1555 results found
Pucher PH, Johnston MJ, Archer S, et al., 2019, Informing the Consent Process for Surgeons: A Survey Study of Patient Preferences, Perceptions, and Risk Tolerance, JOURNAL OF SURGICAL RESEARCH, Vol: 235, Pages: 298-302, ISSN: 0022-4804
Runciman M, Mylonas G, Darzi A, Soft Robotics in Minimally Invasive Surgery, Soft Robotics, ISSN: 2169-5172
Joshi M, Ashrafian H, Aufegger L, et al., 2019, Wearable sensors to improve detection of patient deterioration, EXPERT REVIEW OF MEDICAL DEVICES, Vol: 16, Pages: 145-154, ISSN: 1743-4440
Dilley JWR, Hughes-Hallett A, Pratt PJ, et al., 2019, Perfect Registration Leads to Imperfect Performance: A Randomized Trial of Multimodal Intraoperative Image Guidance., Ann Surg, Vol: 269, Pages: 236-242
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.
Satava RM, Stefanidis D, Levy JS, et al., 2019, Proving the Effectiveness of the Fundamentals of Robotic Surgery (FRS) Skills Curriculum: A Single-blinded, Multispecialty, Multi-institutional Randomized Control Trial., Ann Surg
MINI: Question: Is the Fundamentals of Robotic Surgery (FRS) proficiency-based progression curriculum effective for teaching basic robotic surgery skills? FINDINGS: In an international multi-institutional, multispecialty, blinded, randomized control trial, implementation of the FRS skills curriculum using various simulation platforms led to improved performance of surgical trainees on a transfer test compared with controls.Meaning: The FRS is an effective simulation-based course for training to proficiency on basic robotic surgery skills before surgeons apply those skills clinically. OBJECTIVE: To demonstrate the noninferiority of the fundamentals of robotic surgery (FRS) skills curriculum over current training paradigms and identify an ideal training platform. SUMMARY BACKGROUND DATA: There is currently no validated, uniformly accepted curriculum for training in robotic surgery skills. METHODS: Single-blinded parallel-group randomized trial at 12 international American College of Surgeons (ACS) Accredited Education Institutes (AEI). Thirty-three robotic surgery experts and 123 inexperienced surgical trainees were enrolled between April 2015 and November 2016. Benchmarks (proficiency levels) on the 7 FRS Dome tasks were established based on expert performance. Participants were then randomly assigned to 4 training groups: Dome (n = 29), dV-Trainer (n = 30), and DVSS (n = 32) that trained to benchmarks and control (n = 32) that trained using locally available robotic skills curricula. The primary outcome was participant performance after training based on task errors and duration on 5 basic robotic tasks (knot tying, continuous suturing, cutting, dissection, and vessel coagulation) using an avian tissue model (transfer-test). Secondary outcomes included cognitive test scores, GEARS ratings, and robot familiarity checklist scores. RESULTS: All groups demonstrated significant performance improvement after skills training (P < 0.01). Participating residents and fello
Garas G, Cingolani I, Panzarasa P, et al., 2019, Beyond IDEAL: the importance of surgical innovation metrics, LANCET, Vol: 393, Pages: 315-315, ISSN: 0140-6736
Martin G, Khajuria A, Arora S, et al., 2019, The impact of mobile technology on teamwork and communication in hospitals: a systematic review., J Am Med Inform Assoc
Objectives: Effective communication is critical to the safe delivery of care but is characterized by outdated technologies. Mobile technology has the potential to transform communication and teamwork but the evidence is currently uncertain. The objective of this systematic review was to summarize the quality and breadth of evidence for the impact of mobile technologies on communication and teamwork in hospitals. Materials and Methods: Electronic databases (MEDLINE, PsycINFO, EMBASE, CINAHL Plus, HMIC, Cochrane Library, and National Institute of Health Research Health Technology Assessment) were searched for English language publications reporting communication- or teamwork-related outcomes from mobile technologies in the hospital setting between 2007 and 2017. Results: We identified 38 publications originating from 30 studies. Only 11% were of high quality and none met best practice guidelines for mobile-technology-based trials. The studies reported a heterogenous range of quantitative, qualitative, and mixed-methods outcomes. There is a lack of high-quality evidence, but nonetheless mobile technology can lead to improvements in workflow, strengthen the quality and efficiency of communication, and enhance accessibility and interteam relationships. Discussion: This review describes the potential benefits that mobile technology can deliver and that mobile technology is ubiquitous among healthcare professionals. Crucially, it highlights the paucity of high-quality evidence for its effectiveness and identifies common barriers to widespread uptake. Limitations include the limited number of participants and a wide variability in methods and reported outcomes. Conclusion: Evidence suggests that mobile technology has the potential to significantly improve communication and teamwork in hospital provided key organizational, technological, and security challenges are tackled and better evidence delivered.
