Publications
2252 results found
Elliott P, Eales O, Bodinier B, et al., 2022, Post-peak dynamics of a national Omicron SARS-CoV-2 epidemic during January 2022
Background: Rapid transmission of the SARS-CoV-2 Omicron variant has led to the highestever recorded case incidence levels in many countries around the world.Methods: The REal-time Assessment of Community Transmission-1 (REACT-1) study hasbeen characterising the transmission of the SARS-CoV-2 virus using RT-PCR test results fromself-administered throat and nose swabs from randomly-selected participants in England atages 5 years and over, approximately monthly since May 2020. Round 17 data were collectedbetween 5 and 20 January 2022 and provide data on the temporal, socio-demographic andgeographical spread of the virus, viral loads and viral genome sequence data for positiveswabs.Results: From 102,174 valid tests in round 17, weighted prevalence of swab positivity was4.41% (95% credible interval [CrI], 4.25% to 4.56%), which is over three-fold higher than inDecember 2021 in England. Of 3,028 sequenced positive swabs, 2,393 lineages weredetermined and 2,374 (99.2%) were Omicron including 19 (0.80% of all Omicron lineages)cases of BA.2 sub-lineage and one BA.3 (0.04% of all Omicron) detected on 17 January 2022,and only 19 (0.79%) were Delta. The growth of the BA.2 Omicron sub-lineage against BA.1and its sub-lineage BA.1.1 indicated a daily growth rate advantage of 0.14 (95% CrI, 0.03,0.28) for BA.2, which corresponds to an additive R advantage of 0.46 (95% CrI, 0.10, 0.92).Within round 17, prevalence was decreasing overall (R=0.95, 95% CrI, 0.93, 0.97) butincreasing in children aged 5 to 17 years (R=1.13, 95% CrI, 1.09, 1.18). Those 75 years andolder had a swab-positivity prevalence of 2.46% (95% CI, 2.16%, 2.80%) reflecting a highlevel of infection among a highly vulnerable group. Among the 3,613 swab-positiveindividuals reporting whether or not they had had previous infection, 2,334 (64.6%)reported previous confirmed COVID-19. Of these, 64.4% reported a positive test from 1 to30 days before their swab date. Risks of infection were increased among essential/keyworkers
Smalley K, Aufegger L, Flott K, et al., 2022, The Self-Management Abilities Test (SMAT): a tool to identify the self-management abilities of adults with bronchiectasis, npj Primary Care Respiratory Medicine, Vol: 32, Pages: 1-7, ISSN: 2055-1010
Bronchiectasis is an increasingly common chronic respiratory disease which requires a high level of patient engagement in self-management. Whilst the need for self-management has been recognised, the knowledge and skills needed to do so – and the extent to which patients possess these – has not been well-specified. On one hand, understanding the gaps in people’s knowledge and skills can enable better targeting of self-management supports. On the other, clarity about what they do know can increase patients’ confidence to self-manage. This study aims to develop an assessment of patients’ ability to self-manage effectively, through a consensus-building process with patients, clinicians, and policymakers. The study employs a modified, online 3-round Delphi to solicit the opinions of patients, clinicians, and policymakers (N=30) with experience of bronchiectasis. The first round seeks consensus on the content domains for an assessment of bronchiectasis self-management ability. Subsequent rounds propose and refine multiple-choice assessment items to address the agreed domains. A group of 10 clinicians, 10 patients, and 10 policymakers provide both qualitative and quantitative feedback. Consensus is determined using content validity ratios. Qualitative feedback is analysed using the summative content analysis method. Overarching domains are: General Health Knowledge, Bronchiectasis-Specific Knowledge, Symptom Management, Communication, and Addressing Deterioration, each with two sub-domains. A final assessment tool of 20 items contains two items addressing each sub-domain. This study establishes that there is broad consensus about the knowledge and skills required to self-manage bronchiectasis effectively, across stakeholder groups. The output of the study is an assessment tool that can be used by patients and their healthcare providers to guide the provision of self-management education, opportunities, and support.
