Publications
2252 results found
Danielli S, Ashrafian H, Darzi A, 2023, Healthy city: global systematic scoping review of city initiatives to improve health with policy recommendations, BMC Public Health, Vol: 23, Pages: 1-15, ISSN: 1471-2458
BackgroundGlobal health will increasingly be determined by cities. Currently over half of the world’s population, over 4 billion people, live in cities. This systematic scoping review has been conducted to understand what cities are doing to improve health and healthcare for their populations.MethodsWe conducted a systematic search to identify literature on city-wide initiatives to improve health. The study was conducted in accordance with PRISMA and the protocol was registered with PROSPERO (CRD42020166210).ResultsThe search identified 42,137 original citations, yielding 1,614 papers across 227 cities meeting the inclusion criteria. The results show that the majority of initiatives were targeted at non-communicable diseases. City health departments are making an increasing contribution; however the role of mayors appears to be limited.ConclusionThe collective body of evidence identified in this review, built up over the last 130 years, has hitherto been poorly documented and characterised. Cities are a meta-system with population health dictated by multiple interactions and multidirectional feedback loops. Improving health in cities requires multiple actions, by multiple actors, at every level. The authors use the term ‘The Vital 5’. They are the five most important health risk factors; tobacco use; harmful alcohol use; physical-inactivity, unhealthy diet and planetary health. These ‘Vital 5’ are most concentrated in deprived areas and show the greatest increase in low and middle income countries. Every city should develop a comprehensive strategy and action plan to address these ‘Vital 5’.
Ravindran S, Matharoo M, Marshall S, et al., 2023, Development, validation, and results of a national endoscopy safety attitudes questionnaire (Endo-SAQ), ENDOSCOPY INTERNATIONAL OPEN, Vol: 11, Pages: E679-E689, ISSN: 2364-3722
Acharya A, Judah G, Ashrafian H, et al., 2023, Investigating the national implementation of SMS and mobile messaging In Population Screening (The SIPS Study), EBioMedicine, Vol: 93, Pages: 1-11, ISSN: 2352-3964
BackgroundThe increasing use of mobile messaging within healthcare, poses challenges for screening programmes, which involve communicating with large, diverse populations. This modified Delphi study aimed to create guidance regarding the use of mobile messaging for screening programmes, to facilitate greater, and equitable screening uptake.MethodsInitial recommendations were derived from a literature review, expert scoping questionnaire, public consultation, and discussion with relevant national organisations. Experts from the fields of public health, screening commissioning, industry and academia voted upon the importance and feasibility of these recommendations across two consensus rounds, using a 5-point Likert scale. Items reaching consensus, defined a priori at 70%, on importance and feasibility formed ‘core’ recommendations. Those reaching this threshold on importance only, were labelled ‘desirable’. All items were subsequently discussed at an expert meeting to confirm suitability. FindingsOf the initial 101 items, 23 reached consensus regarding importance and feasibility. These ‘core’ items were divided across six domains: message content, timing, delivery, evaluation, security, and research considerations. ‘Core’ items such as explicitly specifying the sender and the role of patient involvement in development of screening message research had the highest agreement. A further 17 ‘desirable’ items reached consensus regarding importance, but not feasibility, including the integration into GP services to enable telephone verification.InterpretationThese findings forming national guidance for services, will enable programmes to overcome implementation challenges and facilitate uptake of screening invitations. By providing a list of desirable items, this study provides areas for future consideration, as technological innovation in messaging continues to grow.FundingNIHR Imperial Patient Safety Translation
Lawrance E, Thompson R, Roberts L, et al., 2023, Ambient temperature and mental health: a systematic review and meta analysis, The Lancet Planetary Health, Vol: 7, Pages: e580-e589, ISSN: 2542-5196
