Publications
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Chauhan H, Ashrafian H, Takats Z, et al., 2024, ASO Author Reflections: The Impact of DCIS on Positive Margin Rates., Ann Surg Oncol
Chauhan H, Jiwa N, Nagarajan VR, et al., 2024, Clinicopathological Predictors of Positive Resection Margins in Breast-Conserving Surgery., Ann Surg Oncol
BACKGROUND: Ductal carcinoma in situ (DCIS) is associated with risk of positive resection margins following breast-conserving surgery (BCS) and subsequent reoperation. Prior reports grossly underestimate the risk of margin positivity with IBC containing a DCIS component (IBC + DCIS) due to patient-level rather than margin-level analysis. OBJECTIVE: The aim of this study was to delineate the relative risk of IBC + DCIS compared with pure IBC (without a DCIS component) on margin positivity through detailed margin-level interrogation. METHODS: A single institution, retrospective, observational cohort study was conducted in which pathology databases were evaluated to identify patients who underwent BCS over 5 years (2014-2019). Margin-level interrogation included granular detail into the extent, pathological subtype and grade of disease at each resection margin. Predictors of a positive margin were computed using multivariate regression analysis. RESULTS: Clinicopathological details were examined from 5454 margins from 909 women. The relative risk of a positive margin with IBC + DCIS versus pure IBC was 8.76 (95% confidence interval [CI] 6.64-11.56) applying UK Association of Breast Surgery guidelines, and 8.44 (95% CI 6.57-10.84) applying the Society of Surgical Oncology/American Society for Radiation Oncology guidelines. Independent predictors of margin positivity included younger patient age (0.033, 95% CI 0.006-0.060), lower specimen weight (0.045, 95% CI 0.020-0.069), multifocality (0.256, 95% CI 0.137-0.376), lymphovascular invasion (0.138, 95% CI 0.068-0.208) and comedonecrosis (0.113, 95% CI 0.040-0.185). CONCLUSIONS: Compared with pure IBC, the relative risk of a positive margin with IBC + DCIS is approximately ninefold, significantly higher than prior estimates. This margin-level methodology is believed to represent the impact of DCIS more accurately on margin positivity in IBC.
Lidströmer N, Davids J, ElSharkawy M, et al., 2024, Systematic review and meta-analysis for a Global Patient co-Owned Cloud (GPOC)., Nat Commun, Vol: 15
Cloud-based personal health records increase globally. The GPOC series introduces the concept of a Global Patient co-Owned Cloud (GPOC) of personal health records. Here, we present the GPOC series' Prospective Register of Systematic Reviews (PROSPERO) registered and Preferred Reporting Items Systematic and Meta-Analyses (PRISMA)-guided systematic review and meta-analysis. It examines cloud-based personal health records and factors such as data security, efficiency, privacy and cost-based measures. It is a meta-analysis of twelve relevant axes encompassing performance, cryptography and parameters based on efficiency (runtimes, key generation times), security (access policies, encryption, decryption) and cost (gas). This aims to generate a basis for further research, a GPOC sandbox model, and a possible construction of a global platform. This area lacks standard and shows marked heterogeneity. A consensus within this field would be beneficial to the development of a GPOC. A GPOC could spark the development and global dissemination of artificial intelligence in healthcare.
