Imperial College London

Professor the Lord Darzi of Denham PC KBE FRS FMedSci HonFREng

Faculty of MedicineDepartment of Surgery & Cancer

Professor of Surgery
 
 
 
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Contact

 

+44 (0)20 3312 1310a.darzi

 
 
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Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

1335 results found

Ahmed I, Ahmad NS, Ali S, Ali S, George A, Saleem H, Uppal E, Soo J, Mobasheri M, King D, Cox BM, Darzi Aet al., Medication Adherence Apps: A review and content analysis, JMIR mHealth and uHealth, ISSN: 2291-5222

AbstractBackground:Medication adherence is a costly and damaging problem for both healthcare providers and patients alike. 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 the numerous applications (apps) available claiming to improve adherence, a thorough review of adherence applications has not been carried out to date.Objective:(i)To review medication adherence apps (otherwise known as mAdherence app) in the Apple App store and the Google Play repository in terms of their evidence base, medical professional involvement in development, and strategies used to facilitate behaviour change and improve adherence.(ii)To provide a system of classification for these apps. Methods:In April 2015, relevant mAdherence apps were identified by systematically searching the Apple and Google Play app stores using a combination of relevant search terms. Data extracted for each app included app store source, app price, documentation of healthcare 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 standardised medication regimen of three reminders over a four-hour period. Non-adherence features designed to enhance user experience were also documented.Results:The App repository search identified a total of 5889 applications. 806 fulfilled the inclusion criteria initially and were tested. 682 applications were further analysed for data extraction. Of these, 61.7% were free for testing, 8.5% were inaccessible and 29.8% required payment. Of the 421 free applications, 13.8% were developed with HCP involvement and an evidence base was identified in only 0.95%. Of the paid apps, 4.4% had HCP involvement, 0.5% had a documented evidence base and 0.5% had both. 31% of inaccessible apps were

JOURNAL ARTICLE

Attaelmanan I, Bhatti YA, Harris M, Prime M, Darzi Aet al., The development and diffusion of surgical frugal innovations – lessons for the NHS, LSE International Health Policy Conference 2017

CONFERENCE PAPER

Byrne B, Aylin P, Bottle RA, Faiz OD, Darzi A, Vincent CAet al., Failure to engage in surgical quality improvement research is associated with poorer quality of care, Royal Society of Medicine, Coloproctology section: Overseas meeting in Leuven

CONFERENCE PAPER

Byrne B, Faiz O, Darzi A, Vincent Cet al., Do gastrointestinal cancer patients want to decide where they have tests and surgery? A questionnaire study., Digestive Disorders Federation

CONFERENCE PAPER

Khan DZ, Oude Vrielink TJC, Marcus H, Darzi A, Mylonas Get al., NeuroCYCLOPS: development and preclinical validation of a robotic platform for endoscopic neurosurgery, European Association of Neurosurgical Societies (EANS 2016), Publisher: European Association of Neurosurgical Societies

CONFERENCE PAPER

Kogkas A, Darzi A, Mylonas GP, Gaze-Driven Human-Robot Interaction in the Operating Theatre, 6th Joint Workshop on New Technologies for Computer/Robot Assisted Surgery (CRAS 2016)

CONFERENCE PAPER

Leff DR, Shetty K, Yang GZ, Darzi Aet al., Persistent Attentional Demands Despite Laparoscopic Skills Acquisition, JAMA Surgery, ISSN: 2168-6262

JOURNAL ARTICLE

Oude Vrielink TJC, Darzi, Mylonas G, microCYCLOPS: A Robotic System for Microsurgical Applications, 6th Joint Workshop on New Technologies for Computer/Robot Assisted Surgery (CRAS 2016)

CONFERENCE PAPER

Rao AM, Bottle R, Darzi A, Aylin Pet al., Sequence analysis of long-term readmissions among high-impact users of cerebrovascular patients, Stroke Research and Treatment, ISSN: 2090-8105

