Publications
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Deeba S, Purkayastha S, Darzi A, et al., 2011, Obturator hernias: A review of the laparoscopic approach, JOURNAL OF MINIMAL ACCESS SURGERY, Vol: 7, Pages: 201-204, ISSN: 0972-9941
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- Citations: 19
Darzi A, Athanasiou T, 2011, Evidence Synthesis In Healthcare, Publisher: Springer, ISBN: 9780857292063
Through the use of clearly explained examples and practical explanations, this book describes the practical tools, techniques, uses and policy considerations of evidence synthesis techniques in modern healthcare practice.
Darzi A, Athanasiou T, 2011, Evidence Synthesis In Healthcare, Publisher: Springer, ISBN: 9780857292063
Through the use of clearly explained examples and practical explanations, this book describes the practical tools, techniques, uses and policy considerations of evidence synthesis techniques in modern healthcare practice.
Vlaev I, Darzi A, 2011, Preferences and Their Implication for Policy, Health and Wellbeing, Neuroscience of Preference and Choice: Cognitive and Neural Mechanisms, Pages: 305-336, ISBN: 9780123814319
This chapter describes a conceptual framework for population behavior change, which offers a novel perspective of how various constructs from diverse models and research domains link together. Goal-directed or planning systems are centeredin the prefrontal cortex, but may also subsume other mechanisms localized to the hippocampus and dorsomedial striatum. Control over decisions often transfers from goal-directed mechanisms to a habit-based system that controls both action habits and mental habits. Motivation is often defined as activation of goal-oriented behavior even though it may not involve an explicit model of the expected outcomes as in a goal-directed system. Many behavior change interventions focus on the way people think by providing information that, assuming rationality, uses persuasion to adopt a specific behavior and to train the skills needed to adopt this new behavior. A drug-positive result or failure to provide a scheduled specimen resets the voucher value back to an initial low value from which it could increment again.
Corcoles EP, Deeb S, Hanna G, et al., 2011, Adaptation of on-line rapid sampling microdialysis to monitor human intestinal ischaemia, Jurnal Teknologi (Sciences and Engineering), Vol: 54, Pages: 47-59, ISSN: 0127-9696
Intestinal ischaemia or poor perfusion of the gastrointestinal tract is a major cause of post-operative mortality in abdominal surgery. Currently diagnosis of ischaemia relies only on clinical symptoms. Thus, monitoring bowel metabolism as an early marker of intestinal ischaemia is necessary. Human bowel microdialysis has been used in the past to study the metabolism of ichaemia collecting dialysate samples from the peritoneal cavity every 60 minutes. These sampling times carry a long delay for the detection of the typically rapid ischaemic event. We have previously developed a successful biosensor system to monitor neurochemicals in the human brain during surgery and in the intensive care unit The method consists of a flow injection analysis (FIA) system coupled to an enzyme based amperometric detector. The rapid sampling microdialysis monitoring system analysed electrochemically the dialysate glucose and lactate at high time resolution (typically 30 second sampling). Adaptation of the analytical assay system for on-line microdialysis monitoring of human bowel was performed and validated for in vivo procedures. Optimum membranes loading ratios were found to be 1:0.5 GOx:HRP and 2:0.5 LOx:HRP. The ischemic range was found to be 15μM-400μM, 40μM-6mM for glucose and lactate, respectively. The calibration method for these monitorings was concluded with a range from 250 μM to 6 mM. © Universiti Teknologi Malaysia.