Wei J, Nazarian S, Teare J, et al., 2022, A case for improved assessment of gut permeability: a meta-analysis quantifying the lactulose:mannitol ratio in coeliac and Crohn’s disease, BMC Gastroenterology, Vol: 22, ISSN: 1471-230X
Background:A widely used method in assessing small bowel permeability is the lactulose:mannitol test, where the lactulose:mannitol ratio (LMR) is measured. However, there is discrepancy in how the test is conducted and in the values of LMR obtained across studies. This meta-analysis aims to determine LMR in healthy subjects, coeliac and Crohn’s disease.Methods:A literature search was performed using PRISMA guidance to identify studies assessing LMR in coeliac or Crohn’s disease. 19 studies included in the meta-analysis measured gut permeability in coeliac disease, 17 studies in Crohn’s disease. Outcomes of interest were LMR values and comparisons of standard mean difference (SMD) and weighted mean difference (WMD) in healthy controls, inactive Crohn’s, active Crohn’s, treated coeliac and untreated coeliac. Pooled estimates of differences in LMR were calculated using the random effects model.Results:Pooled LMR in healthy controls was 0.014 (95% CI: 0.006–0.022) while pooled LMRs in untreated and treated coeliac were 0.133 (95% CI: 0.089–0.178) and 0.037 (95% CI: 0.019–0.055). In active and inactive Crohn’s disease, pooled LMRs were 0.093 (95% CI: 0.031–0.156) and 0.028 (95% CI: 0.015–0.041). Significant differences were observed in LMR between: (1) healthy controls and treated coeliacs (SMD = 0.409 95% CI 0.034 to 0.783, p = 0.032), (2) healthy controls and untreated coeliacs (SMD = 1.362 95% CI: 0.740 to 1.984, p < 0.001), (3) treated coeliacs and untreated coeliacs (SMD = 0.722 95% CI: 0.286 to 1.157, p = 0.001), (4) healthy controls and inactive Crohn’s (SMD = 1.265 95% CI: 0.845 to 1.686, p < 0.001), (5) healthy controls and active Crohn’s (SMD = 2.868 95% CI: 2.112 to 3.623, p < 0.001), and (6) active Crohn’s and inactive Crohn&rsquo
Yeung KTD, Penney N, Whiley L, et al., 2022, The impact of bariatric surgery on serum tryptophan-kynurenine pathway metabolites, Scientific Reports, Vol: 12, ISSN: 2045-2322
Objectives: This study aims to explore the immediate effects of bariatric surgery on serum tryptophan – kynurenine pathway metabolites in individuals with type 2 diabetes and BMI >30. With the goal of providing insight into the link between tryptophan pathway metabolites, type 2 diabetes, and chronic obesity-induced inflammation. Methods: This longitudinal study included 20 participants. Half were diagnosed with type 2 diabetes. 11 and 9 underwent RYGB and SG respectively. Blood samples were obtained at pre-operative and three months post-operative timepoints. Tryptophan and downstream metabolites of the kynurenine pathway were quantified with an ultrahigh-performance liquid chromatography tandem mass spectrometry with electrospray ionisation method. Results: At 3 months post-operation, RYGB led to significant reductions in tryptophan, kynurenic acid and xanthurenic acid levels when compared to baseline. Significant reductions of the same metabolites after surgery were also observed in individuals with T2D irrespective of surgical procedure. These metabolites were significantly correlated with serum HbA1c levels and BMI. Conclusions: Bariatric surgery, in particular RYGB reduces serum levels of tryptophan and its downstream kynurenine metabolites. These metabolites are associated with T2D and thought to be potentially mechanistic in the systemic processes of obesity induced inflammation leading to insulin resistance. Its reduction after surgery is associated with an improvement in glycaemic control (HbA1c).