JOURNAL ARTICLE

Rao AM, jones A, bottle R, darzi A, aylin Pet al., A retrospective cohort study of high-impact users among patients with cerebrovascular conditions, BMJ Open, ISSN: 2044-6055

JOURNAL ARTICLE

St John ERC, Leff D, takats Z, Darzi Aet al., Rapid Evaporative Ionisation Mass Spectrometry of Electrosurgical Vapours for the Identification of Breast Pathology: Towards an Intelligent Knife for Breast Cancer Surgery, Breast Cancer Research, ISSN: 1465-542X

JOURNAL ARTICLE

Taylor MJ, Kaur M, Sharma U, Taylor D, Reed JE, Darzi Aet al., Using virtual worlds for patient and public engagement., Int J Technol Knowl Soc, Vol: 9, Pages: 31-48, ISSN: 1832-3669

Patient and public involvement is fundamental in healthcare and many methods attempt to facilitate this engagement. The present study investigated use of computer-generated environments known as 'virtual worlds' (VW) as an involvement method. The VW used in the present research was Second Life, which is 3-dimensional, publically accessible and internet-based. It is accessed using digital self-representations, or 'avatars', through which users navigate the virtual environment and communicate with one another. Participants were patients with long-term conditions, frequently involved in shaping health research and care. Some had mobility and communication difficulties, potentially making involvement through traditional face-to-face modes of engagement challenging. There were 2 stages to this study. Stage-1: Participants were introduced to VWs and Second Life. This was followed by a face-to-face focus group discussion (FGD) in order to gain their views on use of SL. Stage-2: An FGD attended by 8 people (4 patients, 3 researchers, 1 healthcare professional) was conducted in Second Life. Training and support on using Second Life had been provided for participants. The FGD took place successfully, although some technical and communication difficulties were experienced. Data was collected in the form of interviews and questionnaires from the patients about their experience of using the virtual world. Participants recognised the potential of VWs as a platform for patient engagement, especially for those who suffer from chronic conditions that impact severely upon their mobility and communication. Participant feedback indicated that potential barriers include technical problems with VW programs and potential user inexperience of using VWs, which may be counteracted by ensuring provision of continuous training and support. In conclusion, this study established the feasibility of using VWs for patient FGDs and indicates a potential of use of VWs for engagement in future, partic

JOURNAL ARTICLE

king HK, shang JS, liu JL, Seneci CA, wisanuvej PW, giataganas PG, patel NS, clark JC, vitiello VV, bergeles CB, pratt PP, di marco AD, kerr KK, darzi AD, yang GZYet al., Micro-IGES Robot for Transanal Robotic Microsurgery., In The Hamlyn Symposium on Medical Robotics.

CONFERENCE PAPER

patel NP, seneci CS, yang GZY, darzi AD, teare JTet al., Flexible platforms for natural orifice transluminal and endoluminal surgery. Endoscopy International Open, 2(02), E117-E123., Endoscopy International Open

JOURNAL ARTICLE

Abeles A, Kwasnicki RM, Darzi A, 2017, Enhanced recovery after surgery: Current research insights and future direction., World J Gastrointest Surg, Vol: 9, Pages: 37-45

Since the concept of enhanced recovery after surgery (ERAS) was introduced in the late 1990s the idea of implementing specific interventions throughout the peri-operative period to improve patient recovery has been proven to be beneficial. Minimally invasive surgery is an integral component to ERAS and has dramatically improved post-operative outcomes. ERAS can be applicable to all surgical specialties with the core generic principles used together with added specialty specific interventions to allow for a comprehensive protocol, leading to improved clinical outcomes. Diffusion of ERAS into mainstream practice has been hindered due to minimal evidence to support individual facets and lack of method for monitoring and encouraging compliance. No single outcome measure fully captures recovery after surgery, rather multiple measures are necessary at each stage. More recently the pre-operative period has been the target of a number of strategies to improve clinical outcomes, described as prehabilitation. Innovation of technology in the surgical setting is also providing opportunities to overcome the challenges within ERAS, e.g., the use of wearable activity monitors to record information and provide feedback and motivation to patients peri-operatively. Both modernising ERAS and providing evidence for key strategies across specialties will ultimately lead to better, more reliable patient outcomes.