Oborn E, Barrett M, Darzi A, 2011, Robots and service innovation in health care, JOURNAL OF HEALTH SERVICES RESEARCH & POLICY, Vol: 16, Pages: 46-50, ISSN: 1355-8196
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- Citations: 24
Rao C, Darzi A, Athanasiou T, 2011, An Introduction to Decision Analysis, Evidence Synthesis in Healthcare: A Practical Handbook for Clinicians, Editors: Darzi, Athanasiou, Berlin Heidelberg, Publisher: Springer-Verlag, ISBN: 978-0-85729-175-2
Rao C, Darzi A, Athanasiou T, 2011, Practical Examples of the Application of Decision Analysis in Healthcare, Evidence Synthesis in Healthcare: A Practical Handbook for Clinicians, Editors: Darzi, Athanasiou, Berlin Heidelberg, Publisher: Springer-Verlag, ISBN: 978-0-85729-175-2
Almoudaris AM, Burns EM, Bottle A, et al., 2011, A colorectal perspective on voluntary submission of outcome data to clinical registries., Br J Surg, Vol: 98, Pages: 132-139
BACKGROUND: The aim of the study was to identify outcome differences amongst patients undergoing resection of colorectal cancer at English National Health Service trusts using Hospital Episode Statistics (HES). A comparison was undertaken of trusts that submitted and those that did not submit, or submitted only poorly, voluntarily to a colorectal clinical registry, the National Bowel Cancer Audit Programme (NBOCAP). METHODS: The NBOCAP data set was used to classify trusts according to submitter status. HES data were used for outcome analysis. Data for major resections of colorectal cancer performed between 1 August 2007 and 31 July 2008 were obtained from HES. Trusts not submitting data to NBOCAP and those submitting less than 10 per cent of their total workload were termed 'non-submitters'. HES data for 30-day mortality, length of stay and readmission rates were compared according to submitter and non-submitter status in multifactorial analyses. RESULTS: A total of 17,722 patients were identified from HES for inclusion. Unadjusted 30-day in-hospital mortality rates were higher in non-submitting than in submitting trusts (5·2 versus 4·0 per cent; P = 0·005). Submitter status was independently associated with reduced 30-day mortality (odds ratio 0·76, 95 per cent confidence interval 0·61 to 0·96; P = 0·021) in regression analysis. CONCLUSION: A higher postoperative mortality rate following resection of colorectal cancer was found in trusts that do not voluntarily report data to NBOCAP. Implications regarding the voluntary nature of submission to such registries should be reviewed if they are to be used for outcome benchmarking.
Kinross J, Alkhamesi N, Barton R, et al., 2011, Global metabolic phenotyping in an experimental laparotomy model of surgical trauma., Journal of Proteome Research, Vol: 1, Pages: 277-287
Surgical trauma initiates a complex series of metabolic host responses designed to maintain homeostasis and ensure survival. (1)H NMR spectroscopy was applied to intraoperative urine and plasma samples as part of a strategy to analyze the metabolic response of Wistar rats to a laparotomy model. Spectral data were analyzed by multivariate statistical analysis. Principal component analysis (PCA) confirmed that surgical injury is responsible for the majority of the metabolic variability demonstrated between animals (R² Urine = 81.2% R² plasma = 80%). Further statistical analysis by orthogonal projection to latent structure discriminant analysis (OPLS-DA) allowed the identification of novel urinary metabolic markers of surgical trauma. Urinary levels of taurine, glucose, urea, creatine, allantoin, and trimethylamine-N-oxide (TMAO) were significantly increased after surgery whereas citrate and 2-oxoglutarate (2-OG) negatively correlated with the intraoperative state as did plasma levels of betaine and tyrosine. Plasma levels of lipoproteins such as VLDL and LDL also rose with the duration of surgery. Moreover, the microbial cometabolites 3-hydroxyphenylpropionate, phenylacetylglycine, and hippurate correlated with the surgical insult, indicating that the gut microbiota are highly sensitive to the global homeostatic state of the host. Metabonomic profiling provides a global overview of surgical trauma that has the potential to provide novel biomarkers for personalized surgical optimization and outcome prediction.
