Publications
239 results found
Altuncu MT, Sorin E, Symons JD, et al., 2019, Extracting information from free text through unsupervised graph-based clustering: an application to patient incident records
The large volume of text in electronic healthcare records often remainsunderused due to a lack of methodologies to extract interpretable content. Herewe present an unsupervised framework for the analysis of free text thatcombines text-embedding with paragraph vectors and graph-theoretical multiscalecommunity detection. We analyse text from a corpus of patient incident reportsfrom the National Health Service in England to find content-based clusters ofreports in an unsupervised manner and at different levels of resolution. Ourunsupervised method extracts groups with high intrinsic textual consistency andcompares well against categories hand-coded by healthcare personnel. We alsoshow how to use our content-driven clusters to improve the supervisedprediction of the degree of harm of the incident based on the text of thereport. Finally, we discuss future directions to monitor reports over time, andto detect emerging trends outside pre-existing categories.
Neves AL, Poovendran D, Freise L, et al., 2019, Secondary Use of Electronic Health Records to Improve Quality and Safety of Care: Healthcare Professionals' Knowledge and Concerns, Journal of Medical Internet Research, ISSN: 1438-8871
Dilley J, Camara M, Omar I, et al., 2019, Evaluating the impact of image guidance in the surgical setting: A systematic review, Surgical Endoscopy, Vol: 33, Pages: 2785-2793, ISSN: 0930-2794
BACKGROUND: Image guidance has been clinically available for over a period of 20 years. Although research increasingly has a translational emphasis, overall the clinical uptake of image guidance systems in surgery remains low. The objective of this review was to establish the metrics used to report on the impact of surgical image guidance systems used in a clinical setting. METHODS: A systematic review of the literature was carried out on all relevant publications between January 2000 and April 2016. Ovid MEDLINE and Embase databases were searched using a title strategy. Reported outcome metrics were grouped into clinically relevant domains and subsequent sub-categories for analysis. RESULTS: In total, 232 publications were eligible for inclusion. Analysis showed that clinical outcomes and system interaction were consistently reported. However, metrics focusing on surgeon, patient and economic impact were reported less often. No increase in the quality of reporting was observed during the study time period, associated with study design, or when the clinical setting involved a surgical specialty that had been using image guidance for longer. CONCLUSIONS: Publications reporting on the clinical use of image guidance systems are evaluating traditional surgical outcomes and neglecting important human and economic factors, which are pertinent to the uptake, diffusion and sustainability of image-guided surgery. A framework is proposed to assist researchers in providing comprehensive evaluation metrics, which should also be considered in the design phase. Use of these would help demonstrate the impact in the clinical setting leading to increased clinical integration of image guidance systems.
Brunckhorst O, Ong QJ, Elson D, et al., 2019, Novel real-time optical imaging modalities for the detection of neoplastic lesions in urology: a systematic review, Surgical Endoscopy, Vol: 33, Pages: 1349-1367, ISSN: 0930-2794
Background Current optical diagnostic techniques for malignancies are limited in their diagnostic accuracy and lack theability to further characterise disease, leading to the rapidly increasing development of novel imaging methods within urology. This systematic review critically appraises the literature for novel imagining modalities, in the detection and staging ofurological cancer and assesses their effectiveness via their utility and accuracy.Methods A systematic literature search utilising MEDLINE, EMBASE and Cochrane Library Database was conducted from1970 to September 2018 by two independent reviewers. Studies were included if they assessed real-time imaging modalities not already approved in guidelines, in vivo and in humans. Outcome measures included diagnostic accuracy and utilityparameters, including feasibility and cost.Results Of 5475 articles identified from screening, a final 46 were included. Imaging modalities for bladder cancer includedoptical coherence tomography (OCT), confocal laser endomicroscopy, autofluorescence and spectroscopic techniques. OCTwas the most widely investigated, with 12 