JOURNAL ARTICLE

Alexander J, Gildea L, Balog J, Speller A, McKenzie J, Muirhead L, Scott A, Kontovounisios C, Rasheed S, Teare J, Hoare J, Veselkov K, Goldin R, Tekkis P, Darzi A, Nicholson J, Kinross J, Takats Zet al., 2017, A novel methodology for in vivo endoscopic phenotyping of colorectal cancer based on real-time analysis of the mucosal lipidome: a prospective observational study of the iKnife, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 31, Pages: 1361-1370, ISSN: 0930-2794

JOURNAL ARTICLE

Bouras G, Burns EM, Howell AM, Bottle A, Athanasiou T, Darzi Aet al., 2017, Linked hospital and primary care database analysis of the impact of short-term complications on recurrence in laparoscopic inguinal hernia repair, HERNIA, Vol: 21, Pages: 191-198, ISSN: 1265-4906

JOURNAL ARTICLE

Bouras G, Markar SR, Burns EM, Huddy JR, Bottle A, Athanasiou T, Darzi A, Hanna GBet al., 2017, The psychological impact of symptoms related to esophagogastric cancer resection presenting in primary care: A national linked database study, EJSO, Vol: 43, Pages: 454-460, ISSN: 0748-7983

JOURNAL ARTICLE

Chana P, Joy M, Casey N, Chang D, Burns EM, Arora S, Darzi AW, Faiz OD, Peden CJet al., 2017, Cohort analysis of outcomes in 69 490 emergency general surgical admissions across an international benchmarking collaborative, BMJ OPEN, Vol: 7, ISSN: 2044-6055

JOURNAL ARTICLE

Flott K, Fontana G, Dhingra-Kumar N, Yu A, Durkin M, Darzi Aet al., 2017, Health care must mean safe care: enshrining patient safety in global health, LANCET, Vol: 389, Pages: 1279-1281, ISSN: 0140-6736

JOURNAL ARTICLE

Harling L, Lambert J, Ashrafian H, Darzi A, Gooderham NJ, Athanasiou Tet al., 2017, Elevated serum microRNA 483-5p levels may predict patients at risk of post-operative atrial fibrillation, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol: 51, Pages: 73-78, ISSN: 1010-7940

JOURNAL ARTICLE

Hassen Y, Johnston M, Barrow EJ, Darzi Aet al., 2017, Safety and the Use of Checklists in Acute Care Surgery, Acute Care Surgery Handbook Volume 1 General Aspects, Non-gastrointestinaI and Critical Care Emergencies, Publisher: Springer, ISBN: 9783319153407

This pocket manual is a practically oriented, wide-ranging guide to acute care surgery general aspects and to non-gastrointestinal emergencies.

BOOK CHAPTER

Howell A-M, Burns EM, Hull L, Mayer E, Sevdalis N, Darzi Aet al., 2017, International recommendations for national patient safety incident reporting systems: an expert Delphi consensus-building process, BMJ QUALITY & SAFETY, Vol: 26, Pages: 150-163, ISSN: 2044-5415

JOURNAL ARTICLE

Kogkas AA, Darzi A, Mylonas GP, 2017, Gaze-contingent perceptually enabled interactions in the operating theatre., Int J Comput Assist Radiol Surg

PURPOSE: Improved surgical outcome and patient safety in the operating theatre are constant challenges. We hypothesise that a framework that collects and utilises information -especially perceptually enabled ones-from multiple sources, could help to meet the above goals. This paper presents some core functionalities of a wider low-cost framework under development that allows perceptually enabled interaction within the surgical environment. METHODS: The synergy of wearable eye-tracking and advanced computer vision methodologies, such as SLAM, is exploited. As a demonstration of one of the framework's possible functionalities, an articulated collaborative robotic arm and laser pointer is integrated and the set-up is used to project the surgeon's fixation point in 3D space. RESULTS: The implementation is evaluated over 60 fixations on predefined targets, with distances between the subject and the targets of 92-212 cm and between the robot and the targets of 42-193 cm. The median overall system error is currently 3.98 cm. Its real-time potential is also highlighted. CONCLUSIONS: The work presented here represents an introduction and preliminary experimental validation of core functionalities of a larger framework under development. The proposed framework is geared towards a safer and more efficient surgical theatre.