Poynter L, Mirnezami R, Galea D, et al., Network mapping of molecular biomarkers influencing radiation response in rectal cancer, Clinical Colorectal Cancer, ISSN: 1533-0028
Khanbhai M, Flott K, Darzi A, et al., 2019, Evaluating Digital Maturity and Patient Acceptability of Real-Time Patient Experience Feedback Systems: Systematic Review, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 21, ISSN: 1438-8871
Goiana-da-Silva F, Cruz-e-Silva D, Miraldo M, et al., 2019, Front-of-pack labelling policies and the need for guidance, LANCET PUBLIC HEALTH, Vol: 4, Pages: E15-E15, ISSN: 2468-2667
Garas G, Cingolani I, Patel V, et al., 2018, Surgical Innovation in the Era of Global Surgery: A Network Analysis., Ann Surg
OBJECTIVE: To present a novel network-based framework for the study of collaboration in surgery and demonstrate how this can be used in practice to help build and nurture collaborations that foster innovation. BACKGROUND: Surgical innovation is a social process that originates from complex interactions among diverse participants. This has led to the emergence of numerous surgical collaboration networks. What is still needed is a rigorous investigation of these networks and of the relative benefits of various collaboration structures for research and innovation. METHODS: Network analysis of the real-world innovation network in robotic surgery. Hierarchical mixed-effect models were estimated to assess associations between network measures, research impact and innovation, controlling for the geographical diversity of collaborators, institutional categories, and whether collaborators belonged to industry or academia. RESULTS: The network comprised of 1700 organizations and 6000 links. The ability to reach many others along few steps in the network (closeness centrality), forging a geographically diverse international profile (network entropy), and collaboration with industry were all shown to be positively associated with research impact and innovation. Closed structures (clustering coefficient), in which collaborators also collaborate with each other, were found to have a negative association with innovation (P < 0.05 for all associations). CONCLUSIONS: In the era of global surgery and increasing complexity of surgical innovation, this study highlights the importance of establishing open networks spanning geographical boundaries. Network analysis offers a valuable framework for assisting surgeons in their efforts to forge and sustain collaborations with the highest potential of maximizing innovation and patient care.
Clarke JM, Warren LR, Arora S, et al., 2018, Guiding interoperable electronic health records through patient-sharing networks, NPJ DIGITAL MEDICINE, Vol: 1, ISSN: 2398-6352
Arhi CS, Burns EM, Bouras G, et al., 2018, Complications after discharge and delays in adjuvant chemotherapy following colonic resection: a cohort study of linked primary and secondary care data., Colorectal Dis
AIM: By understanding the reasons for delays in adjuvant chemotherapy (AC) after colonic resection, there is the potential to improve patient outcome. The aim of this study is to determine the extent and impact of complications after hospital discharge on delays to AC. METHOD: The study cohort included patients from Hospital Episode Statistics (HES) who had a colorectal cancer resection; linkage to primary care data was provided by the Clinical Practice Research Datalink (CPRD). Complications during the index hospital stay (from HES) and after discharge (from CPRD) were compared. The risk of late AC treatment (8 weeks or later) following a complication, stoma at the index procedure or emergency admission was described after accounting for age and Charlson score. A Cox hazards model determined the association of these factors with overall survival (OS). RESULTS: A total of 1266 patients underwent AC following colon cancer resection, of whom 598 (47.2%) received treatment within 8 weeks. Patients receiving late AC had a significantly higher proportion of re-operations (7.0% vs 3.3% P < 0.005) and wound infections (5.5% vs 3.7% P = 0.042), with 96% of the latter only being noted in CPRD. In multivariate analysis, the risk of AC delay significantly increased following a complication (OR 1.53, 95% CI 1.16-2.03, P = 0.003) or a stoma at the index operation. AC delay was associated with worse OS [hazard ratio (HR) 1.44, 95% CI 1.16-1.79, P = 0.001], as was an emergency admission (HR 1.59, 95% CI 1.21-1.98, P < 0.0005). However, the presence of a complication did not independently reduce OS (HR 1.15, 95%CI 0.89-1.48, P = 0.295). CONCLUSION: The true extent and impact of complications following colonic resection is underestimated when only secondary care data are used.