studies demonstrating improvements in overall diagnostic accuracy (sensitivity74.5–100% and specificity 60–98.5%). Upper urinary tract malignancy diagnosis was assessed using photodynamic diagnosis(PDD), narrow band imaging, optical coherence tomography and confocal laser endomicroscopy. Only PDD demonstratedconsistent improvements in overall diagnostic accuracy in five trials (sensitivity 94–96% and specificity 96.6–100%). Limitedevidence for optical coherence tomography in percutaneous renal biopsy was identified, with anecdotal evidence for anymodality in penile cancer.Conclusions Evidence supporting the efficacy for identified novel imaging modalities remains limited at present. However,OCT for bladder cancer and PDD in upper tract malignancy demonstrate the best potential for improvement in overall diagnostic accuracy. OCT may addit
Camara M, Dawda S, Mayer E, et al., 2019, Subject-specific modelling of pneumoperitoneum: model implementation, validation and human feasibility assessment, International Journal of Computer Assisted Radiology and Surgery, Vol: 14, Pages: 841-850, ISSN: 1861-6429
PURPOSE: The aim of this study is to propose a model that simulates patient-specific anatomical changes resulting from pneumoperitoneum, using preoperative data as input. The framework can assist the surgeon through a real-time visualisation and interaction with the model. Such could further facilitate surgical planning preoperatively, by defining a surgical strategy, and intraoperatively to estimate port positions. METHODS: The biomechanical model that simulates pneumoperitoneum was implemented within the GPU-accelerated NVIDIA FleX position-based dynamics framework. Datasets of multiple porcine subjects before and after abdominal insufflation were used to generate, calibrate and validate the model. The feasibility of modelling pneumoperitoneum in human subjects was assessed by comparing distances between specific landmarks from a patient abdominal wall, to the same landmark measurements on the simulated model. RESULTS: The calibration of simulation parameters resulted in a successful estimation of an optimal set parameters. A correspondence between the simulation pressure parameter and the experimental insufflation pressure was determined. The simulation of pneumoperitoneum in a porcine subject resulted in a mean Hausdorff distance error of 5-6 mm. Feasibility of modelling pneumoperitoneum in humans was successfully demonstrated. CONCLUSION: Simulation of pneumoperitoneum provides an accurate subject-specific 3D model of the inflated abdomen, which is a more realistic representation of the intraoperative scenario when compared to preoperative imaging alone. The simulation results in a stable and interactive framework that performs in real time, and supports patient-specific data, which can assist in surgical planning.
Neves AL, Poovendran D, Freise L, et al., 2019, Health care professionals’ perspectives on the secondary use of health records to improve quality and safety of care in England: qualitative study, Publisher: JMIR Preprints
Background:Health care professionals (HCPs) are often patients’ first point of contact in what concerns the communication of the purposes, benefits, and risks of sharing electronic health records (EHRs) for nondirect care purposes. Their engagement is fundamental to ensure patients’ buy-in and a successful implementation of health care data sharing schemes. However, their views on this subject are seldom evaluated.Objective:This study aimed to explore HCPs’ perspectives on the secondary uses of health care data in England. Specifically, we aimed to assess their knowledge on its purposes and the main concerns about data sharing processes.Methods:A total of 30 interviews were conducted between March 27, 2017, and April 7, 2017, using a Web-based interview platform and following a topic guide with open-ended questions. The participants represented a variety of geographic locations across England (London, West Midlands, East of England, North East England, and Yorkshire and the Humber), covering both primary and secondary care services. The transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using the framework analysis method to identify emerging themes.Results:HCPs were knowledgeable about the possible secondary uses of data and highlighted its importance for patient profiling and tailored care, research, quality assurance, public health, and service delivery planning purposes. Main concerns toward data sharing included data accuracy, patients’ willingness to share their records, challenges on obtaining free and informed consent, data security, lack of adequacy or understanding of current policies, and potential patient exposure and exploitation.Conclusions:These results suggest a high level of HCPs’ understanding about the purposes of data sharing for secondary purposes; however, some concerns still remain. A better understanding of HCPs’ knowledge and concerns could inform national communicati