Athanasiou T, Darzi A, Ye Oo A, 2022, Preface, Patient Reported Outcomes and Quality of Life in Cardiovascular Interventions, Pages: v-vii
Gkouzionis I, Nazarian S, Darzi A, et al., 2022, Three-dimensional tissue reconstruction and tracking of a diffuse reflectance spectroscopy probe for real-time tissue classification in upper gastrointestinal cancer surgery, Photonics Europe: Clinical Biophotonics II
Gkouzionis I, Nazarian S, Kawka M, et al., 2022, Real-time tissue classification in stomach and oesophageal cancer based on optical tracking of a diffuse reflectance spectroscopy probe, Photonics West: Advanced Biomedical and Clinical Diagnostic and Surgical Guidance Systems XX
Athanasiou T, Darzi A, Ye Oo A, 2022, Patient Reported Outcomes and Quality of Life in Cardiovascular Interventions, ISBN: 9783031098147
This book provides a guide to the assessment of patient reported outcomes measures and quality of life in cardiovascular interventions, which have become a fundamental component of decision making in bedside medicine, health policy, health economics, and public health. Cardiac surgery, cardiovascular interventions, vascular interventions, and the core principles of quality of life are all covered. This book is the first book to demonstrate how clinicians and policy makers can easily get access to a single source of quality of life and patient reported outcomes measures evidence to help them make the best informed decisions in the field of cardiovascular interventions. This is a rapidly emerging field and the book would be relevant to doctors, healthcare scientists, allied-health professionals, healthcare managers, medical statisticians, healthcare economists, and consultants working in healthcare.
Sounderajah V, Normahani P, Aggarwal R, et al., 2022, Reporting Standards and Quality Assessment Tools in Artificial Intelligence-Centered Healthcare Research, Artificial Intelligence in Medicine, Pages: 385-395, ISBN: 9783030645724
The practice of incomplete study reporting is rife within scientific literature. It hinders the adoption of technologies, introduces considerable “research waste, " and represents a significant moral hazard. In order to combat this issue, there has been a shift towards the use of reporting standards and quality assessment tools, a move that has been endorsed by major biomedical journals as well as other key stakeholders. These instruments help [1] to improve the quality and completeness of study reporting as well as [2] to aid researchers in their assessment of a study’s risk of bias and applicability. These instruments are carefully created through a multistep evidence generation process and are specific to individual study designs or specialties. Recently, it has been noted that many of the existing instruments are poorly suited to aid the reporting and assessment of artificial intelligence (AI)- based studies on account of their niche study considerations. As such, there has been a concerted effort to produce AI-specific extensions to preexisting instruments, such as CONSORT, SPIRIT, STARD, TRIPOD, QUADAS, and PROBAST. This chapter expands upon why AI-specific amendments to these instruments are required in addition to highlighting their contents and proposed scope.
Elson D, Gkouzionis I, Nazarian S, et al., 2022, Using diffuse reflectance spectroscopy for real-time tissue assessment during upper gastrointestinal cancer surgery, IEEE International Conference on Biomedical and Health Informatics
Elson D, Gkouzionis I, Nazarian S, et al., 2022, Real-time tracking of a diffuse reflectance spectroscopy probe for tissue classification in colorectal cancer surgery, Hamlyn Symposium on Medical Robotics Workshop on Sensing and biophotonics for surgical robotics and in vivo diagnostics
Shanthakumar D, Chalau V, Darzi A, et al., 2022, Multiwavelength laser induced fluorescence spectroscopy for breast cancer diagnostics, Association of Breast Surgery
Gkouzionis I, Nazarian S, Darzi A, et al., 2022, Discriminating between cancer and healthy tissue in upper gastrointestinal cancer surgery using deep learning and diffuse reflectance spectroscopy, London Surgery Symposium
Khanbhai M, Warren L, Symons J, et al., 2022, Using natural language processing to understand, facilitate and maintain continuity in patient experience across transitions of care, International Journal of Medical Informatics, Vol: 157, Pages: 1-7, ISSN: 1386-5056