BackgroundIncreasing evidence indicates that ambient outdoor temperature could affect mental health, which is especially concerning in the context of climate change. We aimed to comprehensively analyse the current evidence regarding the associations between ambient temperature and mental health outcomes.MethodsWe did a systematic review and meta-analysis of the evidence regarding associations between ambient outdoor temperature and changes in mental health outcomes. We searched WebOfScience, Embase, PsychINFO, and PubMed for articles published from database origin up to April 7, 2022. Eligible articles were epidemiological, observational studies in humans of all ages, which evaluated real-world responses to ambient outdoor temperature, and had mental health as a documented outcome; studies of manipulated or controlled temperature or those with only physical health outcomes were excluded. All eligible studies were synthesised qualitatively. If three or more studies reported the same or equivalent effect statistics and if they had equivalent exposure, outcome, and metrics, the studies were pooled in a random-effects meta-analysis. The risk of bias for individual studies was assessed using the Newcastle-Ottawa Scale. The quality of evidence across studies was assessed using the Office of Health Assessment and Translation (OHAT) approach.Findings114 studies were included in the systematic review, of which 19 were suitable for meta-analysis. Three meta-analyses were conducted for suicide outcomes: a 1°C increase in mean monthly temperature was associated with an increase in incidence of 1·5% (95% CI 0·8–2·2, p<0·001; n=1 563 109, seven effects pooled from three studies); a 1°C increase in mean daily temperature was associated with an increase in incidence of 1·7% (0·3–3·0, p=0·014; n=113 523, five effects pooled from five studies); and a 1°C increase in mean monthly temperature was associa
Barrow E, Lear RA, Morbi A, et al., 2023, How do hospital inpatients conceptualise patient safety? A qualitative interview study using constructivist grounded theory, BMJ QUALITY & SAFETY, Vol: 32, Pages: 383-393, ISSN: 2044-5415
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Darzi A, 2023, Ukraine can build back a better health system, BMJ-BRITISH MEDICAL JOURNAL, Vol: 381, ISSN: 0959-535X
Atchison C, Whitaker M, Donnelly C, et al., 2023, Characteristics and predictors of persistent symptoms post COVID-19 in children and young people: a large community cross-sectional study in England, Archives of Disease in Childhood, Vol: 108, ISSN: 0003-9888
Objective: To estimate the prevalence of, and associated risk factors for, persistent symptoms post-COVID-19 among children aged 5–17 years in England.Design: Serial cross-sectional study.Setting: Rounds 10–19 (March 2021 to March 2022) of the REal-time Assessment of Community Transmission-1 study (monthly cross-sectional surveys of random samples of the population in England).Study population: Children aged 5–17 years in the community.Predictors: Age, sex, ethnicity, presence of a pre-existing health condition, index of multiple deprivation, COVID-19 vaccination status and dominant UK circulating SARS-CoV-2 variant at time of symptom onset.Main outcome measures: Prevalence of persistent symptoms, reported as those lasting ≥3 months post-COVID-19.Results: Overall, 4.4% (95% CI 3.7 to 5.1) of 3173 5–11 year-olds and 13.3% (95% CI 12.5 to 14.1) of 6886 12–17 year-olds with prior symptomatic infection reported at least one symptom lasting ≥3 months post-COVID-19, of whom 13.5% (95% CI 8.4 to 20.9) and 10.9% (95% CI 9.0 to 13.2), respectively, reported their ability to carry out day-to-day activities was reduced ‘a lot’ due to their symptoms. The most common symptoms among participants with persistent symptoms were persistent coughing (27.4%) and headaches (25.4%) in children aged 5–11 years and loss or change of sense of smell (52.2%) and taste (40.7%) in participants aged 12–17 years. Higher age and having a pre-existing health condition were associated with higher odds of reporting persistent symptoms.Conclusions: One in 23 5–11 year-olds and one in eight 12–17 year-olds post-COVID-19 report persistent symptoms lasting ≥3 months, of which one in nine report a large impact on performing day-to-day activities.