Smalley K, Aufegger L, Flott K, et al., 2019, Which behaviour change techniques are most effective in improving healthcare utilisation in COPD self-management programmes? A protocol for a systematic review, BMJ Open Respiratory Research, Vol: 6, ISSN: 2052-4439
IntroductionSelf-management interventions are often presented as a way to improve the quality of care for patients with chronic illness. However self-management is quite broadly-defined and it remains unclear which types of interventions are most successful. This review will use the Theoretical Domains Framework (TDF) as a lens through which to categorise self-management interventions regarding which programmes are most likely to be effective, and under which circumstances. The aim of this study is to (1) describe the types of self-management programmes that have been developed in chronic obstructive pulmonary disease (COPD); and identify the common elements between these to better classify the self-management. (2) Evaluate the effect that self-management programmes have on COPD patients’ healthcare behaviour, by classifying those programmes by the behaviour change techniques used. Methods and analysisA systematic search of the literature will be performed in MEDLINE, EMBASE, HMIC, and PsycINFO. This review will be limited to randomised controlled trials (RCTs) and quasi-experimental studies. The review will follow PRISMA-P guidelines, and will provide a PRISMA checklist and flowchart. Risk of bias in individual studies will be assessed using the Cochrane Risk of Bias criteria, and the quality of included studies will be evaluated using the GRADE criteria, and will be reported in a Summary of Findings table.The primary analysis will be a catalogue of the interventions based on the components of the TDF that were utilised in the intervention. A matrix comparing included behaviour change techniques to improvements in utilisation will summarise the primary outcomes. Ethics and dissemination Not applicable, as this is a secondary review of the literature.Registration detailsPROSPERO: CRD42018104753
Bashir U, Tree A, Mayer E, et al., 2019, Impact of Ga-68-PSMA PET/CT on management in prostate cancer patients with very early biochemical recurrence after radical prostatectomy, European Journal of Nuclear Medicine and Molecular Imaging, Vol: 46, Pages: 901-907, ISSN: 1619-7070
Purpose: With the availability of ultra-sensitive PSA assays, early biochemical relapse (eBCR) of prostate cancer is increasingly being detected at values much lower than the conventional threshold of 0.2 ng/ml. Accurate localisation of disease in this setting may allow treatment modification and improved outcomes, especially in patients with pelvis-confined or extra-pelvic oligometastasis (defined as up to three pelvic nodal or distant sites). We aimed to measure the detection rate of [68]Ga-PSMA-HBNED-CC (PSMA)-PET/CT and its influence on patient management in eBCR of prostate cancer following radical prostatectomy (RP). Methods: We retrospectively identified 28 patients who underwent PSMA-PET/CT for post-RP eBCR (PSA < 0.5 ng/ml) at our tertiary care cancer centre. Two nuclear medicine physicians independently recorded the sites of PSMA-PET/CT positivity. Multidisciplinary meeting records were accessed to determine changes in management decisions following PSMA-PET/CT scans. Results: The mean age of patients was 65.6 years (range: 50–76.2 years); median PSA was 0.22 ng/ml (interquartile range: 0.15 ng/ml to 0.34 ng/ml). Thirteen patients (46.4%) had received radiotherapy in the past. PSMA-PET/CT was positive in 17 patients (60.7%). Only one patient had polymetastasis (> 3 sites); the remainder either had prostatectomy bed recurrence (n = 2), pelvic oligometastasis (n = 10), or extra-pelvic oligometastasis (n = 4). PSMA-PET/CT resulted in management change in 12 patients (42.8%), involving stereotactic body radiotherapy (n = 6), salvage radiotherapy (n = 4), and systemic treatment (n = 2). Conclusions: Our findings show that PSMA-PET/CT has a high detection rate in the eBCR setting following RP, with a large proportion of patients found to have fewer than three lesions. PSMA-PET/CT may be of value in patients with early PSA failure, and impact on the choice of potentially curative salvage treatments.
