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

1346 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

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

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

Acharya A, Markar SR, Sodergren MH, Malietzis G, Darzi A, Athanasiou T, Khan AZet al., 2017, Meta-analysis of adjuvant therapy following curative surgery for periampullary adenocarcinoma, BRITISH JOURNAL OF SURGERY, Vol: 104, Pages: 814-822, ISSN: 0007-1323

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

Bagnall NM, Pucher PH, Johnston MJ, Arora S, Athanasiou T, Faiz O, Darzi LAet al., 2017, Informing the process of consent for surgery: identification of key constructs and quality factors, JOURNAL OF SURGICAL RESEARCH, Vol: 209, Pages: 86-92, ISSN: 0022-4804

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

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

Cohen D, Vlaev I, McMahon L, Harvey S, Mitchell A, Borovoi L, Darzi Aet al., 2017, The Crucible simulation: Behavioral simulation improves clinical leadership skills and understanding of complex health policy change., Health Care Manage Rev

BACKGROUND: The Health and Social Care Act 2012 represents the most complex National Health Service reforms in history. High-quality clinical leadership is important for successful implementation of health service reform. However, little is known about the effectiveness of current leadership training. PURPOSE: This study describes the use of a behavioral simulation to improve the knowledge and leadership of a cohort of medical doctors expected to take leadership roles in the National Health Service. METHODOLOGY: A day-long behavioral simulation (The Crucible) was developed and run based on a fictitious but realistic health economy. Participants completed pre- and postsimulation questionnaires generating qualitative and quantitative data. Leadership skills, knowledge, and behavior change processes described by the "theory of planned behavior" were self-assessed pre- and postsimulation. RESULTS: Sixty-nine medical doctors attended. Participants deemed the simulation immersive and relevant. Significant improvements were shown in perceived knowledge, capability, attitudes, subjective norms, intentions, and leadership competency following the program. Nearly one third of participants reported that they had implemented knowledge and skills from the simulation into practice within 4 weeks. CONCLUSIONS: This study systematically demonstrates the effectiveness of behavioral simulation for clinical management training and understanding of health policy reform. Potential future uses and strategies for analysis are discussed. PRACTICE IMPLICATIONS: High-quality care requires understanding of health systems and strong leadership. Policymakers should consider the use of behavioral simulation to improve understanding of health service reform and development of leadership skills in clinicians, who readily adopt skills from simulation into everyday practice.

JOURNAL ARTICLE

Erridge S, Pucher PH, Markar SR, Malietzis G, Athanasiou T, Darzi A, Sodergren MH, Jiao LRet al., 2017, Meta-analysis of determinants of survival following treatment of recurrent hepatocellular carcinoma., Br J Surg

BACKGROUND: Intrahepatic recurrence of hepatocellular carcinoma (HCC) following resection is common. However, no current consensus guidelines exist to inform management decisions in these patients. Systematic review and meta-analysis of survival following different treatment modalities may allow improved treatment selection. This review aimed to identify the optimum treatment strategies for HCC recurrence. METHODS: A systematic review, up to September 2016, was conducted in accordance with MOOSE guidelines. The primary outcome was the hazard ratio for overall survival of different treatment modalities. Meta-analysis of different treatment modalities was carried out using a random-effects model, with further assessment of additional prognostic factors for survival. RESULTS: Nineteen cohort studies (2764 patients) were included in final data analysis. The median 5-year survival rates after repeat hepatectomy (525 patients), ablation (658) and transarterial chemoembolization (TACE) (855) were 35·2, 48·3 and 15·5 per cent respectively. Pooled analysis of ten studies demonstrated no significant difference between overall survival after ablation versus repeat hepatectomy (hazard ratio 1·03, 95 per cent c.i. 0·68 to 1·55; P = 0·897). Pooled analysis of seven studies comparing TACE with repeat hepatectomy showed no statistically significant difference in survival (hazard ratio 1·61, 0·99 to 2·63; P = 0·056). CONCLUSION: Based on these limited data, there does not appear to be a significant difference in survival between patients undergoing repeat hepatectomy or ablation for recurrent HCC. The results also identify important negative prognostic factors (short disease-free interval, multiple hepatic metastases and large hepatic metastases), which may influence choice of treatment.

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

Howell AM, Burns EM, Hull L, Mayer E, Sevdalis N, Darzi Aet al., 2017, Incident reporting: rare incidents may benefit from national problem solving., BMJ Qual Saf, Vol: 26

JOURNAL ARTICLE

Issa H, Kulasabanathan K, Darzi A, Harris Met al., 2017, Shared learning in an interconnected world: the role of international health partnerships., J R Soc Med

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

Kontovounisios C, Qiu S, Rasheed S, Darzi A, Tekkis Pet al., 2017, The role of neurotensin as a novel biomarker in the endoscopic screening of high-risk population for developing colorectal neoplasia., Updates Surg

Colorectal cancer screening programs aim at early detection of cancer to reduce incidence rates and mortality. The objective of this study is to identify the role of neurotensin in the endoscopic screening of high-risk population for developing colorectal neoplasia. Blood samples from patients referred for urgent colonoscopy to investigate symptoms suspicious of colorectal cancer were collected. Blood neurotensin levels were measured using enzyme-linked immunosorbent assay. Colonoscopy findings were used as reference for determining the diagnostic accuracy of blood neurotensin. The study comprised 26 patients in total: 12 healthy and 14 with colon pathology (13 high-grade dysplasia adenomatous polyps, 1 adenocarcinoma). There were no statistically significant differences in the clinical and biochemical parameters between colon pathology and healthy group except neurotensin levels. Pathology in colon was associated with 3.7-fold increase in NT levels. In multivariate analysis, patients with pathology in colon have increased serum neurotensin levels compared to controls adjusted for age, gender, BMI and co-morbidities. The value of 12.93 pg/ml is associated with 87.5% sensitivity and 91.7% specificity for discriminating the colon pathology from normal colonic epithelium (p = 0.001). Neurotensin plasma values differentiate healthy people from patients suffering from colonic pathologies such as adenomatous polyps and cancer. The use of neurotensin as a potential endoscopic screening tool for identifying high-risk population for developing colorectal cancer is promising, but much has to be done before it is validated in larger scale prospective studies.

JOURNAL ARTICLE

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