Ahmed K, Ibrahim A, Anderson O, et al., 2011, Development of a Surgical Educational Research Program—Fundamental Principles and Challenges, J Surg Res
BackgroundSurgical educational research is the scientific investigation of any aspect of surgical learning, teaching, training, and assessment. The research into development and validation of educational tools is vital to optimize patient care. This can be accomplished by establishing high quality educational research programs within academic surgical departments. This article aims to identify the components involved in educational research and describes the challenges as well as solutions to establishing a high quality surgical educational research program.MethodsA variety of sources including journal articles, books, and online literature were reviewed in order to determine the pathways involved in conducting educational research and establishing a research program.ResultsIt is vital to ensure that educational research is acceptable, innovative, robust in design, funded correctly, and disseminated successfully. Challenges faced by the current surgical research programs include structural organization, academic support, credibility, time, funding, relevance, and growth. The solutions to these challenges have been discussed.ConclusionsTo ensure research in surgical education is of high quality and yields credible results, strong leadership in the organization of an educational research program is necessary.
Ahmed K, Rowland S, Patel VM, et al., 2011, Specialist anatomy: Is the structure of teaching adequate?, Surgeon, Vol: 9, Pages: 312-317, ISSN: 1479-666X
BACKGROUND: A knowledge and understanding of specialist anatomy, which includes radiological, laparoscopic, endoscopic and endovascular anatomy is essential for interpretation of imaging and development of procedural skills. METHODS AND MATERIALS: Medical students, specialist trainees and specialists from the London (England, UK) area were surveyed to investigate individual experiences and recommendations for: (1) timing of the introduction of specialist anatomy teaching, and (2) pedagogical methods used. Opinions relating to radiological, laparoscopic, endoscopic and endovascular anatomy were collected. Non-parametric tests were used to investigate differences in recommendations between specialist trainees and specialists. RESULTS: Two hundred and twenty-eight (53%) individuals responded to the survey. Imaging was most commonly used to learn radiological anatomy (94.5%). Procedural observation was most commonly used to learn laparoscopic (89.0%), endoscopic (87.3%) and endovascular anatomy (66.2%). Imaging was the most recommended method to learn radiological anatomy (92.1%). Procedural observation was the most recommended method for learning laparoscopic (80.0%), endoscopic (81.2%) and endovascular anatomy (42.5%). Specialist trainees and specialists recommended introduction of specialist anatomy during undergraduate training. CONCLUSION: Although the methods for specialist anatomy learning are in practice, there is no consensus on timing and structure within the anatomy curriculum. Recommendations from trainees and specialists should be considered so that the existing curriculum can be refined to maximise learning outcomes.
Ashrafian H, Ahmed K, Rowland S, et al., 2011, Metabolic surgery and cancer: The protective effects of bariatric procedures., Cancer, Vol: 117, Pages: 1788-1799, ISSN: 0008-543X
The worldwide epidemic of obesity and the global incidence of cancer are both increasing. There is now epidemiological evidence to support a correlation between obesity, weight gain, and some cancers. Metabolic or bariatric surgery can provide sustained weight loss and reduced obesity-related mortality. These procedures can also improve the metabolic profile to decrease cardiovascular risk and resolve diabetes in morbidly obese patients. The operations offer several physiological steps, the so-called BRAVE effects: 1) bile flow alteration, 2) reduction of gastric size, 3) anatomical gut rearrangement and altered flow of nutrients, 4) vagal manipulation and 5) enteric gut hormone modulation. Metabolic operations are also associated with a significant reduction of cancer incidence and mortality. The cancer-protective role of metabolic surgery is strongest for female obesity-related tumors; however, the underlying mechanisms may involve both weight-dependent and weight-independent effects. These include the improvement of insulin resistance with attenuation of the metabolic syndrome as well as decreased oxidative stress and inflammation in addition to the beneficial modulation of sex steroids, gut hormones, cellular energetics, immune system, and adipokines. Elucidating the precise metabolic mechanisms of cancer prevention by metabolic surgery can increase our understanding of how obesity, diabetes, and metabolic syndrome are associated with cancer. It may also offer novel treatment strategies in the management of tumor generation and growth.
