surg
OBJECTIVE: To evaluate how antireflux surgery influences the risk of esophageal cancer in patients with gastroesophageal reflux disease (GERD) and Barrett esophagus. BACKGROUND: GERD is a major risk factor for esophageal adenocarcinoma, and the United Kingdom has the highest incidence of esophageal adenocarcinoma globally. METHODS: Hospital Episode Statistics database was used to identify all patients in England aged over 18 years diagnosed with GERD with or without Barrett Esophagus from 2000 to 2012, with antireflux surgery being the exposure investigated. The Clinical Practice Research Datalink (CPRD) was used to provide a sensitivity analysis comparing proton pump inhibitor therapy and antireflux surgery. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox proportional hazards model with inverse probability weights based on the probability of having surgery to adjust for selection bias and confounding factors. RESULTS: (i) Hospital Episode Statistics analysis; among 838,755 included patients with GERD and 28,372 with Barrett esophagus, 22,231 and 737 underwent antireflux surgery, respectively. In GERD patients, antireflux surgery reduced the risk of esophageal cancer (HR = 0.64; 95% CI 0.52-0.78). In Barrett esophagus patients, the corresponding HR was (HR = 0.47; 95% CI 0.12-1.90).(ii) CPRD analysis; antireflux surgery was associated with decreased point estimates of esophageal adenocarcinoma in patients with GERD (0% vs. 0.2%; P = 0.16) and Barrett esophagus (HR = 0.75; 95% CI 0.21-2.63), but these were not statistically significant. CONCLUSION: Antireflux surgery may be associated with a reduced risk of esophageal cancer risk, however it remains primarily an operation for symptomatic relief.
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