BackgroundPatient centred care necessitates that healthcare experiences and perceived outcomes be considered across all transitions of care. Information encoded within free-text patient experience comments relating to transitions of care are not captured in a systematic way due to the manual resource required. We demonstrate the use of natural language processing (NLP) to extract meaningful information from the Friends and Family Test (FFT).MethodsFree-text fields identifying favourable service (“What did we do well?”) and areas requiring improvement (“What could we do better?”) were extracted from 69,285 FFT reports across four care settings at a secondary care National Health Service (NHS) hospital. Sentiment and patient experience themes were coded by three independent coders to produce a training dataset. The textual data was standardised with a series of pre-processing techniques and the performance of six machine learning (ML) models was obtained. The best performing ML model was applied to predict the themes and sentiment from the remaining reports. Comments relating to transitions of care were extracted, categorised by sentiment, and care setting to identify the most frequent words/combinations presented as tri-grams and word clouds.ResultsThe support vector machine (SVM) ML model produced the highest accuracy in predicting themes and sentiment. The most frequent single words relating to transition and continuity with a negative sentiment were “discharge” in inpatients and Accident and Emergency, “appointment” in outpatients, and “home’ in maternity. Tri-grams identified from the negative sentiments such as ‘seeing different doctor’, ‘information aftercare lacking’, ‘improve discharge process’ and ‘timing discharge letter’ have highlighted some of the problems with care transitions. None of this information was available from the quantitative data.Conc
Williams SP, Purkayastha S, Chaturvedi S, et al., 2022, The GP-OH (General Practice - Organizational Health) Survey: Development and Validation of a Novel Instrument to Measure Organizational Health in General Practice., Hosp Top, Vol: 100, Pages: 177-187
Primary care healthcare organizations are complex and multidimensional, and there has been much discussion about the potential dangers of focusing on outcomes as quality indicators in isolation without understanding the processes and system characteristics that drive them. Organizational health, as a concept, shifts the focus of measurement upstream and considers the elements needed for sustainable long-term success. This study has both designed and tested the first survey seeking to measure organizational health specifically within the context of primary care. A stepwise approach was taken to ensure that the validity and reliability of the survey was examined at multiple stages.Supplemental data for this article is available online at https://doi.org/10.1080/00185868.2021.1947164.
Williams SP, Purkayastha S, Chaturvedi S, et al., 2022, Organizational health and independent sector healthcare organizations, International Journal of Healthcare Management, Vol: 15, Pages: 196-203, ISSN: 2047-9719
With an increasing proportion of UK healthcare delivered by independent sector providers (ISPs) it is important that performance data is reviewed with a similar rigour as within the public sector. However, there is a relative paucity of work considering quotients of performance in the independent healthcare sector. This study sets out to measure organizational health within ISPs in the UK and juxtapose this with contemporaneous data taken from public sector NHS organizations. Survey data was tested for construct validity with fit of the existing factor structure of the Healthcare-OH survey examined using confirmatory factor analysis (CFA). Multiple-group CFA was used to establish measurement invariance to permit comparison of latent sum scores between ISP and NHS organizations. Measurement invariance analysis evaluated the fit of sequential invariance models, proceeding iteratively to establish partial metric and scalar invariance. Latent sum scores comparisons demonstrated ISPs outperformed NHS trusts across all elements of organizational health. This is the first time organizational health has been measured in ISPs explicitly for comparison with results in the public sector. Comparative measurement and analysis in this way is novel and has the potential of fostering a two-way learning process for the ultimate benefit of both NHS and ISP organizations.