Ongolo-Zogo C, El-Khechen H, Morfaw F, et al., 2023, The Cameroon Health Research and Evidence Database (CAMHRED): tools and methods for local evidence mapping., Health Res Policy Syst, Vol: 21
BACKGROUND: Local evidence is important for contextualized knowledge translation. It can be used to adapt global recommendations, to identify future research priorities and inform local policy decisions. However, there are challenges in identifying local evidence in a systematic, comprehensive, and timely manner. There is limited guidance on how to map local evidence and provide it to users in an accessible and user-friendly way. In this study, we address these issues by describing the methods for the development of a centralized database of health research evidence for Cameroon and its applications for research prioritization and decision making. METHODS: We searched 10 electronic health databases and hand-searched the archives of non-indexed African and Cameroonian journals. We screened titles, abstracts, and full texts of peer reviewed journal articles published between 1999 and 2019 in English or French that assess health related outcomes in Cameroonian populations. We extracted relevant study characteristics based on a pre-established guide. We developed a coding scheme or taxonomy of content areas so that local evidence is mapped to corresponding domains and subdomains. Pairs of reviewers coded articles independently and resolved discrepancies by consensus. Moreover, we developed guidance on how to search the database, use search results to create evidence maps and conduct knowledge gap analyses. RESULTS: The Cameroon Health Research and Evidence Database (CAMHRED) is a bilingual centralized online portal of local evidence on health in Cameroon from 1999 onwards. It currently includes 4384 studies categorized into content domains and study characteristics (design, setting, year and language of publication). The database is searchable by keywords or through a guided search. Results including abstracts, relevant study characteristics and bibliographic information are available for users to download. Upon request, guidance on how to optimize search results for ap
Danielli S, Ashrafian H, Darzi A, 2023, Population health: transformation will happen at the speed of trust, JOURNAL OF PUBLIC HEALTH, Vol: 45, Pages: 410-413, ISSN: 1741-3842
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Gkouzionis I, Zhong Y, Nazarian S, et al., 2023, A YOLOv5-based network for the detection of a diffuse reflectance spectroscopy probe to aid surgical guidance in gastrointestinal cancer surgery, International Journal of Computer Assisted Radiology and Surgery, Vol: 19, ISSN: 1861-6410
PURPOSE: A positive circumferential resection margin (CRM) for oesophageal and gastric carcinoma is associated with local recurrence and poorer long-term survival. Diffuse reflectance spectroscopy (DRS) is a non-invasive technology able to distinguish tissue type based on spectral data. The aim of this study was to develop a deep learning-based method for DRS probe detection and tracking to aid classification of tumour and non-tumour gastrointestinal (GI) tissue in real time. METHODS: Data collected from both ex vivo human tissue specimen and sold tissue phantoms were used for the training and retrospective validation of the developed neural network framework. Specifically, a neural network based on the You Only Look Once (YOLO) v5 network was developed to accurately detect and track the tip of the DRS probe on video data acquired during an ex vivo clinical study. RESULTS: Different metrics were used to analyse the performance of the proposed probe detection and tracking framework, such as precision, recall, mAP 0.5, and Euclidean distance. Overall, the developed framework achieved a 93% precision at 23 FPS for probe detection, while the average Euclidean distance error was 4.90 pixels. CONCLUSION: The use of a deep learning approach for markerless DRS probe detection and tracking system could pave the way for real-time classification of GI tissue to aid margin assessment in cancer resection surgery and has potential to be applied in routine surgical practice.
Umeojiako W, Hurndall KH, Mansuri A, et al., 2023, The Role of Patient Reported Outcomes Measures (PROMS) and Health-Related Quality-of-Life (HRQoL) in Economic Analysis, Patient Reported Outcomes and Quality of Life in Surgery, Editors: Patel, Athanasiou, Darzi, Publisher: Springer, ISBN: 9783031275968
In this chapter the importance of quality-of-life estimates in the prevailing paradigm for economic evaluation is discussed. Empirical methods for measuring quality-of-life are described. Finally, the generic and disease-specific PROMS used to derive estimates of quality-of-life in economic evaluation are discussed.