Pearce A, Reid A, Huddart R, et al., 2019, Comparison of post chemotherapy retroperitoneal lymph node dissection (PC-RPLND) outcomes from a single high volume UK centre with national registry outcomes, Annual Scientific Meeting of the Urological-Society-of-Australia-and-New-Zealand, Publisher: WILEY, Pages: 79-79, ISSN: 1464-4096
Pearce A, Whibley J, Walker S, et al., 2019, IDENTIFYING FACTORS WHICH PROLONG LENGTH OF STAY FOLLOWING OPEN RETROPERITONEAL LYMPH NODE DISSECTION, 114th Annual Meeting of the American-Urological-Association (AUA), Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E1071-E1072, ISSN: 0022-5347
Brunckhorst O, Ong QJ, Elson D, et al., 2019, ASYSTEMATIC REVIEW OF NOVEL REAL-TIMEOPTICAL IMAGING MODALITIES FOR UROLOGICAL NEOPLASMS, 114th Annual Meeting of the American-Urological-Association (AUA), Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E287-E287, ISSN: 0022-5347
Camara M, Mayer E, Darzi A, et al., 2019, Intraoperative ultrasound for improved 3D tumour reconstruction in robot-assisted surgery: An evaluation of feedback modalities, International Journal of Medical Robotics and Computer Assisted Surgery, Vol: 15, Pages: 1-9, ISSN: 1478-5951
BACKGROUND: Intraoperative ultrasound scanning induces deformation on the tissue in the absence of a feedback modality, which results in a 3D tumour reconstruction that is not directly representative of real anatomy. METHODS: A biomechanical model with different feedback modalities (haptic, visual, or auditory) was implemented in a simulation environment. A user study with 20 clinicians was performed to assess which modality resulted in the 3D tumour volume reconstruction that most resembled the reference configuration from the respective computed tomography (CT) scans. RESULTS: Integrating a feedback modality significantly improved the scanning performance across all participants and data sets. The optimal feedback modality to adopt varied depending on the evaluation. Nonetheless, using guidance with feedback is always preferred compared with none. CONCLUSIONS: The results demonstrated the urgency to integrate a feedback modality framework into clinical practice, to ensure an improved scanning performance. Furthermore, this framework enabled an evaluation that cannot be performed in vivo.
Huddart RA, Reid AH, Mayer E, et al., 2019, Clinical outcomes of minimally invasive retroperitoneal lymph node dissection and single dose carboplatin for clinical stage Ila seminoma., ASCO-SITC Clinical Immuno-Oncology Symposium, Publisher: AMER SOC CLINICAL ONCOLOGY, ISSN: 0732-183X
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Huddart RA, Mayer E, Jay A, et al., 2019, The features and management of late relapse of non-seminomatous germ cell tumors: The Royal Marsden Experience., ASCO-SITC Clinical Immuno-Oncology Symposium, Publisher: AMER SOC CLINICAL ONCOLOGY, ISSN: 0732-183X
Dilley J, Hughes-Hallett A, Pratt P, et al., 2019, Perfect registration leads to imperfect performance: a randomised trial of multimodal intraoperative image guidance, Annals of Surgery, Vol: 269, Pages: 236-242, ISSN: 0003-4932
Objective – To compare surgical safety and efficiency of two 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 randomisation to one of three study arms: AR, IG or NG. Each performed three 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’s 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 AR group. Compared to 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 to 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.