Goiana-da-Silva F, Cruz-e-Silva D, Gregorio MJ, et al., 2018, The future of the sweetened beverages tax in Portugal, LANCET PUBLIC HEALTH, Vol: 3, Pages: E562-E562, ISSN: 2468-2667
Normahani P, Kwasnicki R, Bicknell C, et al., 2018, Wearable Sensor Technology Efficacy in Peripheral Vascular Disease (wSTEP) A Randomized Controlled Trial, ANNALS OF SURGERY, Vol: 268, Pages: 1113-1118, ISSN: 0003-4932
Arhi CS, Bottle A, Burns EM, et al., 2018, Comparison of cancer diagnosis recording between the Clinical Practice Research Datalink, Cancer Registry and Hospital Episodes Statistics, CANCER EPIDEMIOLOGY, Vol: 57, Pages: 148-157, ISSN: 1877-7821
Smalley K, Aufegger L, Flott K, et al., Which behaviour change techniques are most effective in improving healthcare utilisation in COPD self-management programmes?, BMJ Open Respiratory Research, ISSN: 2052-4439
IntroductionSelf-management interventions are often presented as a way to improve the quality of care for patients with chronic illness. However self-management is quite broadly-defined and it remains unclear which types of interventions are most successful. This review will use the Theoretical Domains Framework (TDF) as a lens through which to categorise self-management interventions regarding which programmes are most likely to be effective, and under which circumstances. The aim of this study is to (1) describe the types of self-management programmes that have been developed in chronic obstructive pulmonary disease (COPD); and identify the common elements between these to better classify the self-management. (2) Evaluate the effect that self-management programmes have on COPD patients’ healthcare behaviour, by classifying those programmes by the behaviour change techniques used. Methods and analysisA systematic search of the literature will be performed in MEDLINE, EMBASE, HMIC, and PsycINFO. This review will be limited to randomised controlled trials (RCTs) and quasi-experimental studies. The review will follow PRISMA-P guidelines, and will provide a PRISMA checklist and flowchart. Risk of bias in individual studies will be assessed using the Cochrane Risk of Bias criteria, and the quality of included studies will be evaluated using the GRADE criteria, and will be reported in a Summary of Findings table.The primary analysis will be a catalogue of the interventions based on the components of the TDF that were utilised in the intervention. A matrix comparing included behaviour change techniques to improvements in utilisation will summarise the primary outcomes. Ethics and dissemination Not applicable, as this is a secondary review of the literature.Registration detailsPROSPERO: CRD42018104753
Markar SR, Arhi C, Wiggins T, et al., 2018, Reintervention After Antireflux Surgery for Gastroesophageal Reflux Disease in England., Ann Surg
BACKGROUND: After antireflux surgery, highly variable rates of recurrent gastroesophageal reflux disease (GERD) have been reported. OBJECTIVE: To identify the occurrence and risk factors of recurrent GERD requiring surgical reintervention or medication. METHODS: The Hospital Episode Statistics database was used to identify adults in England receiving primary antireflux surgery for GERD in 2000 to 2012 with follow-up through 2014, and the outcome was surgical reintervention. In a subset of participants, the Clinical Practice Research Datalink was additionally used to assess proton pump inhibitor therapy for at least 6 months (medical reintervention). Risk factors were assessed using multivariable Cox regression providing adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs). RESULTS: Among 22,377 patients who underwent primary antireflux surgery in the Hospital Episode Statistics dataset, 811 (3.6%) had surgical reintervention, with risk factors being age 41 to 60 years (HR = 1.22, 95% CI 1.03-1.44), female sex (HR = 1.5; 95% CI 1.3-1.74), white ethnicity (HR = 1.71, 95% CI 1.06-2.77), and low hospital annual volume of antireflux surgery (HR = 1.32, 95% CI 1.04-1.67). Among 2005 patients who underwent primary antireflux surgery in the Clinical Practice Research Datalink dataset, 189 (9.4%) had surgical reintervention and 1192 (59.5%) used proton pump inhibitor therapy, with risk factors for the combined outcome being age >60 years (HR = 2.38, 95% CI 1.81-3.13) and preoperative psychiatric morbidity (HR = 1.58, 95% CI 1.25-1.99). CONCLUSION: At least 3.6% of patients may require surgical reintervention and 59.5% medical therapy following antireflux surgery in England. The influence of patient characteristics and hospital volume highlights the need for patient selection and surgical experience in successful antireflux surgery.