Mitra A, Das B, Sarraf K, et al., 2024, Bone health following paediatric and adolescent bariatric surgery: a systematic review and meta-analysis, EClinicalMedicine, Vol: 69, ISSN: 2589-5370
Background:Childhood obesity is a pressing health crisis of epidemic proportions. Bariatric surgery (BS) is an effective weight loss solution however its role in the paediatric population is contentious owing to the paucity of weight specific and generalised health outcomes. This systematic review and meta-analysis aimed to assess the impact of paediatric BS on bone health.Methods:This prospectively registered systematic review (PROSPERO ID: CRD42023432035) was performed in accordance with PRISMA guidelines. We searched MEDLINE (1946–1928 September 2023), EMBASE (1947–1928 September 2023) via the Ovid platform, and the Cochrane Review Library to identify scientific publications reporting bone outcome measures in patients under the age of 18 years who underwent BS. Meta-analysis was undertaken on post-operative weight and bone parameters in paediatric patients following BS. Outcomes were reported as weighted or standardized mean difference with 95 percent confidence intervals. Subgroup analysis by intervention, quality scoring and risk of bias were assessed.Findings:Twelve studies with 681 patients across 5 countries (mean age 17 ± 0.57 years) were included. The quality of included studies was rated as high and there was substantial between-study heterogeneity for most factors included in the meta-analysis (I2 from 0% to 99.1%). Patients underwent Roux-en-Y gastric bypass (RYGB, n = 216), sleeve gastrectomy (SG, n = 257), gastric band (n = 184) or intragastric balloon placement (n = 24). BS was associated with significant weight reduction, body mass index (BMI) −12.7 kg/m2 (95% CI −14.5 to −10.9, p < 0.001), with RYGB being most effective, BMI −16.58 kg/m2 (95% CI −19.6 to −13.6, p < 0.001). Patients who underwent SG or RYGB had significantly lower lumbar bone mineral density, −0.96 g/cm2 (95% CI −0.1 to −0.03, p < 0.001), Z score, −1.132 (95% CI −1.8 to −0.45, p <
Ashrafian H, 2024, The earliest description of possible viral haemorrhagic fever identified in ancient Greece., J Travel Med, Vol: 31
Sargsyan N, Das B, Robb H, et al., 2024, Outcomes of One-Anastomosis Gastric Bypass Conversion to Roux-en-Y Gastric Bypass for Severe Obesity: A Systematic Review and Meta-analysis., Obes Surg, Vol: 34, Pages: 976-984
One-anastomosis gastric bypass (OAGB) is an effective procedure to treat severe obesity. However, conversion to Roux-en-Y gastric bypass (RYGB) is increasing. We therefore conducted a systematic review to determine the safety and efficacy associated with OAGB-RYGB conversion. A systematic search was conducted by three independent reviewers using Medline, Embase, and the Cochrane library following PRISMA guidelines. Six studies including 134 patients were selected who were undergoing OAGB-RYGB conversion. The most common indications were reflux (47.8%), malnutrition (31.3%), and inadequate weight loss (8.2%). Study outcomes demonstrated 100% resolution of bile reflux. Overall, there was medium-term weight gain of 0.61 BMI. OAGB to RYGB conversion leads to resolution of reflux symptoms. However, it is associated with weight regain, albeit this may be acceptable to patients to treat biliary reflux.
Mitra A, 2024, Bone health following Paediatric and Adolescent Bariatric Surgery: A Systematic Review and Meta- analysis, EClinicalMedicine, ISSN: 2589-5370
Sargsyan N, Chen JY, Aggarwal R, et al., 2024, The effects of bariatric surgery on cardiac function: a systematic review and meta-analysis, International Journal of Obesity, Vol: 48, Pages: 166-176, ISSN: 0307-0565
INTRODUCTION: Obesity is associated with alterations in cardiac structure and haemodynamics leading to cardiovascular mortality and morbidity. Culminating evidence suggests improvement of cardiac structure and function following bariatric surgery. OBJECTIVE: To evaluate the effect of bariatric surgery on cardiac structure and function in patients before and after bariatric surgery. METHODS: Systematic review and meta-analysis of studies reporting pre- and postoperative cardiac structure and function parameters on cardiac imaging in patients undergoing bariatric surgery. RESULTS: Eighty studies of 3332 patients were included. Bariatric surgery is associated with a statistically significant improvement in cardiac geometry and function including a decrease of 12.2% (95% CI 0.096-0.149; p < 0.001) in left ventricular (LV) mass index, an increase of 0.155 (95% CI 0.106-0.205; p < 0.001) in E/A ratio, a decrease of 2.012 mm (95% CI 1.356-2.699; p < 0.001) in left atrial diameter, a decrease of 1.16 mm (95% CI 0.62-1.69; p < 0.001) in LV diastolic dimension, and an increase of 1.636% (95% CI 0.706-2.566; p < 0.001) in LV ejection fraction after surgery. CONCLUSION: Bariatric surgery led to reverse remodelling and improvement in cardiac geometry and function driven by metabolic and haemodynamic factors.