Bakri NAC, Kwasnicki R, Tenang L, et al., 2023, Upper Limb Recovery Following Mastectomy with and without Breast Reconstruction Measured Using Wearable Activity Monitors, 24th Annual Meeting of The American Society of Breast Surgeons (ASBrS), Publisher: SPRINGER, Pages: S614-S615, ISSN: 1068-9265
Sivananthan A, Kokgas A, Glover B, et al., 2023, EYE CONTROLLED ENDOSCOPY - A BENCHTOP TRIAL OF A NOVEL ROBOTIC SYSTEM, Digestive Disease Week (DDW), Publisher: MOSBY-ELSEVIER, Pages: AB770-AB771, ISSN: 0016-5107
Feather C, Appelbaum N, Darzi A, et al., 2023, Indication documentation and indication-based prescribing within electronic prescribing systems: a systematic review and narrative synthesis, BMJ QUALITY & SAFETY, Vol: 32, Pages: 357-368, ISSN: 2044-5415
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Eales O, Haw D, Wang H, et al., 2023, Dynamics of SARS-CoV-2 infection hospitalisation and infection fatality ratios over 23 months in England, PLoS Biology, Vol: 21, Pages: 1-21, ISSN: 1544-9173
The relationship between prevalence of infection and severe outcomes such as hospitalisation and death changed over the course of the COVID-19 pandemic. Reliable estimates of the infection fatality ratio (IFR) and infection hospitalisation ratio (IHR) along with the time-delay between infection and hospitalisation/death can inform forecasts of the numbers/timing of severe outcomes and allow healthcare services to better prepare for periods of increased demand. The REal-time Assessment of Community Transmission-1 (REACT-1) study estimated swab positivity for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in England approximately monthly from May 2020 to March 2022. Here, we analyse the changing relationship between prevalence of swab positivity and the IFR and IHR over this period in England, using publicly available data for the daily number of deaths and hospitalisations, REACT-1 swab positivity data, time-delay models, and Bayesian P-spline models. We analyse data for all age groups together, as well as in 2 subgroups: those aged 65 and over and those aged 64 and under. Additionally, we analysed the relationship between swab positivity and daily case numbers to estimate the case ascertainment rate of England's mass testing programme. During 2020, we estimated the IFR to be 0.67% and the IHR to be 2.6%. By late 2021/early 2022, the IFR and IHR had both decreased to 0.097% and 0.76%, respectively. The average case ascertainment rate over the entire duration of the study was estimated to be 36.1%, but there was some significant variation in continuous estimates of the case ascertainment rate. Continuous estimates of the IFR and IHR of the virus were observed to increase during the periods of Alpha and Delta's emergence. During periods of vaccination rollout, and the emergence of the Omicron variant, the IFR and IHR decreased. During 2020, we estimated a time-lag of 19 days between hospitalisation and swab positivity, and 26 days between deaths
O'Brien N, Ayisi-Boateng NK, Lounsbury O, et al., 2023, Digital health in primary health care: Current use and future opportunities in the Sub-Saharan African region, Digital health in primary health care: Current use and future opportunities in the Sub-Saharan African region, Publisher: Imperial College London
Beaney T, Clarke J, Alboksmaty A, et al., 2023, Evaluating the impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in patients with COVID-19 assessed in Emergency Departments in England: a retrospective matched cohort study, Emergency Medicine Journal, Vol: 40, Pages: 460-465, ISSN: 1472-0205
Background:To identify the impact of a national pulse oximetry remote monitoring programme for COVID-19 (COVID Oximetry @home; CO@h) on health service use and mortality in patients attending Emergency Departments (EDs).Methods:We conducted a retrospective matched cohort study of patients enrolled onto the CO@h pathway from EDs in England. We included all patients with a positive COVID-19 test from 1st October 2020 to 3rd May 2021 who attended ED from three days before to ten days after the date of the test. All patients who were admitted or died on the same or following day to the first ED attendance within the time window were excluded. In the primary analysis, participants enrolled onto CO@h were matched using demographic and clinical criteria to participants who were not enrolled. Five outcome measures were examined within 28 days of first ED attendance: i) death from any cause; ii) any subsequent ED attendance; iii) any emergency hospital admission; iv) critical care admission; and v) length of stay.Results:15,621 participants were included in the primary analysis, of whom 639 were enrolled onto CO@h and 14,982 were controls. Odds of death were 52% lower in those enrolled (95% CI: 7%-75% lower) compared to those not enrolled on CO@h. Odds of any ED attendance or admission were 37% (95% CI: 16-63%) and 59% (95% CI: 16-63%) higher, respectively, in those enrolled. Of those admitted, those enrolled had 53% (95% CI: 7%-76%) lower odds of critical care admission. There was no significant impact on length of stay.Conclusions:These findings indicate that for patients assessed in ED, pulse oximetry remote monitoring may be a clinically effective and safe model for early detection of hypoxia and escalation. However, possible selection biases might limit the generalisability to other populations.