Patel V, Aggarwal R, Taylor D, et al., 2011, Implementation of virtual online patient simulation, Studies in Health Technology and Informatics, Vol: 163 Medicine Meets Virtual Reality 18, Pages: 440-446
The development and use of virtual patients has become more expansive. Previous strategies to aid their development have been described to aid their formation. This study describes the development of a series of virtual patients following a methodology proposed by Posel et al [1]. Ten virtual patients with surgical pathology were developed using a reproducible framework. This article serves to guide virtual patient authors as a working description of virtual patient design in order to assist them for future virtual patient development.
Taylor D, Patel V, Cohen D, et al., 2011, Single and multi-user virtual patient design in the virtual world, Studies in Health Technology and Informatics, Vol: 163: Medicine Meets Virtual Reality 18, Pages: 650-652
This research addresses the need for the flexible creation of immersive clinical training simulations for multiple interacting participants and virtual patients by using scalable open source virtual world technologies. Initial development of single-user surgical virtual patients has been followed by that of multi-user multiple casualties in a field environment and an acute hospital emergency department. The authors aim to validate and extend their reproducible framework for eventual application of virtual worlds to whole hospital major incident response simulation and to multi-agency, pan-geographic mass casualty exercises.
Newton RC, Kemp SV, Yang G-Z, et al., 2011, Tracheobronchial Amyloidosis and Confocal Endomicroscopy, RESPIRATION, Vol: 82, Pages: 209-211, ISSN: 0025-7931
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- Citations: 12
Kinross JM, Darzi AW, Nicholson JK, 2011, Gut microbiome-host interactions in health and disease, GENOME MEDICINE, Vol: 3, ISSN: 1756-994X
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- Citations: 438
Newton RC, Noonan D, Payne C, et al., 2011, Probe tip contact force and bowel distension affect crypt morphology during confocal endomicroscopy, Publisher: BMJ Publishing Group Ltd and British Society of Gastroenterology, Pages: A12-A13
Nestel D, Kneebone R, Nolan C, et al., 2011, Formative assessment of procedural skills: students' responses to the Objective Structured Clinical Examination and the Integrated Performance Procedural Instrument, ASSESSMENT & EVALUATION IN HIGHER EDUCATION, Vol: 36, Pages: 171-183, ISSN: 0260-2938
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- Citations: 5
Faiz O, Haji A, Bottle A, et al., 2011, Elective colonic surgery for cancer in the elderly: an investigation into postoperative mortality in English NHS hospitals between 1996 and 2007, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Vol: 13, Pages: 779-785, ISSN: 1463-1318
BACKGROUND: This study was primarily aimed to quantify perioperative mortality risk in elderly patients undergoing elective colonic resectional surgery. In addition, the safety of minimally invasive colonic surgery in this patient group was evaluated. METHODS: All patients aged > 75 undergoing elective colonic resection for colorectal malignancy between 1996 and 2007 in English NHS hospitals were included from the Hospital Episode Statistics (HES) dataset. RESULTS: Between the study dates, 28,746 patients > 75 years underwent elective colonic resection. The national annual number of colonic excisions carried out amongst elderly patients increased from 2188 patients in 1996/7 to 3240 patients in 2006/7. Following adjustment for gender, comorbidity and surgical approach, advancing age was an independent predictor for 30-day mortality (OR 2.47 for patients aged 85-89 vs 75-79, P < 0.001). Use of laparoscopy was a significant predictor of reduced perioperative mortality (OR 0.56, P = 0.003) once adjusted for advancing age, gender and comorbidity. Comparison of 30-day and 1-year postoperative mortality following elective colonic resection in patients aged 90 revealed a large excess of patients dying outside of the immediate perioperative period (10.1% and 26.2% for proximal cancers, respectively; 12.9% and 36.1% for distal colonic resections, respectively). CONCLUSIONS: Advancing age is an independent risk factor for postoperative death in elderly patients undergoing elective colonic resection for cancer. The risk of death in the elderly is extremely high and surgical decision-making should incorporate the mortality risk that occurs outside the immediate perioperative period. In this national series, patients selected for a laparoscopic procedure were at lower risk of perioperative death than those undergoing the conventional approach.