Penney N, Yeung D, Garcia-Perez I, et al., 2021, Longitudinal Multi-omic Phenotyping Reveals Host-microbe Responses to Bariatric Surgery, Glycaemic Control and Obesity
<jats:title>Abstract</jats:title> <jats:p>Resolution of type-2 diabetes (T2D) is common following bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB). However, the underlying mechanisms have not been fully elucidated. To address this we compared the integrated serum, urine and faecal metabolic profiles of obese participants with and without T2D (n=81, T2D=42) with participants who underwent RYGB or sleeve gastrectomy (pre and 3-months post-surgery; n=27), taking diet into account. We co-modelled these data with shotgun metagenomic profiles of the gut microbiota to provide a comprehensive atlas of host-gut microbe responses to bariatric surgery, weight-loss and glycaemic control at the systems level. Bariatric surgery reversed a number of disrupted pathways characteristic of T2D. The differential metabolite set representative of bariatric surgery overlapped with both diabetes (19.3% commonality) and BMI (18.6% commonality). However, the percentage overlap between diabetes and BMI was minimal (4.0% commonality), consistent with weight-independent mechanisms of T2D resolution. The gut microbiota was more strongly correlated to BMI than T2D, although we identified some pathways such as amino acid metabolism that correlated with changes to the gut microbiota and which influence glycaemic control. Improved understanding of GM-host co-metabolism may lead to novel therapies for weight-loss or diabetes.</jats:p>
Elliott P, Bodinier B, Eales O, et al., 2021, Rapid increase in Omicron infections in England during December 2021: REACT-1 study
Background: The highest-ever recorded numbers of daily severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in England has been observed during December 2021 and have coincided with a rapid rise in the highly transmissible Omicron variant despite high levels of vaccination in the population. Although additional COVID-19 measures have beenintroduced in England and internationally to contain the epidemic, there remains uncertainty about the spread and severity of Omicron infections among the general population.Methods: The REal-time Assessment of Community Transmission–1 (REACT-1) study has been monitoring the prevalence of SARS-CoV-2 infection in England since May 2020.REACT-1 obtains self-administered throat and nose swabs from a random sample of the population of England at ages 5 years and over. Swabs are tested for SARS-CoV-2 infection by reverse transcription polymerase chain reaction (RT-PCR) and samples testing positive are sent for viral genome sequencing. To date 16 rounds have been completed, each including~100,000 or more participants with data collected over a period of 2 to 3 weeks per month.Socio-demographic, lifestyle and clinical information (including previous history of COVID-19 and symptoms prior to swabbing) is collected by online or telephone questionnaire. Here we report results from round 14 (9-27 September 2021), round 15 (19 October - 05 November2021) and round 16 (23 November - 14 December 2021) for a total of 297,728 participants with a valid RT-PCR test result, of whom 259,225 (87.1%) consented for linkage to their NHS records including detailed information on vaccination (vaccination status, date). We usedthese data to estimate community prevalence and trends by age and region, to evaluate vaccine effectiveness against infection in children ages 12 to 17 years, and effect of a third (booster) dose in adults, and to monitor the emergence of the Omicron variant in England.Results: We observed a high overall prevalen
Darzi A, 2021, Whitty's critics fail to see that science is driven by what we don't know-not what we do, BMJ-BRITISH MEDICAL JOURNAL, Vol: 375, ISSN: 0959-535X
Acharya A, Judah G, Ashrafian H, et al., 2021, Investigating the implementation of SMS and mobile messaging In Population Screening (The SIPS Study): Protocol for a Delphi Study, JMIR Research Protocols, Vol: 10, Pages: 1-8, ISSN: 1929-0748
BackgroundThe use of mobile messaging including Short Message Service (SMS) and Web-based messaging in healthcare has grown significantly. Using messaging to facilitate patient communication has been advocated in several circumstances including population screening. These programmes, however, pose unique challenges to mobile communication, as messaging is often sent from a central hub to a diverse population with differing needs. Despite this, there is a paucity of robust frameworks to guide implementation. ObjectiveThis protocol describes the methods that will be used to develop a guide for the principles of use of mobile messaging for population screening programmes in England.Methods This modified Delphi study will be conducted in two parts: evidence synthesis and consensus generation. The former will incorporate a literature review of publications from 1st January 