Altuncu MT, Mayer E, Yaliraki SN, et al., 2019, From free text to clusters of content in health records: An unsupervised graph partitioning approach, Applied Network Science, Vol: 4, ISSN: 2364-8228
Electronic Healthcare records contain large volumes of unstructured data in different forms. Free text constitutes a large portion of such data, yet this source of richly detailed information often remains under-used in practice because of a lack of suitable methodologies to extract interpretable contentin a timely manner. Here we apply network-theoretical tools to the analysis of free text in Hospital Patient Incident reports in the English National Health Service, to find clusters of reports in an unsupervised manner and at different levels of resolution based directly on the free text descriptions contained within them. To do so, we combine recently developed deep neural network text-embedding methodologies based on paragraph vectors with multi-scale Markov Stability community detection applied to a similarity graph of documents obtained from sparsified text vector similarities. We showcase the approach with the analysis of incident reports submitted in Imperial College Healthcare NHS Trust, London. The multiscale community structure reveals levels of meaning with different resolution in the topics of the dataset, as shown by relevant descriptive terms extracted from thegroups of records, as well as by comparing a posteriori against hand-coded categories assigned by healthcare personnel. Our content communities exhibit good correspondence with well-defined hand-coded categories, yet our results also provide further medical detail in certain areas as well asrevealing complementary descriptors of incidents beyond the external classification. We also discuss how the method can be used to monitor reports over time and across different healthcare providers, and to detect emerging trends that fall outside of pre-existing categories.
Khanbhai MHF, Flott KM, Darzi A, et al., 2019, Evaluating digital maturity and patient acceptability of real-time patient experience feedback systems: a systematic review, Journal of Medical Internet Research, Vol: 21, ISSN: 1438-8871
Background:One of the essential elements of a strategic approach to improving patients’ experience is to measure and report on patients’ experiences in real time. Real-time feedback (RTF) is increasingly being collected using digital technology; however, there are several factors that may influence the success of the digital system.Objective:The aim of this review was to evaluate the digital maturity and patient acceptability of real-time patient experience feedback systems.Methods:We systematically searched the following databases to identify papers that used digital systems to collect RTF: The Cochrane Library, Global Health, Health Management Information Consortium, Medical Literature Analysis and Retrieval System Online, EMBASE, PsycINFO, Web of Science, and CINAHL. In addition, Google Scholar and gray literature were utilized. Studies were assessed on their digital maturity using a Digital Maturity Framework on the basis of the following 4 domains: capacity/resource, usage, interoperability, and impact. A total score of 4 indicated the highest level of digital maturity.Results:RTF was collected primarily using touchscreens, tablets, and Web-based platforms. Implementation of digital systems showed acceptable response rates and generally positive views from patients and staff. Patient demographics according to RTF responses varied. An overrepresentation existed in females with a white predominance and in patients aged ≥65 years. Of 13 eligible studies, none had digital systems that were deemed to be of the highest level of maturity. Three studies received a score of 3, 2, and 1, respectively. Four studies scored 0 points. While 7 studies demonstrated capacity/resource, 8 demonstrated impact. None of the studies demonstrated interoperability in their digital systems.Conclusions:Patients and staff alike are willing to engage in RTF delivered using digital technology, thereby disrupting previous paper-based feedback. However, a lack of emphasis on di
Brunckhorst O, Ong, Qi Jia, et al., 2019, Novel Modalities for Real-Time Optical Imaging in Urological Neoplasms: A Systematic Review, 34th Annual European Association of Urology Congress
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 Journal of Surgery, Vol: 42, Pages: 3874-3879, ISSN: 1432-2323
AimsPost-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.MethodsOver 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.ResultsA 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.ConclusionsPatients aged at least 56 years and/or requiring glycopyrrolate—often administered during laparoscopic procedures—are at increased risk of POUR following ambulatory general surgery.
Flott K, Nelson D, Moorcroft T, et al., 2018, Enhancing safety culture through improved incident reporting: A case study in translational research, Health Affairs, Vol: 37, Pages: 1797-1804, ISSN: 0278-2715
The Imperial College Healthcare National Health Service Trust, a large health care provider in London, together with an academic research unit, used a learning health systems cycle of interventions. The goals were to improve patient safety incident reporting and learning and shape a more just organizational safety culture. Following a phase of feedback gathering from front-line staff, seven evidence-based interventions were implemented and evaluated from October 2016 to August 2018. Indicators of safety culture, incident reporting rates, and reported rates of harm to patients and "never events" (events that should not happen in medical practice) were continuously monitored. In this article we report on this initiative, including its early results. We observed improvement on some measures of safety culture and incident reporting rates. Staff members' perceptions of six of the seven interventions were positive. The intervention exercise demonstrated the importance of health care policies in supporting local ownership of safety culture and encouraging the application of rigorous research standards.
