150 results found
Dilley JWR, Hughes-Hallett A, Pratt PJ, et al., 2018, Perfect Registration Leads to Imperfect Performance: A Randomized Trial of Multimodal Intraoperative Image Guidance., Ann Surg
OBJECTIVE: To compare surgical safety and efficiency of 2 image guidance modalities, perfect augmented reality (AR) and side-by-side unregistered image guidance (IG), against a no guidance control (NG), when performing a simulated laparoscopic cholecystectomy (LC). BACKGROUND: Image guidance using AR offers the potential to improve understanding of subsurface anatomy, with positive ramifications for surgical safety and efficiency. No intra-abdominal study has demonstrated any advantage for the technology. Perfect AR cannot be provided in the operative setting in a patient; however, it can be generated in the simulated setting. METHODS: Thirty-six experienced surgeons performed a baseline LC using the LapMentor simulator before randomization to 1 of 3 study arms: AR, IG, or NG. Each performed 3 further LC. Safety and efficiency-related simulator metrics, and task workload (SURG-TLX) were collected. RESULTS: The IG group had a shorter total instrument path length and fewer movements than NG and AR groups. Both IG and NG took a significantly shorter time than AR to complete dissection of Calot triangle. Use of IG and AR resulted in significantly fewer perforations and serious complications than the NG group. IG had significantly fewer perforations and serious complications than the AR group. Compared with IG, AR guidance was found to be significantly more distracting. CONCLUSION: Side-by-side unregistered image guidance (IG) improved safety and surgical efficiency in a simulated setting when compared with AR or NG. IG provides a more tangible opportunity for integrating image guidance into existing surgical workflow as well as delivering the safety and efficiency benefits desired.
Flott K, Darzi A, Gancarczyk S, et al., 2018, Improving the Usefulness and Use of Patient Survey Programs: National Health Service Interview Study, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 20, ISSN: 1438-8871
Flott K, Darzi A, Mayer E, 2018, Care pathway and organisational features driving patient experience: statistical analysis of large NHS datasets., BMJ Open, Vol: 8
OBJECTIVE: The aim of this study was to identify the care pathway and organisational factors that predict patient experience. DESIGN: Statistical analysis of large National Health Service (NHS) datasets. SETTING ANDPARTICIPANTS: England; acute NHS organisational-level data. PRIMARY AND SECONDARY OUTCOME MEASURES: The relationship of care pathway and organisational variables to organisation-level patient experience. RESULTS: A framework of 18 care pathway and organisational variables were created based on the existing literature. 11 of these correlated to patient experience in univariate analyses. Multicollinearity tests resulted in 1 of the 11 variables holding a correlation to another variable larger than r=0.70. A significant multilinear regression equation, including the final 10 variables, was found (F(10,108)=6.214, p<0.00), with an [Formula: see text] of 0.365. Two variables were significant in predicting better in patient experience: Amount of support to clinical staff (beta=0.2, p=0.02) and the proportion of staff who would recommend the trust as a place to work or receive treatment (beta=0.26, p=0.01). Two variables were significant in predicting a negative impact on the patient's rating of their experience: Number of patients spending over 4 hours from decision to admit to admission (beta=-1.99, p=0.03) and the percentage of estates and hotel services contracted out (beta=-0.23, p=0.01). CONCLUSIONS: These results indicate that augmenting clinical support and investing in the mechanisms that facilitate positive staff experience is essential to delivering appropriate, informative and patient-centric care. Reducing wait times and the extent of external contracting within hospitals is also likely to improve patient ratings of experience. Understanding the relationship between patient experience and objective, measurable organisational features promote a more patient-centric interpretation of quality and compel a better use of patient experience feedback to
Murray AC, Markar S, Mackenzie H, et al., 2018, An observational study of the timing of surgery, use of laparoscopy and outcomes for acute cholecystitis in the USA and UK, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 32, Pages: 3055-3063, ISSN: 0930-2794
Scott AJ, Mason SE, Langdon AJ, et al., 2018, Prospective Risk Factor Analysis for the Development of Post-operative Urinary Retention Following Ambulatory General Surgery., World J Surg