Camara M, Mayer E, Darzi A, et al., 2018, Intraoperative ultrasound for improved 3D tumour reconstruction in robot-assisted surgery: An evaluation of feedback modalities., Int J Med Robot
BACKGROUND: Intraoperative ultrasound scanning induces deformation on the tissue in the absence of a feedback modality, which results in a 3D tumour reconstruction that is not directly representative of real anatomy. METHODS: A biomechanical model with different feedback modalities (haptic, visual, or auditory) was implemented in a simulation environment. A user study with 20 clinicians was performed to assess which modality resulted in the 3D tumour volume reconstruction that most resembled the reference configuration from the respective computed tomography (CT) scans. RESULTS: Integrating a feedback modality significantly improved the scanning performance across all participants and data sets. The optimal feedback modality to adopt varied depending on the evaluation. Nonetheless, using guidance with feedback is always preferred compared with none. CONCLUSIONS: The results demonstrated the urgency to integrate a feedback modality framework into clinical practice, to ensure an improved scanning performance. Furthermore, this framework enabled an evaluation that cannot be performed in vivo.
Gowers SAN, Hamaoui K, Vallant N, et al., 2018, An improved rapid sampling microdialysis system for human and porcine organ monitoring in a hospital setting, ANALYTICAL METHODS, Vol: 10, Pages: 5273-5281, ISSN: 1759-9660
Goiana Silva F, Cruz-e-Silva D, Miraldo M, et al., Supporting member states develop consumer-friendly front of pack labelling policies: guidance from the World Health Organization, Lancet Public Health, ISSN: 2468-2667
Ashcroft J, Patel R, Singh H, et al., The Impact of Transcranial direct current stimulation (tDCS) on a surgical knot-tying task, Research Afternoon, Department of Surgery and Cancer, Imperial College London
Ashrafian H, Darzi A, 2018, Transforming health policy through machine learning, PLOS MEDICINE, Vol: 15, ISSN: 1549-1676
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, ANNALS OF SURGERY, Vol: 268, Pages: 861-867, ISSN: 0003-4932
Flott K, Nelson D, Moorcroft T, et al., 2018, Enhancing Safety Culture Through Improved Incident Reporting: A Case Study In Translational Research., Health Aff (Millwood), Vol: 37, Pages: 1797-1804
The Imperial College Healthcare National Health Service Trust, a large health care provider in London, together with an academic research unit, used a learning health systems cycle of interventions. The goals were to improve patient safety incident reporting and learning and shape a more just organizational safety culture. Following a phase of feedback gathering from front-line staff, seven evidence-based interventions were implemented and evaluated from October 2016 to August 2018. Indicators of safety culture, incident reporting rates, and reported rates of harm to patients and "never events" (events that should not happen in medical practice) were continuously monitored. In this article we report on this initiative, including its early results. We observed improvement on some measures of safety culture and incident reporting rates. Staff members' perceptions of six of the seven interventions were positive. The intervention exercise demonstrated the importance of health care policies in supporting local ownership of safety culture and encouraging the application of rigorous research standards.
Singh H, Modi HN, Ranjan S, et al., 2018, Robotic Surgery Improves Technical Performance and Enhances Prefrontal Activation During High Temporal Demand, ANNALS OF BIOMEDICAL ENGINEERING, Vol: 46, Pages: 1621-1636, ISSN: 0090-6964
Selvendran SS, Penney NC, Aggarwal N, et al., 2018, Treatment of Obesity in Young People-a Systematic Review and Meta-analysis (vol 28, pg 2537, 2018), OBESITY SURGERY, Vol: 28, Pages: 3361-3361, ISSN: 0960-8923
Joshi M, Ashrafian H, Darzi A, 2018, Is it time for hospitals with smart wards?, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 111, Pages: 345-346, ISSN: 0141-0768
Modi HN, Singh H, Yang G-Z, et al., 2018, Neural Correlates of Stress Resilience in the Operating Room, JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, Vol: 227, Pages: E208-E208, ISSN: 1072-7515
Dilley J, Pratt P, Kyrgiou M, et al., 2018, Current and Future Use of Radiological Images in the Management of Gynecological Malignancies - A Survey of Practice in the UK, ANTICANCER RESEARCH, Vol: 38, Pages: 5867-5876, ISSN: 0250-7005
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.