JOURNAL ARTICLE

Kulasabanathan K, Issa H, Bhatti Y, Prime M, Del Castillo J, Darzi A, Harris Met al., 2017, Do International Health Partnerships contribute to reverse innovation? a mixed methods study of THET-supported partnerships in the UK, GLOBALIZATION AND HEALTH, Vol: 13, ISSN: 1744-8603

JOURNAL ARTICLE

Kulendran M, Borovoi L, Purkayastha S, Darzi A, Vlaev Iet al., 2017, Impulsivity predicts weight loss after obesity surgery., Surg Obes Relat Dis

OBJECTIVE: There is evidence that executive function, and specifically inhibitory control, is related to obesity and eating behavior. The goal of this study was to determine whether personality traits and inhibitory control predict weight loss after bariatric procedures. Although the impressive weight reduction after bariatric surgery has been shown in short- and medium-term studies, the effect of personality traits on this reduction is uncertain. Specifically, the effect of impulsivity is still largely unknown. SETTING: Patients attending either a multidisciplinary information session or outpatient clinic at the Imperial Weight Management Centre were recruited with informed consent into the trial over a 4-month period from January to April 2013. Participants were invited to attend behavioral testing on an outpatient basis in a silent room invigilated by a single researcher. METHODS: Forty-five bariatric patients participated in the study (25 patients had a gastric bypass, with a mean BMI of 41.8 and age of 39.0 years; 20 had a sleeve gastrectomy, with a mean BMI of 47.2 and age of 49.0 years). All patients completed personality measures of impulsivity-Barratt's Impulsivity Scale, as well as behavioral measures of impulsivity-the stop-signal reaction-time (SSRT) task measuring inhibitory control and the temporal discounting task measuring reward processing. Those measures were examined in relation to weight loss 6 months after surgery. RESULTS: The surgical procedure and changes in the behavioral measure of inhibitory control (SSRT) were found to be significant predictors of reduction in body mass index (BMI) in patients undergoing bariatric surgery. The sleeve gastrectomy group found a reduction in BMI of 14.1%, which was significantly less than the 25% reduction in BMI in the gastric bypass group. The direction (parameter estimate) of the significant effect was positive for SSRT change, which indicates that pre- and postreduction in impulsivity predicts reduction

JOURNAL ARTICLE

Leff DR, Yongue G, Vlaev I, Orihuela-Espina F, James D, Taylor MJ, Athanasiou T, Dolan R, Yang G-Z, Darzi Aet al., 2017, "Contemplating the Next Maneuver" Functional Neuroimaging Reveals Intraoperative Decision-making Strategies, ANNALS OF SURGERY, Vol: 265, Pages: 320-330, ISSN: 0003-4932

JOURNAL ARTICLE

Leff DR, Yongue G, Vlaev I, Orihuela-Espina F, James D, Taylor MJ, Athanasiou T, Dolan R, Yang GZ, Darzi Aet al., 2017, "Contemplating the Next Maneuver": Functional Neuroimaging Reveals Intraoperative Decision-making Strategies., Ann Surg, Vol: 265, Pages: 320-330