AIMS: Post-operative urinary retention (POUR) is a common cause of unplanned admission following day-case surgery and has negative effects on both patient and surgical institution. We aimed to prospectively evaluate potential risk factors for the development of POUR following day-case general surgical procedures. METHODS: Over a 24-week period, consecutive adult patients undergoing elective day-case general surgery at a single institution were prospectively recruited. Data regarding urinary symptoms, comorbidities, drug history, surgery and perioperative anaesthetic drug use were collected. The primary outcome was the incidence of POUR, defined as an impairment of bladder voiding requiring either urethral catheterisation, unplanned overnight admission or both. Potential risk factors for the development of POUR were analysed by logistic regression. RESULTS: A total of 458 patients met the inclusion criteria during the study period, and data were collected on 382 (83%) patients (74.3% male). Sixteen patients (4.2%) experienced POUR. Unadjusted analysis demonstrated three significant risk factors for the development of POUR: age ≥ 56 years (OR 7.77 [2.18-27.78], p = 0.002), laparoscopic surgery (OR 3.37 [1.03-12.10], p = 0.044) and glycopyrrolate administration (OR 5.56 [2.00-15.46], p = 0.001). Male sex and lower urinary tract symptoms were not significant factors. Multivariate analysis combining type of surgery, age and glycopyrrolate use revealed that only age ≥ 56 years (OR 8.14 [2.18-30.32], p = 0.0018) and glycopyrrolate administration (OR 3.48 [1.08-11.24], p = 0.0370) were independently associated with POUR. CONCLUSIONS: Patients aged at least 56 years and/or requiring glycopyrrolate-often administered during laparoscopic procedures-are at increased risk of POUR following ambulatory general surgery.
Wedge DC, Gundem G, Mitchell T, et al., 2018, Sequencing of prostate cancers identifies new cancer genes, routes of progression and drug targets, Nature Genetics, Vol: 50, Pages: 682-692, ISSN: 1061-4036
© 2018 The Author(s). Prostate cancer represents a substantial clinical challenge because it is difficult to predict outcome and advanced disease is often fatal. We sequenced the whole genomes of 112 primary and metastatic prostate cancer samples. From joint analysis of these cancers with those from previous studies (930 cancers in total), we found evidence for 22 previously unidentified putative driver genes harboring coding mutations, as well as evidence for NEAT1 and FOXA1 acting as drivers through noncoding mutations. Through the temporal dissection of aberrations, we identified driver mutations specifically associated with steps in the progression of prostate cancer, establishing, for example, loss of CHD1 and BRCA2 as early events in cancer development of ETS fusion-negative cancers. Computational chemogenomic (canSAR) analysis of prostate cancer mutations identified 11 targets of approved drugs, 7 targets of investigational drugs, and 62 targets of compounds that may be active and should be considered candidates for future clinical trials.
Archer S, Hull L, Soukup T, et al., 2017, Development of a theoretical framework of factors affecting patient safety incident reporting: a theoretical review of the literature, BMJ OPEN, Vol: 7, ISSN: 2044-6055
Camacho N, Van Loo P, Edwards S, et al., 2017, Appraising the relevance of DNA copy number loss and gain in prostate cancer using whole genome DNA sequence data., PLoS Genet, Vol: 13
A variety of models have been proposed to explain regions of recurrent somatic copy number alteration (SCNA) in human cancer. Our study employs Whole Genome DNA Sequence (WGS) data from tumor samples (n = 103) to comprehensively assess the role of the Knudson two hit genetic model in SCNA generation in prostate cancer. 64 recurrent regions of loss and gain were detected, of which 28 were novel, including regions of loss with more than 15% frequency at Chr4p15.2-p15.1 (15.53%), Chr6q27 (16.50%) and Chr18q12.3 (17.48%). Comprehensive mutation screens of genes, lincRNA encoding sequences, control regions and conserved domains within SCNAs demonstrated that a two-hit genetic model was supported in only a minor proportion of recurrent SCNA losses examined (15/40). We found that recurrent breakpoints and regions of inversion often occur within Knudson model SCNAs, leading to the identification of ZNF292 as a target gene for the deletion at 6q14.3-q15 and NKX3.1 as a two-hit target at 8p21.3-p21.2. The importance of alterations of lincRNA sequences was illustrated by the identification of a novel mutational hotspot at the KCCAT42, FENDRR, CAT1886 and STCAT2 loci at the 16q23.1-q24.3 loss. Our data confirm that the burden of SCNAs is predictive of biochemical recurrence, define nine individual regions that are associated with relapse, and highlight the possible importance of ion channel and G-protein coupled-receptor (GPCR) pathways in cancer development. We concluded that a two-hit genetic model accounts for about one third of SCNA indicating that mechanisms, such haploinsufficiency and epigenetic inactivation, account for the remaining SCNA losses.