Almoudaris AM, Burns EM, Bottle A, et al., 2011, A colorectal perspective on voluntary submission of outcome data to clinical registries, The British journal of surgery, Vol: 98, Pages: 132-139, ISSN: 1365-2168
BACKGROUND: The aim of the study was to identify outcome differences amongst patients undergoing resection of colorectal cancer at English National Health Service trusts using Hospital Episode Statistics (HES). A comparison was undertaken of trusts that submitted and those that did not submit, or submitted only poorly, voluntarily to a colorectal clinical registry, the National Bowel Cancer Audit Programme (NBOCAP). METHODS: The NBOCAP data set was used to classify trusts according to submitter status. HES data were used for outcome analysis. Data for major resections of colorectal cancer performed between 1 August 2007 and 31 July 2008 were obtained from HES. Trusts not submitting data to NBOCAP and those submitting less than 10 per cent of their total workload were termed 'non-submitters'. HES data for 30-day mortality, length of stay and readmission rates were compared according to submitter and non-submitter status in multifactorial analyses. RESULTS: A total of 17,722 patients were identified from HES for inclusion. Unadjusted 30-day in-hospital mortality rates were higher in non-submitting than in submitting trusts (5.2 versus 4.0 per cent; P = 0.005). Submitter status was independently associated with reduced 30-day mortality (odds ratio 0.76, 95 per cent confidence interval 0.61 to 0.96; P = 0.021) in regression analysis. CONCLUSION: A higher postoperative mortality rate following resection of colorectal cancer was found in trusts that do not voluntarily report data to NBOCAP. Implications regarding the voluntary nature of submission to such registries should be reviewed if they are to be used for outcome benchmarking.
Burns EM, Bottle A, Aylin P, et al., 2011, Volume analysis of outcome following restorative proctocolectomy, The British journal of surgery, Vol: 98, Pages: 408-417, ISSN: 1365-2168
BACKGROUND: This observational study aimed to determine national provision and outcome following pouch surgery (restorative proctocolectomy, RPC) and to examine the effect of institutional and surgeon caseload on outcome. METHODS: All patients undergoing primary RPC between April 1996 and March 2008 in England were identified from the administrative database Hospital Episode Statistics. Institutions and surgeons were categorized according to the total RPC caseload performed over the study interval. RESULTS: Some 5771 primary elective pouch procedures were undertaken at 154 National Health Service hospital trusts. Median follow-up was 65 (interquartile range (i.q.r.) 28-106) months. The 30-day in-hospital mortality rate was 0.5 per cent and the 1-year overall mortality rate 1.5 per cent. Some 30.5 per cent of trusts performed fewer than two procedures per year, and 91.4 per cent of surgical teams (456 of 499) carried out 20 or fewer RPCs over 8 years. Median surgeon volume was 4 (i.q.r. 1-9) cases. Failure occurred in 6.4 per cent of cases. Low-volume surgeons operated on more patients at the extremes of age (P < 0.001) and a lower proportion with ulcerative colitis (P < 0.001). Older age, increasing co-morbidity, increasing social deprivation, and both lower provider and surgeon caseload were independent predictors of longer length of stay. Older patient age and low institutional volume status were independent predictors of failure. CONCLUSION: Many English institutions and surgeons carry out extremely low volumes of RPC surgery. Case selection differed significantly between high- and low-volume surgeons. Institutional volume and older age were positively associated with increased pouch failure.