2000 to the present. This will elicit key themes to inform an online scoping questionnaire posed to a group of experts from academia, clinical medicine, industry and public health. Thematic analysis of free-text responses by two independent authors will elicit items to be used in the consensus generation. Patient and Public Involvement groups will be convened to ensure that a comprehensive item list is generated, which represents the public’s perspective. Each item will then be anonymously voted upon by experts as to its importance and feasibility of implementation in screening, during three rounds of a Delphi process. Consensus will be defined a priori at 70%, with items considered important and feasible eligible for inclusion into the final recommendation. A list of desirable items (important, but not currently feasible) will be developed to guide future work. ResultsThe Institutional Review Board at Imperial College London has granted ethical approval (20IC6088). Results are expected to involve a list of recommendations to screening services with findings made available to screening services
Eales O, Page AJ, de Oliveira Martins L, et al., 2021, SARS-CoV-2 lineage dynamics in England from September to November 2021: high diversity of Delta sub-lineages and increased transmissibility of AY.4.2
<jats:title>Abstract</jats:title><jats:p>Since the emergence of SARS-CoV-2, evolutionary pressure has driven large increases in the transmissibility of the virus. However, with increasing levels of immunity through vaccination and natural infection the evolutionary pressure will switch towards immune escape. Here we present phylogenetic relationships and lineage dynamics within England (a country with high levels of immunity), as inferred from a random community sample of individuals who provided a self-administered throat and nose swab for rt-PCR testing as part of the REal-time Assessment of Community Transmission-1 (REACT-1) study. From 9 to 27 September 2021 (round 14) and 19 October to 5 November 2021 (round 15), all lineages sequenced within REACT-1 were Delta or a Delta sub-lineage with 44 unique lineages identified. The proportion of the original Delta variant (B.1.617.2) was found to be increasing between September and November 2021, which may reflect an increasing number of sub-lineages which have yet to be identified. The proportion of B.1.617.2 was greatest in London, which was further identified as a region with an increased level of genetic diversity. The Delta sub-lineage AY.4.2 was found to be robustly increasing in proportion, with a reproduction number 15% (8%, 23%) greater than its parent and most prevalent lineage, AY.4. Both AY.4.2 and AY.4 were found to be geographically clustered in September but this was no longer the case by late October/early November, with only the lineage AY.6 exhibiting clustering towards the South of England. Though no difference in the viral load based on cycle threshold (Ct) values was identified, a lower proportion of those infected with AY.4.2 had symptoms for which testing is usually recommend (loss or change of sense of taste, loss or change of sense of smell, new persistent cough, fever), compared to AY.4 (p = 0.026). The evolutionary rate of SARS-CoV-2, as measured by the mutation rate, was fou
Nazarian S, Gkouzionis I, Kawka M, et al., 2021, Real-time tracking and classification of tumour and non-tumour tissue in upper gastrointestinal cancer specimens using diffuse reflectance spectroscopy, UGI Congress 2021, ISSN: 0007-1323
Aggarwal R, Visram S, Martin G, et al., 2021, Defining the enablers and barriers to the implementation of large-scale healthcare related mobile technology: a qualitative case study in a tertiary hospital setting, JMIR mHealth and uHealth, Vol: 10, Pages: 1-11, ISSN: 2291-5222
Background:The successful implementation of clinical smartphone applications in hospital settings requires close collaboration with industry partners. A large-scale hospital-wide implementation of a clinical mobile application for healthcare professionals developed in partnership with Google Health and academic partners was deployed on a Bring Your Own Device (BYOD) basis using mobile device management (MDM) at our UK academic hospital. As this was the first large-scale implementation of this type of innovation in the UK health system, important insights and lessons learned from the deployment may be useful to other organisations considering implementing similar technology in partnership with commercial companies.Objective:The aims of this study were to define the key enablers and barriers, and to propose a ‘roadmap’ for the implementation of a hospital-wide clinical mobile application developed in collaboration with an industry partner as a data processor and an academic partner for independent evaluation.Methods:Semi-structured interviews were conducted with high-level stakeholders from industry, academia and healthcare providers who had instrumental roles