Camara M, Mayer E, Darzi A, et al., 2017, Simulation of Patient-Specific Deformable Ultrasound Imaging in Real Time, Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), Vol: 10549 LNCS, Pages: 11-18, ISSN: 0302-9743
© 2017, Springer International Publishing AG. Intraoperative ultrasound is an imaging modality frequently used to provide delineation of tissue boundaries. This paper proposes a simulation platform that enables rehearsal of patient-specific deformable ultrasound scanning in real-time, using preoperative CT as the data source. The simulation platform was implemented within the GPU-accelerated NVIDIA FleX position-based dynamics framework. The high-resolution particle model is used to deform both surface and volume meshes. The latter is used to compute the barycentric coordinates of each simulated ultrasound image pixel in the surrounding volume, which is then mapped back to the original undeformed CT volume. To validate the computation of simulated ultrasound images, a kidney phantom with an embedded tumour was CT-scanned in the rest position and at five different levels of probe-induced deformation. Measures of normalised cross-correlation and similarity between features were adopted to compare pairs of simulated and ground truth images. The accurate results demonstrate the potential of this approach for clinical translation.
Carter AW, Mandavia R, Mayer E, et al., 2017, Systematic review of economic analyses in patient safety: a protocol designed to measure development in the scope and quality of evidence, BMJ OPEN, Vol: 7, ISSN: 2044-6055
Flott K, Hounsome L, Vuik S, et al., 2017, A patient-centric approach to improving experience in urological cancer care, JOURNAL OF CLINICAL UROLOGY, Vol: 10, Pages: 39-46, ISSN: 2051-4158
Flott KM, Graham C, Darzi A, et al., 2017, Can we use patient-reported feedback to drive change? The challenges of using patient-reported feedback and how they might be addressed, BMJ QUALITY & SAFETY, Vol: 26, Pages: 502-507, ISSN: 2044-5415
Howell A-M, Burns EM, Hull L, et al., 2017, International recommendations for national patient safety incident reporting systems: an expert Delphi consensus-building process, BMJ QUALITY & SAFETY, Vol: 26, Pages: 150-163, ISSN: 2044-5415
Howell A-M, Burns EM, Hull L, et al., 2017, Incident reporting: rare incidents may benefit from national problem solving, BMJ QUALITY & SAFETY, Vol: 26, Pages: 517-517, ISSN: 2044-5415
Jallad S, Hounsome L, Verne J, et al., 2017, Where are we with improving outcome guidance? An update on pelvic urological services in the NHS, JOURNAL OF CLINICAL UROLOGY, Vol: 10, Pages: 29-33, ISSN: 2051-4158
Jay A, Aldiwani M, Wijayarathna S, et al., 2017, THE FEATURES AND MANAGEMENT OF LATE RELAPSE OF NON-SEMINOMATOUS GERM CELL TUMOURS, Annual Meeting of the American-Urological-Association (AUA), Publisher: ELSEVIER SCIENCE INC, Pages: E1041-E1041, ISSN: 0022-5347
Kockelbergh R, Hounsome L, Mayer E, 2017, The Epidemiology of urological cancer 2001-2013, JOURNAL OF CLINICAL UROLOGY, Vol: 10, Pages: 3-8, ISSN: 2051-4158
Lee KA, Mayer E, Khoo V, 2017, Painful testicular metastasis from prostate adenocarcinoma, BMJ Case Reports, Vol: 2017
© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. A 60-year-old man presented with unilateral testicular pain and urinary frequency. His presenting prostate-specific antigen (PSA) was 100 ng/mL, and a biopsy revealed Gleason 4+4 prostate adenocarcinoma. The significance of his initial PSA was somewhat complicated by possible prostatitis and early initiation of bicalutamide. PSA rose on two occasions prior to radiotherapy but coincided with a flare of testicular pain on one of these. Whole-body staging diffusion-weighted MRI scan was negative. He was treated with 3 years of androgen deprivation therapy (ADT) and radical radiotherapy. PSA fell to undetectable levels on ADT. Twelve months following completion of ADT, PSA rose to 3.6 ng/mL. No disease recurrence was noted on restaging MRI pelvis. The patient was well, except for persistent testicular symptoms, which failed to resolve following multiple antibiotics. Testicular tumour markers were negative. Ultrasound findings were consistent with chronic epididymitis. A right orchidectomy was performed for symptomatic relief, confirming metastatic prostate adenocarcinoma.