OBJECTIVE: To investigate differences in the quality, confidence, and consistency of intraoperative surgical decision making (DM) and using functional neuroimaging expose decision systems that operators use. SUMMARY BACKGROUND DATA: Novices are hypothesized to use conscious analysis (effortful DM) leading to activation across the dorsolateral prefrontal cortex, whereas experts are expected to use unconscious automation (habitual DM) in which decisions are recognition-primed and prefrontal cortex independent. METHODS: A total of 22 subjects (10 medical student novices, 7 residents, and 5 attendings) reviewed simulated laparoscopic cholecystectomy videos, determined the next safest operative maneuver upon video termination (10 s), and reported decision confidence. Video paradigms either declared ("primed") or withheld ("unprimed") the next operative maneuver. Simultaneously, changes in cortical oxygenated hemoglobin and deoxygenated hemoglobin inferring prefrontal activation were recorded using Optical Topography. Decision confidence, consistency (primed vs unprimed), and quality (script concordance) were assessed. RESULTS: Attendings and residents were significantly more certain (P < 0.001), and decision quality was superior (script concordance: attendings = 90%, residents = 78.3%, and novices = 53.3%). Decision consistency was significantly superior in experts (P < 0.001) and residents (P < 0.05) than novices (P = 0.183). During unprimed DM, novices showed significant activation of the dorsolateral prefrontal cortex, whereas this activation pattern was not observed among residents and attendings. During primed DM, significant activation was not observed in any group. CONCLUSIONS: Expert DM is characterized by improved quality, consistency, and confidence. The findings imply attendings use a habitual decision system, whereas novices use an effortful approach under uncertainty. In the presence of operative cues (primes), novices disengage

JOURNAL ARTICLE

Manfield JH, Yu KK-H, Efthimiou E, Darzi A, Athanasiou T, Ashrafian Het al., 2017, Bariatric Surgery or Non-surgical Weight Loss for Idiopathic Intracranial Hypertension? A Systematic Review and Comparison of Meta-analyses, OBESITY SURGERY, Vol: 27, Pages: 513-521, ISSN: 0960-8923

JOURNAL ARTICLE

Modi HN, Singh H, Orihuela-Espina F, Athanasiou T, Fiorentino F, Yang GZ, Darzi A, Leff DRet al., 2017, Temporal Stress in the Operating Room: Brain Engagement Promotes "Coping" and Disengagement Prompts "Choking"., Ann Surg

OBJECTIVE: To investigate the impact of time pressure (TP) on prefrontal activation and technical performance in surgical residents during a laparoscopic suturing task. BACKGROUND: Neural mechanisms enabling surgeons to maintain performance and cope with operative stressors are unclear. The prefrontal cortex (PFC) is implicated due to its role in attention, concentration, and performance monitoring. METHODS: A total of 33 residents [Postgraduate Year (PGY)1-2 = 15, PGY3-4 = 8, and PGY5 = 10] performed a laparoscopic suturing task under "self-paced" (SP) and "TP" conditions (TP = maximum 2 minutes per knot). Subjective workload was quantified using the Surgical Task Load Index. PFC activation was inferred using optical neuroimaging. Technical skill was assessed using progression scores (au), error scores (mm), leak volumes (mL), and knot tensile strengths (N). RESULTS: TP led to greater perceived workload amongst all residents (mean Surgical Task Load Index score ± SD: PGY1-2: SP = 160.3 ± 24.8 vs TP = 202.1 ± 45.4, P < 0.001; PGY3-4: SP = 123.0 ± 52.0 vs TP = 172.5 ± 43.1, P < 0.01; PGY5: SP = 105.8 ± 55.3 vs TP = 159.1 ± 63.1, P < 0.05). Amongst PGY1-2 and PGY3-4, deterioration in task progression, error scores and knot tensile strength (P < 0.05), and diminished PFC activation was observed under TP. In PGY5, TP resulted in inferior task progression and error scores (P < 0.05), but preservation of knot tensile strength. Furthermore, PGY5 exhibited less attenuation of PFC activation under TP, and greater activation than either PGY1-2 or PGY3-4 under both experimental conditions (P < 0.05). CONCLUSIONS: Senior residents cope better with temporal demands and exhibit greater technical performance stability under pressure, possibly due to sustained PFC activation and greater task engagement. Future work should seek to develop training strategies that recruit prefrontal resources, enha

JOURNAL ARTICLE

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