in the implementation of the application at our hospital. The interviews explored participant’s views on the enablers and barriers to the implementation process. Interviews were analysed using a broadly deductive approach to thematic analysis.Results:In total, 14 participants were interviewed. Key enablers identified were the establishment of a steering committee with high-level clinical involvement, well-defined roles and responsibilities between partners, effective communication strategies with end-users, safe information governance precautions and increased patient engagement and transparency. Barriers identified were the lack of dedicated resources for mobile change at our hospital, risk aversion, unclear strategy and regulation, and the implications of BYOD and MDM policies. The key lesson
Sivananthan A, Gueroult A, Zijlstra G, et al., 2021, Using Mixed Reality Headsets to Deliver Remote Bedside Teaching During the COVID-19 Pandemic: Feasibility Trial of HoloLens 2 (Preprint)
<sec> <title>BACKGROUND</title> <p>COVID-19 has had a catastrophic impact in terms of human lives lost. Medical education has also been impacted as appropriately stringent infection control policies precluded medical trainees from attending clinical teaching. Lecture-based education has been easily transferred to a digital platform, but bedside teaching has not.</p> </sec> <sec> <title>OBJECTIVE</title> <p>This study aims to assess the feasibility of using a mixed reality (MR) headset to deliver remote bedside teaching.</p> </sec> <sec> <title>METHODS</title> <p>Two MR sessions were led by senior doctors wearing the HoloLens headset. The trainers selected patients requiring their specialist input. The headset allowed bidirectional audiovisual communication between the trainer and trainee doctors. Trainee doctor conceptions of bedside teaching, impact of the COVID-19 pandemic on bedside teaching, and the MR sessions were evaluated using pre- and postround questionnaires, using Likert scales. Data related to clinician exposure to at-risk patients and use of personal protective equipment (PPE) were collected.</p> </sec> <sec> <title>RESULTS</title> <p>Prequestionnaire respondents (n=24) strongly agreed that bedside teaching is key to educating clinicians (median 7, IQR 6-7). Postsession questionnaires showed that, overall, users subjectively agreed the MR session was helpful to their learning (median 6, IQR 5.25-7) and that it was worthwhile (median 6, IQR 5.25-7). Mixed reality versus in-person teaching led to a 79.5% reduction in cumulat
Khanbhai M, Flott K, Manton D, et al., 2021, Identifying factors that promote and limit the effective use of real-time patient experience feedback: a mixed-methods study in secondary care, BMJ Open, Vol: 11, Pages: 1-7, ISSN: 2044-6055
Objectives:The Friends and Family Test (FFT) is commissioned by the National Health Service (NHS) in England to capture patient experience as a real-time feedback initiative for patient-centred quality improvement (QI). The aim of this study was to create a process map in order to identify the factors that promote and limit the effective use of FFT as a real-time feedback initiative for patient-centred QI. Setting:This study was conducted at a large London NHS Trust. Services include accident and emergency, inpatient, outpatient and maternity, which routinely collect FFT patient experience data. Participants:Healthcare staff and key stakeholders involved in FFT.Interventions:Semi-structured interviews were conducted on fifteen participants from a broad range of professional groups to evaluate their engagement with the FFT. Interview data were recorded, transcribed, and analysed for using deductive thematic analysis.Results:Concerns related to inefficiency in the flow of FFT data, lack of time to analyse FFT reports (with emphasis on high level reporting rather than QI), insufficient access to FFT reports and limited training provided to understand FFT reports for frontline staff. The sheer volume of data received was not amenable to manual thematic analysis resulting in inability to acquire insight from the free-text. This resulted in staff ambivalence towards FFT as a near real-time feedback initiative.Conclusions:The results state that there is too much FFT free text for meaningful analysis, and the output is limited to the provision of sufficient capacity and resource to analyse the data, without consideration of other options, such as text analytics and amending the data collection tool.
Gkouzionis I, Nazarian S, Anandakumar A, et al., 2021, Using diffuse reflectance spectroscopy probe tracking to identify non-tumour and tumour tissue in upper gastrointestinal specimens, Translational Biophotonics: Diagnostics and Therapeutics, Publisher: SPIE
The use of a diffuse reflectance spectroscopy probe and tracking system was successfully used in real-time for automated tissue classification in upper gastrointestinal surgery to aid resection margin assessment.