Ravindran S, Matharoo M, Rutter MD, et al., 2024, Patient safety incidents in endoscopy: a human factors analysis of nonprocedural significant harm incidents from the National Reporting and Learning System (NRLS)., Endoscopy, Vol: 56, Pages: 89-99
BACKGROUND: Despite advances in understanding and reducing the risk of endoscopic procedures, there is little consideration of the safety of the wider endoscopy service. Patient safety incidents (PSIs) still occur. We sought to identify nonprocedural PSIs (nPSIs) and their causative factors from a human factors perspective and generate ideas for safety improvement. METHODS: Endoscopy-specific PSI reports were extracted from the National Reporting and Learning System (NRLS). A retrospective, cross-sectional human factors analysis of data was performed. Two independent researchers coded data using a hybrid thematic analysis approach. The Human Factors Analysis and Classification System (HFACS) was used to code contributory factors. Analysis informed creation of driver diagrams and key recommendations for safety improvement in endoscopy. RESULTS: From 2017 to 2019, 1181 endoscopy-specific PSIs of significant harm were reported across England and Wales, with 539 (45.6%) being nPSIs. Five categories accounted for over 80% of all incidents, with "follow-up and surveillance" being the largest (23.4% of all nPSIs). From the free-text incident reports, 487 human factors codes were identified. Decision-based errors were the most common act prior to PSI occurrence. Other frequent preconditions to incidents were focused on environmental factors, particularly overwhelmed resources, patient factors, and ineffective team communication. Lack of staffing, standard operating procedures, effective systems, and clinical pathways were also contributory. Seven key recommendations for improving safety have been made in response to our findings. CONCLUSIONS: This was the first national-level human factors analysis of endoscopy-specific PSIs. This work will inform safety improvement strategies and should empower individual services to review their approach to safety.
van Nijnatten TJA, Payne NR, Hickman SE, et al., 2024, Corrigendum to "Overview of trials on artificial intelligence algorithms in breast cancer screening - A roadmap for international evaluation and implementation" [Eur. J. Radiol. 167 (2023) 111087]., Eur J Radiol, Vol: 170
Qiu CS, Ashrafian H, 2024, Once a doctor, always a doctor., J R Soc Med, Vol: 117, Pages: 42-44
Kovacevic L, Naik R, Lugo-Palacios DG, et al., 2023, The impact of collaborative organisational models and general practice size on patient safety and quality of care in the English National Health Service: A systematic review., Health Policy, Vol: 138
Collaborative primary care has become an increasingly popular strategy to manage existing pressures on general practice. In England, the recent changes taking place in the primary care sector have included the formation of collaborative organisational models and a steady increase in practice size. The aim of this review was to summarise the available evidence on the impact of collaborative models and general practice size on patient safety and quality of care in England. We searched for quantitative and qualitative studies on the topic published between January 2010 and July 2023. The quality of articles was assessed using the Newcastle-Ottawa Scale and the Critical Appraisal Skills Programme checklist. We screened 6533 abstracts, with full-text screening performed on 76 records. A total of 29 articles were included in the review. 19 met the inclusion criteria following full-text screening, with seven identified through reverse citation searching and three through expert consultation. All studies were found to be of moderate or high quality. A predominantly positive impact on service delivery measures and patient-level outcomes was identified. Meanwhile, the evidence on the effect on pay-for-performance outcomes and hospital admissions is mixed, with continuity of care and access identified as a concern. While this review is limited to evidence from England, the findings provide insights for all health systems undergoing a transition towards collaborative primary care.
Fadel MG, Fehervari M, Das B, et al., 2023, Vagal nerve therapy in the management of obesity: a systematic review and metaanalysis, European Surgical Research, Vol: 64, Pages: 365-375, ISSN: 1421-9921
Introduction: The vagus nerve has an important role in satiety, metabolism, and autonomic control in upper gastrointestinal function. However, the role and effects of vagal nerve therapy on weight loss remain controversial. This systematic review and meta-analysis assessed the effects of vagal nerve therapy on weight loss, body mass index (BMI), and obesity-related conditions. Methods: MEDLINE, EMBASE, and CINAHL databases were searched for studies up to April 2022 that reported on percentage excess weight loss (%EWL) or BMI at 12 months or remission of obesity-related conditions following vagal nerve therapy from January 2000 to April 2022. Weighted mean difference (WMD) was calculated, meta-analysis was performed using random-effects models, and between-study heterogeneity was assessed. Results: Fifteen studies, of which nine were randomised controlled trials, of 1,447 patients were included. Vagal nerve therapy led to some improvement in %EWL (WMD 17.19%; 95% confidence interval [CI]: 10.94–23.44; p < 0.001) and BMI (WMD −2.24 kg/m2; 95% CI: −4.07 to −0.42; p = 0.016). There was a general improvement found in HbA1c following vagal nerve therapy when compared to no treatment given. No major complications were reported. Conclusions: Vagal nerve therapy can safely result in a mild-to-moderate improvement in weight loss. However, further clinical trials are required to confirm these results and investigate the possibility of the long-term benefit of vagal nerve therapy as a dual therapy combined with standard surgical bariatric interventions.