Dilley J, Pratt P, Kyrgiou M, et al., 2018, Current and future use of radiological images in the management of gynecological malignancies - a survey of practice in the UK, Anticancer Research, Vol: 38, Pages: 5867-5876, ISSN: 0250-7005
Background/Aim: Radiology provides increasingly accurate and complex information. Understanding the clinicians' interpretation of scans could improve surgical planning, decision-making; informed training and development of augmented imaging. This was a survey exploring the interpretation of imaging by clinicians and its use in operative preparation and prediction. Materials and Methods: The survey was open for two-months and circulated online to British Gynaecological Cancer society members. Results: Seventy-three (19%) members completed the survey. Respondents had a confidence level of 51% in their ability to interpret computed tomography (CT) and/or magnetic resonance imaging (MRI) images independently. Preoperative imaging was commonly used to plan operations, predict complications and complete resection. Images were reviewed for primary (96.3%)/interval (92.6%) ovarian debulking, but less so for vulvectomy (45%). Scan (79.6%) and multidisciplinary team meeting (MDT) (66.6%) reports were used more often than scan images (50%) for operative planning. Amount and pattern of disease on scan were the most important factors predicting operating time. Conclusion: Imaging influences the surgeon's planning, however respondents lack confidence. Training of clinicians in radiological interpretation needs to improve. Augmented image interfaces could facilitate this.
Neves AL, Carter AW, Freise L, et al., 2018, Impact of sharing electronic health records with patients on the quality and safety of care: a systematic review and narrative synthesis protocol, BMJ Open, Vol: 8, ISSN: 2044-6055
Introduction: Providing patients with access to electronic health records (EHRs) has emerged as a promising solution to improve quality of care and safety. As the efforts to develop and implement EHR-based data sharing platforms mature and scale up worldwide, there is a need to evaluate the impact of these interventions and to weigh their relative risks and benefits, in order to inform evidence-based health policies. The aim of this work is to systematically characterise and appraise the demonstrated benefits and risks of sharing EHR with patients, by mapping them across the six domains of quality of care of the Institute of Medicine (IOM) analytical framework (ie, patient-centredness, effectiveness, efficiency, timeliness, equity and safety).Methods and analysis: CINAHL, Cochrane, Embase, HMIC, Medline/PubMed and PsycINFO databases will be searched from January 1997 to August 2017. Primary outcomes will include measures related with the six domains of quality of care of the IOM analytical framework. The quality of the studies will be assessed using the Cochrane Risk of Bias Tool, the ROBINS-I Tool and the Drummond’s checklist. A narrative synthesis will be conducted for all included studies. Subgroup analysis will be performed by domain of quality of care domain and by time scale (ie, short-term, medium-term or long-term impact). The body of evidence will be summarised in a Summary of Findings table and its strength assessed according to the GRADE criteria.Ethics and dissemination: This review does not require ethical approval as it will summarise published studies with non-identifiable data. This protocol complies with the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols guidelines. Findings will be disseminated widely through peer-reviewed publication and conference presentations, and patient partners will be included in summarising the research findings into lay summaries and reports.PROSPERO registration number: CRD42017070092.