Arora S, Tsang F, Kekecs Z, et al., 2021, Patient Safety Education 20 years after the Institute of Medicine Report: results from a cross-sectional National Survey, Journal of Patient Safety, Vol: 17, Pages: 1884-1888, ISSN: 1549-8417
Objectives Educating healthcare professionals in patient safety is essential to achieving sustainable improvements in care. This study aimed to identify the key constituents of patient safety education alongside its facilitators and barriers from a frontline perspective.Methods An electronic survey was sent to 592 healthcare professionals and educators in patient safety education in the United Kingdom. Two independent reviewers conducted a thematic analysis of the free-text data. Themes focused on effective content, learning practices and facilitators and barriers to patient safety education.Results Of 592 individuals completing the survey, 545 (92%) submitted analyzable responses. Interrater reliability of coding was high with Cohen k value of 0.86. Participants endorsed experiential and interactive learning as ideal modalities for delivery and expressed a need for content to be based on real clinical cases and tailored to the needs of the learners. The most commonly mentioned facilitators were standardization of methods and assessment (49%), dedicated funding (21%), and culture of openness (20%). Staffing problems and high workload (41%) and lack of accessibility of training (23%) were identified as primary barriers of efficacy and uptake.Conclusions This study identified key factors to the success of patient safety education in terms of content and delivery alongside facilitators and barriers. Future curricula developers and interventions should improve standardization, funding, culture, and access so as to optimize education programs to enhance patient safety.
Yeung KTD, Penney N, Harling L, et al., 2021, Response to comment on "'Does sleeve gastrectomy expose the distal esophagus to severe reflux?' So what? Keep the big picture in perspective", Annals of Surgery, Vol: 274, Pages: e793-e794, ISSN: 0003-4932
Satava RM, Stefanidis D, Levy JS, et al., 2021, Response to "Proving the effectiveness of the Fundamentals of Robotic Surgery (FRS) Skills Curriculum: a single-blinded, multispecialty, multi-institutional randomized control trial" Not only surgeon's manual skills...", Annals of Surgery, Vol: 274, Pages: e847-e848, ISSN: 0003-4932
Acharya A, Sounderajah V, Ashrafian H, et al., 2021, A systematic review of interventions to improve breast cancer screening health behaviours, Preventive Medicine, Vol: 153, ISSN: 0091-7435
Whilst breast cancer screening has been implemented in many countries, uptake is often suboptimal. Consequently, several interventions targeting non-attendance behaviour have been developed. This systematic review aims to appraise the successes of interventions, identifying and comparing the specific techniques they use to modify health behaviours. A literature search (PROSPERO CRD42020212090) between January 2005 and December 2020 using PubMed, Medline, PsycInfo, EMBASE and Google Scholar was conducted. Studies which investigated patient-facing interventions to increase attendance at breast cancer screening appointments were included. Details regarding the intervention delivery, theoretical background, and contents were extracted, as was quantitative data on the impact on attendance rates, compared to control measures. Interventions were also coded using the Behavioural Change Techniques (BCT) Taxonomy. In total fifty-four studies, detailing eighty interventions, met the inclusion criteria. Only 50% of interventions reported a significant impact on screening attendance. Thirty-two different BCTs were used, with 'prompts/cues' the most commonly incorporated (77.5%), however techniques from the group 'covert learning' had the greatest pooled effect size 0.12 (95% CI 0.05-0.19, P < 0·01, I2 = 91.5%). 'Problem solving' was used in the highest proportion of interventions that significantly increased screening attendance (69.0%). 70% of the interventions were developed using behavioural theories. These results show interventions aimed at increasing screening uptake are often unsuccessful. Commonly used approaches which focus upon explaining the consequences of not attending mammograms were often ineffective. Problem solving, however, has shown promise. These techniques should be investigated further, as should emerging technologies which can enable interventions to be feasibly translated at a population-level.
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.