Shanthakumar D, Leiloglou M, Kelliher C, et al., 2023, A comparison of spectroscopy and imaging techniques utilizing spectrally resolved diffusely reflected light for intraoperative margin assessment in breast-conserving surgery: a systematic review and meta-analysis, Cancers, Vol: 15, ISSN: 2072-6694
Up to 19% of patients require re-excision surgery due to positive margins in breast-conserving surgery (BCS). Intraoperative margin assessment tools (IMAs) that incorporate tissue optical measurements could help reduce re-excision rates. This review focuses on methods that use and assess spectrally resolved diffusely reflected light for breast cancer detection in the intraoperative setting. Following PROSPERO registration (CRD42022356216), an electronic search was performed. The modalities searched for were diffuse reflectance spectroscopy (DRS), multispectral imaging (MSI), hyperspectral imaging (HSI), and spatial frequency domain imaging (SFDI). The inclusion criteria encompassed studies of human in vivo or ex vivo breast tissues, which presented data on accuracy. The exclusion criteria were contrast use, frozen samples, and other imaging adjuncts. 19 studies were selected following PRISMA guidelines. Studies were divided into point-based (spectroscopy) or whole field-of-view (imaging) techniques. A fixed-or random-effects model analysis generated pooled sensitivity/specificity for the different modalities, following heterogeneity calculations using the Q statistic. Overall, imaging-based techniques had better pooled sensitivity/specificity (0.90 (CI 0.76-1.03)/0.92 (CI 0.78-1.06)) compared with probe-based techniques (0.84 (CI 0.78-0.89)/0.85 (CI 0.79-0.91)). The use of spectrally resolved diffusely reflected light is a rapid, non-contact technique that confers accuracy in discriminating between normal and malignant breast tissue, and it constitutes a potential IMA tool.
Alexander J, Posma J, Scott A, et al., 2023, Pathobionts in the tumour microbiota predict survival following resection for colorectal cancer, Microbiome, Vol: 11, Pages: 1-14, ISSN: 2049-2618
Background and aimsThe gut microbiota is implicated in the pathogenesis of colorectal cancer (CRC). We aimed to map the CRC mucosal microbiota and metabolome and define the influence of the tumoral microbiota on oncological outcomes.MethodsA multicentre, prospective observational study was conducted of CRC patients undergoing primary surgical resection in the UK (n = 74) and Czech Republic (n = 61). Analysis was performed using metataxonomics, ultra-performance liquid chromatography-mass spectrometry (UPLC-MS), targeted bacterial qPCR and tumour exome sequencing. Hierarchical clustering accounting for clinical and oncological covariates was performed to identify clusters of bacteria and metabolites linked to CRC. Cox proportional hazards regression was used to ascertain clusters associated with disease-free survival over median follow-up of 50 months.ResultsThirteen mucosal microbiota clusters were identified, of which five were significantly different between tumour and paired normal mucosa. Cluster 7, containing the pathobionts Fusobacterium nucleatum and Granulicatella adiacens, was strongly associated with CRC (PFDR = 0.0002). Additionally, tumoral dominance of cluster 7 independently predicted favourable disease-free survival (adjusted p = 0.031). Cluster 1, containing Faecalibacterium prausnitzii and Ruminococcus gnavus, was negatively associated with cancer (PFDR = 0.0009), and abundance was independently predictive of worse disease-free survival (adjusted p = 0.0009). UPLC-MS analysis revealed two major metabolic (Met) clusters. Met 1, composed of medium chain (MCFA), long-chain (LCFA) and very long-chain (VLCFA) fatty acid species, ceramides and lysophospholipids, was negatively associated with CRC (PFDR = 2.61 × 10−11); Met 2, composed of phosphatidylcholine species, nucleosides and amino acids, was strongly associated with CRC (PFDR&
Alexander JL, Posma JM, Scott A, et al., 2023, NETWORKS OF PATHOBIONTS IN THE TUMOUR MUCOSAL NICHE PREDICT SURVIVAL FOLLOWING COLORECTAL CANCER RESECTION, Digestive Disease Week (DDW), Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S469-S470, ISSN: 0016-5085
Lam K, Gadi N, Acharya A, et al., 2023, Interventions for sustainable surgery: a systematic review, International Journal of Surgery, Vol: 109, Pages: 1447-1458, ISSN: 1743-9159