Lisa F, Neves AL, Flott K, et al., 2018, Patients’ Ability to Review Electronic Health Record Information to Identify Potential Errors: A Pilot Qualitative Study
Background:Evidence suggests that healthcare data sharing may strengthen care coordination, improve quality and safety, and reduce costs. However, in order to achieve efficient, meaningful adoption of healthcare data sharing initiatives, it is necessary to engage all stakeholders, from healthcare professionals to patients. Although previous work has assessed healthcare professionals’ perceptions of data sharing, the general public perspectives and particularly seldom heard groups, have yet to be fully assessed.Objective:This study aims to explore public views, particularly their hopes and concerns, around healthcare data sharing.Methods:An original, immersive public engagement interactive experience was developed - “The Can of Worms” installation - in which participants were prompted to reflect about data sharing through listening to individual stories around healthcare data sharing. A multidisciplinary team with expertise in research, public involvement and human-centered design developed the concept. The installation took place in three separate events, between Nov 2018 and Nov 2019. A combination of convenience and snowballing sampling was used. Participants were asked to fill self-administered feedback cards, and to describe their hopes and fears about the meaningful use of data in healthcare. The transcripts were compiled verbatim and systematically reviewed by four independent reviewers using the thematic analysis method to identify emerging themes.Results:Our approach exemplifies the potential of using interdisciplinary expertise in research, public involvement and human-centered design, to tell stories, collect perspectives, and spark conversation around complex topics in participatory digital medicine. A total of 352 qualitative feedback cards were collected, each reflecting participants’ ‘hopes’ and ‘fears’ for healthcare data sharing. Thematic analyses identified six themes under ‘hopes’: (1) ena
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, ISSN: 2044-6055
Objective: The aim of this study was to identify the care pathway and organisational factors that predict patient experience Design: Statistical analysis of large NHS datasets Setting & participants: England; Acute NHS organisational-level dataPrimary 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. Eleven of these correlated to patient experience in univariate analyses. Multi-collinearity tests resulted in one of the 11 variables holding a correlation to another variable larger than r=0.70. A significant multi-linear regression equation including the final ten variables was found (F(10,108) = 6.214, p < 0.00), with an R^2 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 promotes a more patient-centric interpretation of quality and compels a better use of patient experience feedback to drive im
Altuncu MT, Mayer E, Yaliraki SN, et al., 2018, From Text to Topics in Healthcare Records: An Unsupervised Graph Partitioning Methodology, 2018 KDD Conference Proceedings - MLMH: Machine Learning for Medicine and Healthcare
Electronic Healthcare Records contain large volumes of unstructured data,including extensive free text. Yet this source of detailed information oftenremains under-used because of a lack of methodologies to extract interpretablecontent in a timely manner. Here we apply network-theoretical tools to analysefree text in Hospital Patient Incident reports from the National HealthService, to find clusters of documents with similar content in an unsupervisedmanner at different levels of resolution. We combine deep neural networkparagraph vector text-embedding with multiscale Markov Stability communitydetection applied to a sparsified similarity graph of document vectors, andshowcase the approach on incident reports from Imperial College Healthcare NHSTrust, London. The multiscale community structure reveals different levels ofmeaning in the topics of the dataset, as shown by descriptive terms extractedfrom the clusters of records. We also compare a posteriori against hand-codedcategories assigned by healthcare personnel, and show that our approachoutperforms LDA-based models. Our content clusters exhibit good correspondencewith two levels of hand-coded categories, yet they also provide further medicaldetail in certain areas and reveal complementary descriptors of incidentsbeyond the external classification taxonomy.
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, Vol: 32, Pages: 3055-3063, ISSN: 0930-2794
BACKGROUND: Evidence supports early laparoscopic cholecystectomy for acute cholecystitis. Differences in treatment patterns between the USA and UK, associated outcomes and resource utilization are not well understood. METHODS: In this retrospective, observational study using national administrative data, emergency patients admitted with acute cholecystitis were identified in England (Hospital Episode Statistics 1998-2012) and USA (National Inpatient Sample 1998-2011). Proportions of patients who underwent emergency cholecystectomy, utilization of laparoscopy and associated outcomes including length of stay (LOS) and complications were compared. The effect of delayed treatment on subsequent readmissions was evaluated for England. RESULTS: Patients with a diagnosis of acute cholecystitis totaled 1,191,331 in the USA vs. 288 907 in England. Emergency cholecystectomy was performed in 628,395 (52.7% USA) and 45,299 (15.7% England) over the time period. Laparoscopy was more common in the USA (82.8 vs. 37.9%; p < 0.001). Pre-treatment (1 vs. 2 days; p < 0.001) and total ( 4 vs. 7 days; p < 0.001) LOS was lower in the USA. Overall incidence of bile duct injury was higher in England than the USA (0.83 vs. 0.43%; p < 0.001), but was no different following laparoscopic surgery (0.1%). In England, 40.5% of patients without an immediate cholecystectomy were subsequently readmitted with cholecystitis. An additional 14.5% were admitted for other biliary complications, amounting to 2.7 readmissions per patient in the year following primary admission. CONCLUSION: This study highlights management practices for acute cholecystitis in the USA and England. Despite best evidence, index admission laparoscopic cholecystectomy is performed less in England, which significantly impacts subsequent healthcare utilization.