Zhang J, gallifant J, pierce R, et al., 2023, Quantifying digital health inequality across a national healthcare system, BMJ Health & Care Informatics, Vol: 30, ISSN: 2632-1009
Objectives Digital health inequality, observed as differential utilisation of digital tools between population groups, has not previously been quantified in the National Health Service (NHS). Deployment of universal digital health interventions, including a national smartphone app and online primary care services, allows measurement of digital inequality across a nation. We aimed to measure population factors associated with digital utilisation across 6356 primary care providers serving the population of England.Methods We used multivariable regression to test association of population and provider characteristics (including patient demographics, socioeconomic deprivation, disease burden, prescribing burden, geography and healthcare provider resource) with activation of two independent digital services during 2021/2022.Results We find a significant adjusted association between increased population deprivation and reduced digital utilisation across both interventions. Multivariable regression coefficients for most deprived quintiles correspond to 4.27 million patients across England where deprivation is associated with non-activation of the NHS App.Conclusion Results are concerning for technologically driven widening of healthcare inequalities. Targeted incentive to digital is necessary to prevent digital disparity from becoming health outcomes disparity.
Che Bakri NA, Kwasnicki RM, Giannas E, et al., 2023, ASO author reflections: objective outcome measure of upper limb function following axillary lymph node dissection and sentinel lymph node biopsy, Annals of Surgical Oncology, Vol: 30, Pages: 7133-7134, ISSN: 1068-9265
Ashrafian H, 2023, Engineering a social contract: Rawlsian distributive justice through algorithmic game theory and artificial intelligence, AI and Ethics, Vol: 3, Pages: 1447-1454, ISSN: 2730-5953
<jats:title>Abstract</jats:title><jats:p>The potential for artificial intelligence algorithms and game theory concepts to offer prescriptive and decision-making capability for humankind is increasingly recognized. This derives from the increasing availability of granular, multivariable, well-curated data offering analytical insights for necessarily complex human behaviors and activities. Of the multitude of situations that this decision-making aptitude presents, the application to governmental policy offers a commanding case. This would allow decisions to be made for the benefit of societies and citizens based on rigorous objective information devoid of the traditional approach of choosing policies and societal values based on the opinion of a handful of selected representatives who may be exposed to a lack of comprehensive data analysis capacity and subject to personal biases. There would need to be a critical requirement of wider socially responsible data practices here, beyond those of technical considerations and the incorporation of wider societal fairness approaches. Amongst the schools of political thought particularly acquiescent to the application by this approach would be the egalitarian approach of John Rawls. Here an Original Position’s pre-determination tool of Veil of Ignorance and ensuing Difference Principal presents a method of distributive justice that can be clearly mathematically defined in economics theory through Wald’s Maximin principle. This offers an opportunity to apply algorithmic game theory and artificial intelligence computational approaches to implement Rawlsian distributive justice that are presented and discussed. The outputs from the algorithmic acquaintance of Rawlsian egalitarianism with applicable state data, protected with appropriate privacy, security, legal, ethical and social governance could in turn lead to automated direct governmental choices and an objective Social Contract for citizens
Fehervari M, Fadel MG, Alghazawi LOK, et al., 2023, Medium-term weight loss and remission of comorbidities following endoscopic sleeve gastroplasty: a systematic review and meta-analysis., Obesity Surgery, Vol: 33, Pages: 3527-3538, ISSN: 0960-8923
This systematic review and meta-analysis aimed to determine the short- and medium-term weight loss outcomes and comorbidity resolution following endoscopic sleeve gastroplasty. Our search identified 35 relevant studies containing data from 7525 patients. Overall, pooled short-term (12 months) total weight loss (TWL) was 16.2% (95% CI 13.1–19.4%) in 23 studies (n = 5659). Pooled medium-term TWL was 15.4% (95% CI 13.7–17.2%) in 10 studies (n = 4040). Diabetes resolution was 55.4% (95% CI 46–64%), hypertension resolution was 62.8% (95% CI 43–82%), dyslipidaemia resolution was 56.3% (95% CI 49–63%), and obstructive sleep apnoea resolution was 51.7% (95% CI 16.2–87.3%) in four studies (n = 480). This pooled analysis demonstrates that ESG can induce durable weight loss and resolution of obesity-associated comorbidities in patients with moderate obesity.