Objective: To systematically evaluate interventions designed to improve the sustainability of surgical practice with respect to their environmental and financial impact.Background: Surgery contributes significantly to emissions attributed to healthcare due to its high resource and energy use. Several interventions across the operative pathway have, therefore, been trialed to minimize this impact. Few comparisons of the environmental and financial effects of these interventions exist.Materials and Methods: A search of studies published up to 2nd February 2022 describing interventions to increase surgical sustainability was undertaken. Articles regarding the environmental impact of only anesthetic agents were excluded. Data regarding environmental and financial outcomes were extracted with a quality assessment completed dependent upon study design.Results: 1162 articles were retrieved, of which 21 studies met inclusion criteria. 25 interventions were described, which were categorized into 5 domains: ‘reduce and rationalize’, ‘reusable equipment and textiles’, ‘recycling and waste segregation’, ‘anesthetic alternatives’ and ‘other’. 11/21 studies examined reusable devices; those demonstrating a benefit, reported 40-66% lower emissions than with single-use alternatives. In studies not showing a lower carbon footprint, reduction in manufacturing emissions were offset by the high environmental impact of local fossil-fuel based energy required for sterilization. The per use monetary cost of reusable equipment was 47-83% of the single-use equivalent.Conclusions: A narrow repertoire of interventions to improve the environmental sustainability of surgery has been trialed. The majority focus upon reusable equipment. Emissions and cost data is limited, with longitudinal impacts rarely investigated. Real-world appraisals will facilitate implementation, as will an understanding of how sustainability impacts surgical deci
Ravindran S, Cavilla R, Ashrafian H, et al., 2023, Development of the "Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills" (TEAM-ENTS) behavioral marker system, ENDOSCOPY, Vol: 55, Pages: 403-412, ISSN: 0013-726X
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Shaw A, Leis M, Howitt P, et al., 2023, From plans to actions: closing the implementation gap for patient safety, LANCET, Vol: 401, Pages: 1421-1421, ISSN: 0140-6736
Ghafur S, O'Brien N, Howitt P, et al., 2023, NHS Data - Maximising its impact for all, Publisher: Imperial College London
Che Bakri NA, Kwasnicki R, Khan N, et al., 2023, Impact of axillary lymph node dissection and sentinel lymph node biopsy on upper limb morbidity in breast cancer patients: a systematic review and meta-analysis, Annals of Surgery, Vol: 277, Pages: 572-580, ISSN: 0003-4932
Objective: To evaluate the impact of ALND and SLNB on upper limb (UL) morbidity in breastcancer patients.Summary Background: Axillary de-escalation is motivated by a desire to reduce harm ofALND. Understanding the impact of axillary surgery and disparities in operative procedureson post-operative arm morbidity would better direct resources to the point of need and cementthe need for de-escalation strategies.Methods: Embase, Medline, CINAHL and PsychINFO were searched from 1990 until March2020. Included studies were randomized-controlled and observational studies focusing on ULmorbidities, in breast surgery patients. The study followed the Preferred Reporting Items forSystematic Reviews and Meta-Analyses (PRISMA) guidelines. The prevalence of upper limbmorbidity comparing SLNB and ALND at less than 12 months, 12-24 months and beyond 24months were analyzed.Results: Sixty-seven studies were included. All studies reported a higher rate of lymphedemaand pain after ALND compared to SLNB. The difference in lymphedema and pain prevalencebetween SLNB and ALND was 13.7% (95% CI 10.5-16.8, p<0.005) and 24.2% (95% CI 12.1-36.3, p<0.005) respectively. Pooled estimates for prevalence of reduced strength and rangeof motion after SLNB and ALND were 15.2% vs 30.9% and 17.1% vs 29.8% respectively.Type of axillary surgery, greater BMI, and radiotherapy were some of the predictors for ULmorbidities.Conclusions: Prevalence of lymphedema after ALND was higher than previously estimated.ALND patients experienced greater rates of lymphedema, pain, reduced strength, and ROMcompared to SLNB. The findings support the continued drive to de-escalate axillary surgery.