Neves AL, Roy R, Wadge H, et al., 2017, A framework for evaluating the economic impact of EHR-based interventions
Omar I, Dilley J, Pucher P, et al., 2017, THE ROBOTIX SIMULATOR: FACE AND CONTENT VALIDATION USING THE FUNDAMENTALS OF ROBOTIC SURGERY(FRS)CURRICULUM, Annual Meeting of the American-Urological-Association (AUA), Publisher: ELSEVIER SCIENCE INC, Pages: E700-E701, ISSN: 0022-5347
Poovendran D, Wadge H, Roy R, et al., 2017, A qualitative evaluation of the CIE Programme implementation in North West London
Vuik SI, Fontana G, Mayer E, et al., 2017, Do hospitalisations for ambulatory care sensitive conditions reflect low access to primary care? An observational cohort study of primary care usage prior to hospitalisation., BMJ Open, Vol: 7
OBJECTIVES: To explore whether hospitalisations for ambulatory care sensitive conditions (ACSCs) are associated with low access to primary care. DESIGN: Observational cohort study over 2008 to 2012 using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases. SETTING: English primary and secondary care. PARTICIPANTS: A random sample of 300 000 patients. MAIN OUTCOME MEASURES: Emergency hospitalisation for an ACSC. RESULTS: Over the long term, patients with ACSC hospitalisations had on average 2.33 (2.17 to 2.49) more general practice contacts per 6 months than patients with similar conditions who did not require hospitalisation. When accounting for the number of diagnosed ACSCs, age, gender and GP practice through a nested case-control method, the difference was smaller (0.64 contacts), but still significant (p<0.001).In the short-term analysis, measured over the 6 months prior to hospitalisation, patients used more GP services than on average over the 5 years. Cases had significantly (p<0.001) more primary care contacts in the 6 months before ACSC hospitalisations (7.12, 95% CI 6.95 to 7.30) than their controls during the same 6 months (5.57, 95% CI 5.43 to 5.72). The use of GP services increased closer to the time of hospitalisation, with a peak of 1.79 (1.74 to 1.83) contacts in the last 30 days before hospitalisation. CONCLUSIONS: This study found no evidence to support the hypothesis that low access to primary care is the main driver of ACSC hospitalisations. Other causes should also be explored to understand how to use ACSC admission rates as quality metrics, and to develop the appropriate interventions.
Camara M, Mayer E, Darzi A, et al., 2016, Soft tissue deformation for surgical simulation: a position-based dynamics approach, INTERNATIONAL JOURNAL OF COMPUTER ASSISTED RADIOLOGY AND SURGERY, Vol: 11, Pages: 919-928, ISSN: 1861-6410
Flott K, Callahan R, Darzi A, et al., 2016, A Patient-Centered Framework for Evaluating Digital Maturity of Health Services: A Systematic Review, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 18, Pages: 153-162, ISSN: 1438-8871
Flott K, Callahan R, Darzi A, et al., 2016, A Patient-Centered Framework for Evaluating Digital Maturity of Health Services: A Systematic Review, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 18, ISSN: 1438-8871
Flott K, Darzi A, Mayer E, 2016, EVALUATION FRAMEWORK FOR PATIENT SAFETY INCIDENT REPORTING SYSTEMS, INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, Vol: 28, Pages: 8-9, ISSN: 1353-4505
Hughes-Hallett A, Browne D, Mensah E, et al., 2016, Assessing the impact of mass media public health campaigns. Be Clear on Cancer 'blood in pee': a case in point, BJU INTERNATIONAL, Vol: 117, Pages: 570-575, ISSN: 1464-4096
Hughes-Hallett A, Pratt P, Mayer E, et al., 2016, Using preoperative imaging for intraoperative guidance: a case of mistaken identity, INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Vol: 12, Pages: 262-267, ISSN: 1478-5951
Mason SE, Scott AJ, Mayer E, et al., 2016, Patient-related risk factors for urinary retention following ambulatory general surgery: a systematic review and meta-analysis, AMERICAN JOURNAL OF SURGERY, Vol: 211, Pages: 1126-1134, ISSN: 0002-9610
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