Zhang J, Morley J, Gallifant J, et al., 2023, Mapping and evaluating whole nation data flows: transparency, privacy, and guiding infrastructural transformation, The Lancet: Digital Health, Vol: 5, Pages: e737-e748, ISSN: 2589-7500
The importance of big health data is recognised worldwide. Most UK National Health Service (NHS) care interactions are recorded in electronic health records, resulting in an unmatched potential for population-level datasets. However, policy reviews have highlighted challenges from a complex data-sharing landscape relating to transparency, privacy, and analysis capabilities. In response, we used public information sources to map all electronic patient data flows across England, from providers to more than 460 subsequent academic, commercial, and public data consumers. Although NHS data support a global research ecosystem, we found that multistage data flow chains limit transparency and risk public trust, most data interactions do not fulfil recommended best practices for safe data access, and existing infrastructure produces aggregation of duplicate data assets, thus limiting diversity of data and added value to end users. We provide recommendations to support data infrastructure transformation and have produced a website (https://DataInsights.uk) to promote transparency and showcase NHS data assets.
van Nijnatten TJA, Payne NR, Hickman SE, et al., 2023, Overview of trials on artificial intelligence algorithms in breast cancer screening - A roadmap for international evaluation and implementation, EUROPEAN JOURNAL OF RADIOLOGY, Vol: 167, ISSN: 0720-048X
Ashrafian H, 2023, Rheumatology hand signs in a Shepherd by Joachim Wtewael (1566-1638), RHEUMATOLOGY INTERNATIONAL, Vol: 43, Pages: 1765-1766, ISSN: 0172-8172
Ashrafian H, 2023, Goiter and thyroid eye sign in the Madonna and Child with Angels by Francesco del Cossa (c. 1430-1477), JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION, Vol: 46, Pages: 1945-1946, ISSN: 0391-4097
Ashrafian H, 2023, Differential diagnosis of the periorbital lump on "Young Woman with Unicorn" (1505-1506) by Raphael (1483-1520), EUROPEAN JOURNAL OF OPHTHALMOLOGY, Vol: 33, Pages: NP144-NP145, ISSN: 1120-6721
Ashrafian H, 2023, The Creation of Adam's Divinity and the School of Athens by Michelangelo and Raphael displaying clinical hand and foot signs to elucidate painting characters, RHEUMATOLOGY INTERNATIONAL, ISSN: 0172-8172
Che Bakri NA, Kwasnicki RMM, Giannas E, et al., 2023, ASO Visual Abstract: The Use of Wearable Activity Monitors to Measure the Upper Limb Physical Activity After Axillary Lymph Node Dissection and Sentinel Lymph Node Biopsy, ANNALS OF SURGICAL ONCOLOGY, ISSN: 1068-9265
Zhang J, Ashrafian H, Delaney B, et al., 2023, Impact of primary to secondary care data sharing on care quality in NHS England hospitals, npj Digital Medicine, Vol: 6, Pages: 1-10, ISSN: 2398-6352
Health information exchange (HIE) is seen as a key component of effective care but remains poorly evidenced at a health system level. In the UK National Health Service (NHS), the ability to share primary care data with secondary care clinicians is a focus of continued digital investment. In this study, we report the evolution of interoperable technology across a period of rapid digital transformation in NHS England from 2015 to 2019, and test association of primary to secondary care data-sharing capabilities with clinical care quality indicators across all acute secondary care providers (n=135 NHS Trusts). In multivariable analyses, data-sharing capabilities are associated with reduction in patients breaching an Accident & Emergency (A&E) 4-hour decision time threshold, and better patient-reported experience of acute hospital care quality. Using synthetic control analyses, we estimate mean 2.271% (STD+/-3.371) absolute reduction in A&E 4-hour decision time breach, 12 months following introduction of data-sharing capabilities. Our findings support current digital transformation programs for developing regional HIE networks but highlight the need to focus on implementation factors in addition to technological procurement.