Clarke J, Beaney T, Alboksmaty A, et al., 2023, Factors associated with enrolment into a national COVID-19 pulse oximetry remote monitoring programme in England: a retrospective observational study, The Lancet: Digital Health, Vol: 5, Pages: e194-e205, ISSN: 2589-7500
BACKGROUND: Hypoxaemia is an important predictor of severity in individuals with COVID-19 and can present without symptoms. The COVID Oximetry @home (CO@h) programme was implemented across England in November, 2020, providing pulse oximeters to higher-risk people with COVID-19 to enable early detection of deterioration and the need for escalation of care. We aimed to describe the clinical and demographic characteristics of individuals enrolled onto the programme and to assess whether there were any inequalities in enrolment. METHODS: This retrospective observational study was based on data from a cohort of people resident in England recorded as having a positive COVID-19 test between Oct 1, 2020, and May 3, 2021. The proportion of participants enrolled onto the CO@h programmes in the 7 days before and 28 days after a positive COVID-19 test was calculated for each clinical commissioning group (CCG) in England. Two-level hierarchical multivariable logistic regression with random intercepts for each CCG was run to identify factors predictive of being enrolled onto the CO@h programme. FINDINGS: CO@h programme sites were reported by NHS England as becoming operational between Nov 21 and Dec 31, 2020. 1 227 405 people resident in 72 CCGs had a positive COVID-19 test between the date of programme implementation and May 3, 2021, of whom 19 932 (1·6%) were enrolled onto the CO@h programme. Of those enrolled, 14 441 (72·5%) were aged 50 years or older or were identified as clinically extremely vulnerable (ie, having a high-risk medical condition). Higher odds of enrolment onto the CO@h programme were found in older individuals (adjusted odds ratio 2·21 [95% CI 2·19-2·23], p<0·001, for those aged 50-64 years; 3·48 [3·33-3·63], p<0·001, for those aged 65-79 years; and 2·50 [2·34-2·68], p<0·001, for those aged ≥80 years), in individuals of non-White ethnicity (1·3
Che Bakri NA, Kwasnicki RM, Khan N, et al., 2023, Impact of Axillary Lymph Node Dissection and Sentinel Lymph Node Biopsy on Upper Limb Morbidity in Breast Cancer Patients A Systematic Review and Meta-Analysis, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: 572-580, ISSN: 0003-4932
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Goble M, Caddick V, Patel R, et al., 2023, Optical neuroimaging and neurostimulation in surgical training and assessment: a state-of-the-art review, Frontiers in Neuroergonomics, Vol: 4, Pages: 1-8, ISSN: 2673-6195
Introduction: Functional near-infrared spectroscopy (fNIRS) is a non-invasive optical neuroimaging technique used to assess surgeons' brain function. The aim of this narrative review is to outline the effect of expertise, stress, surgical technology, and neurostimulation on surgeons' neural activation patterns, and highlight key progress areas required in surgical neuroergonomics to modulate training and performance.Methods: A literature search of PubMed and Embase was conducted to identify neuroimaging studies using fNIRS and neurostimulation in surgeons performing simulated tasks.Results: Novice surgeons exhibit greater haemodynamic responses across the pre-frontal cortex than experts during simple surgical tasks, whilst expert surgical performance is characterized by relative prefrontal attenuation and upregulation of activation foci across other regions such as the supplementary motor area. The association between PFC activation and mental workload follows an inverted-U shaped curve, activation increasing then attenuating past a critical inflection point at which demands outstrip cognitive capacity Neuroimages are sensitive to the impact of laparoscopic and robotic tools on cognitive workload, helping inform the development of training programs which target neural learning curves. FNIRS differs in comparison to current tools to assess proficiency by depicting a cognitive state during surgery, enabling the development of cognitive benchmarks of expertise. Finally, neurostimulation using transcranial direct-current-stimulation may accelerate skill acquisition and enhance technical performance.Conclusion: FNIRS can inform the development of surgical training programs which modulate stress responses, cognitive learning curves, and motor skill performance. Improved data processing with machine learning offers the possibility of live feedback regarding surgeons' cognitive states during operative procedures.