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-+, ISSN: 1061-4036
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- Citations: 140
Flott K, Darzi A, Gancarczyk S, et al., 2018, Improving the usefulness and use of patient survey programmes: Views from the frontline, Journal of Medical Internet Research, Vol: 20, Pages: e141-e141, ISSN: 1438-8871
Background: A growing body of evidence suggests a concerning lag between collection of patient experience data and its application in service improvement. This study aims to identify what health care staff perceive to be the barriers and facilitators to using patient-reported feedback and showcase successful examples of doing so.Objective: This study aimed to apply a systems perspective to suggest policy improvements that could support efforts to use data on the frontlines.Methods: Qualitative interviews were conducted in eight National Health Service provider locations in the United Kingdom, which were selected based on National Inpatient Survey scores. Eighteen patient-experience leads were interviewed about using patient-reported feedback with relevant staff. Interviews were transcribed and underwent thematic analysis. Staff-identified barriers and facilitators to using patient experience feedback were obtained.Results: The most frequently cited barriers to using patient reported feedback pertained to interpreting results, understanding survey methodology, presentation of data in both national Care Quality Commission and contractor reports, inability to link data to other sources, and organizational structure. In terms of a wish list for improved practice, staff desired more intuitive survey methodologies, the ability to link patient experience data to other sources, and more examples of best practice in patient experience improvement. Three organizations also provided examples of how they successfully used feedback to improve care.Conclusions: Staff feedback provides a roadmap for policy makers to reconsider how data is collected and whether or not the national regulations on surveys and patient experience data are meeting the quality improvement needs of local organizations.
Lee KA, Mayer E, Khoo V, 2017, Painful testicular metastasis from prostate adenocarcinoma, BMJ Case Reports, Vol: 2017, ISSN: 1757-790X
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.
Archer SA, 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
Objectives The development and implementation of incident reporting systems within healthcare continues to be a fundamental strategy to reduce preventable patient harm and improve the quality and safety of healthcare. We sought to identify factors contributing to patient safety incident reporting.Design To facilitate improvements in incident reporting, a theoretical framework, encompassing factors that act as barriers and enablers ofreporting, was developed. Embase, Ovid MEDLINE(R) and PsycINFO were searched to identify relevant articles published between January 1980 and May 2014. A comprehensive search strategy including MeSH terms and keywords was developed to identify relevant articles. Data were extracted by three independent researchers; to ensure the accuracy of data extraction, all studies eligible for inclusion were rescreened by two reviewers.Results The literature search identified 3049 potentially eligible articles; of these, 110 articles, including >29 726 participants, met the inclusion criteria. In total, 748 barriers were identified (frequency count) across the 110 articles. In comparison, 372 facilitators to incident reporting and 118 negative cases were identified. The top two barriers cited were fear of adverse consequences (161, representing 21.52% of barriers) and process and systems of reporting (110, representing 14.71% of barriers). In comparison, the top two facilitators were organisational (97, representing 26.08% of facilitators) and process and systems of reporting (75, representing 20.16% of facilitators).Conclusion A wide range of factors contributing to engagement in incident reporting exist. Efforts that address the current tendency to under-report must consider the full range of factors in order to develop interventions as well as a strategic policy approach for improvement.
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