Jones CM, Darzi A, Athanasiou T, 2011, A Practical Approach to Diagnostic Meta-analysis, EVIDENCE SYNTHESIS IN HEALTHCARE: A PRACTICAL HANDBOOK FOR CLINICIANS, Editors: Athanasiou, Darzi, Publisher: SPRINGER-VERLAG BERLIN, Pages: 201-219, ISBN: 978-0-85729-175-2
Ashrafian H, Darzi A, Athanasiou T, 2011, Evidence Synthesis: Evolving Methodologies to Optimise Patient Care and Enhance Policy Decisions, EVIDENCE SYNTHESIS IN HEALTHCARE: A PRACTICAL HANDBOOK FOR CLINICIANS, Editors: Athanasiou, Darzi, Publisher: SPRINGER-VERLAG BERLIN, Pages: 1-46, ISBN: 978-0-85729-175-2
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- Citations: 5
Jones CM, Darzi A, Athanasiou T, 2011, Diagnostic Tests, EVIDENCE SYNTHESIS IN HEALTHCARE: A PRACTICAL HANDBOOK FOR CLINICIANS, Editors: Athanasiou, Darzi, Publisher: SPRINGER-VERLAG BERLIN, Pages: 115-125, ISBN: 978-0-85729-175-2
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- Citations: 1
Corcoles EP, Deeba S, Hanna GB, et al., 2011, Bowel Ischemia Monitoring Using Rapid Sampling Microdialysis Biosensor System, 5TH KUALA LUMPUR INTERNATIONAL CONFERENCE ON BIOMEDICAL ENGINEERING 2011 (BIOMED 2011), Vol: 35, Pages: 275-+, ISSN: 1680-0737
Shang J, Noonan DP, Payne C, et al., 2011, An articulated universal joint based flexible access robot for minimally invasive surgery, Pages: 1147-1152
Patel V, Aggarwal R, Osinibi E, et al., 2011, Operating room introduction for the novice, The American Journal of Surgery, ISSN: 0002-9610
BackgroundThis study assessed the implementation of a theater induction curriculum through a didactic lecture, an online Second Life operating room, and a simulated operating suite.MethodsSixty operating room novices were randomized into 4 groups: control (n = 15), didactic lecture (n = 15), Second Life (n = 15), and simulated operating suite (n = 15). The study followed a pretest and posttest design with a training intervention between operating room attendances. Outcome measures were knowledge, skills, and attitudes, measured using observed behavior and a self-report scale, with knowledge further assessed using multiple-choice questionnaires.ResultsThe lecture, Second Life, and simulated operating suite groups demonstrated significant improvements in all outcome measures. After the intervention, these 3 groups had significantly higher behavior (P < .001), self-report (P < .05), and knowledge (P < .05) scores than the control group.ConclusionsThis study demonstrates the value of delivering a theater induction curriculum for operating room preparation.
Sodergren MH, Pucher P, Clark J, et al., 2011, Disinfection of the Access Orifice in NOTES: Evaluation of the Evidence Base., Diagn Ther Endosc, Vol: 2011
Introduction. Appropriate prevention of infection is a key area of research in natural orifice translumenal endoscopic surgery (NOTES), as identified by the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR). Methods. A review of the literature was conducted evaluating the evidence base for access orifice preparation/treatment in NOTES procedures in the context of infectious complications. Recommendations based on the Oxford Centre for Evidence-Based Medicine guidelines were made. Results. The most robust evidence includes several experimental randomised controlled trials assessing infectious complications in the transgastric approach to NOTES. Transvaginal procedures are long established for accessing the peritoneal cavity following disinfection with antiseptic. Only experimental case series for transcolonic and transvesical approaches are described. Conclusion. Grade C recommendation requiring no preoperative preparation can be made for the transgastric approach. Antiseptic irrigation is recommended for transvaginal (grade C) NOTES access, as is current practice. Further human trials need to be conducted to corroborate the current evidence base for transgastric closure. It is important that future trials are conducted in a methodologically robust fashion, with emphasis on clinical outcomes and standardisation of enterotomy closure and postoperative therapy.
Davis R, Sevdalis N, Pinto A, et al., 2011, Patients’ attitudes towards patient safety interventions: Results of two exploratory studies, Health Expectations
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