Sivananthan A, Kerry G, Darzi A, et al., 2023, Orientation in upper gastrointestinal endoscopy—the only way is up, World Journal of Gastrointestinal Endoscopy, Vol: 15, Pages: 146-152, ISSN: 1948-5190
BACKGROUNDOesophagogastroduodenoscopy is the gold standard investigation for the upper gastrointestinal (UGI) tract. Orientation during endoscopy is challenging and United Kingdom training focusses on technical competence and procedural safety. The reported location of UGI pathologies is crucial to post-endoscopic planning.AIMTo evaluate endoscopists’ ability to spatially orientate themselves within the UGI tract.METHODSA cross sectional descriptive study elicited, using an anonymised survey, the ability of endoscopists to orientate themselves within the UGI tract. The primary outcome was percentage of correct answers from all surveyed; secondary outcomes were percentage of correct answers from experienced vs novice endoscopists. Pearson’s χ2 test was applied to compare groups.RESULTSOf 188 respondents, 86 were experienced endoscopists having completed over 1000 endoscopies. 44.4% of respondents correctly identified the anterior stomach and 47.3% correctly identified the posterior of the second part of the duodenum (D2). Experienced endoscopists were significantly more likely than novice to identify the anterior stomach correctly [61.6% vs 31.3%, X2 (1, n = 188) = 11.10, P = 0.001]. There was no significant difference between the two groups in identifying the posterior of D2.CONCLUSIONThe majority of endoscopists surveyed were unable to identify key landmarks within the UGI tract. Endoscopic orientation appears to improve with experience yet there are some areas still not well recognised. This has potential considerable impact on post-endoscopic management of patients with posterior duodenal ulcers being more likely to perforate and associated with a higher rebleeding risk. We suggest the development of a consensus statement on endoscopic description.
Elliott P, Whitaker M, Tang D, et al., 2023, Design and implementation of a national SARS-CoV-2 monitoring programme in England: REACT-1 Study, American Journal of Public Health, ISSN: 0090-0036
Data System. The REal-time Assessment of Community Transmission-1 (REACT-1) Study was funded by the Department of Health and Social Care in England to provide reliable and timely estimates of prevalence of SARS-CoV-2 infection by time, person and place.Data Collection/Processing. The data were obtained by writing to named individuals aged 5 years and above in random cross-sections of the population of England, using the National Health Service (NHS) list of patients registered with a general practitioner (>99% coverage) as sampling frame. Data were collected 2-3 weekly approximately every month across 19distinct rounds of data collection from May 1, 2020 to March 31, 2022.Data Analysis/Dissemination. The data and study materials are widely disseminated via the study website, preprints, publications in peer-reviewed journals and the media. Data tabulations suitably anonymised to protect participant confidentiality are available on request to the study’s Data Access Committee.Implications. The study provided inter alia real-time data on SARS-CoV-2 prevalence over time, by area, and by socio-demographic variables; estimates of vaccine effectiveness; symptom profiles and detected emergence of new variants based on viral genome sequencing.
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