Li E, Lounsbury O, Clarke J, et al., 2023, Perceptions of chief clinical information officers on the state of electronic health records systems interoperability in NHS England: a qualitative interview study, BMC Medical Informatics and Decision Making, Vol: 23, Pages: 1-15, ISSN: 1472-6947
BackgroundIn the era of electronic health records (EHR), the ability to share clinical data is a key facilitator of healthcare delivery. Since the introduction of EHRs, this aspect has been extensively studied from the perspective of healthcare providers. Less often explored are the day-to-day challenges surrounding the procurement, deployment, maintenance, and use of interoperable EHR systems, from the perspective of healthcare administrators, such as chief clinical information officers (CCIOs).ObjectiveOur study aims to capture the perceptions of CCIOs on the current state of EHR interoperability in the NHS, its impact on patient safety, the perceived facilitators and barriers to improving EHR interoperability, and what the future of EHR development in the NHS may entail.MethodsSemi-structured interviews were conducted between November 2020 – October 2021. Convenience sampling was employed to recruit NHS England CCIOs. Interviews were digitally recorded and transcribed verbatim. A thematic analysis was performed by two independent researchers to identify emerging themes.ResultsFifteen CCIOs participated in the study. Participants reported that limited EHR interoperability contributed to the inability to easily access and transfer data into a unified source, thus resulting in data fragmentation. The resulting lack of clarity on patients' health status negatively impacts patient safety through suboptimal care coordination, duplication of efforts, and more defensive practice. Facilitators to improving interoperability included the recognition of the need by clinicians, patient expectations, and the inherent centralised nature of the NHS. Barriers included systems usability difficulties, and institutional, data management, and financial-related challenges. Looking ahead, participants acknowledged that realising that vision across the NHS would require a renewed focus on mandating data standards, user-centred design, greater patient involvement, and encouraging i
Dattani R, Ul-Haq Z, Shah M, et al., 2023, Association and progression of multi-morbidity with Chronic Kidney Disease stage 3a secondary to Type 2 Diabetes Mellitus, grouped by albuminuria status in the multi-ethnic population of Northwest London: a real-world study, PLoS One, Vol: 18, ISSN: 1932-6203
IntroductionThe prevalence of Diabetic Kidney Disease (DKD) secondary to Type 2 Diabetes Mellitus (T2DM) is rising worldwide. However, real-world data linking glomerular function and albuminuria to the degree of multi-morbidity is lacking. We thus utilised the Discover dataset, to determine this association.MethodPatients with T2DM diagnosed prior to 1st January 2015 with no available biochemical evidence of CKD were included. Patients subsequently diagnosed and coded for CKD3a in 2015, were grouped by the degree of albuminuria. Baseline and 5-year co-morbidity was determined, as were prescribing practices with regards to prognostically beneficial medication.ResultsWe identified 56,261 patients with T2DM, of which 1082 had CKD stage 3a diagnosed in 2015 (224-CKD3aA1,154-CKD3aA2,93-CKD3aA1; 611 patients with CKD3a but no uACR available in 2015 were excluded from follow up). No statistically significant difference was observed in the degree of co-morbidities at baseline. A significant difference in the degree of hypertension, retinopathy, ischaemic heart disease and vascular disease from baseline compared to study end point was observed for all 3 study groups. Comparing co-morbidities developed at study end point, highlighted a statistical difference between CKD3aA1 Vs CKD3aA3 for retinopathy alone and for hypertension and heart failure between CKD3aA2 Vs CKD3aA3. 40.8% of patients with CKD3aA2 or A3 were prescribed Renin Angiotensin Aldosterone inhibitors (RAASi) therapy between June-December 2021. Survival analysis showed 15% of patients with CKD3aA3 developed CKD stage 5 within 5 years of diagnosis.DiscussionCKD3a secondary to DKD is associated with significant multimorbidity at baseline and 5 years post diagnosis, with CKD3aA3 most strongly associated with CKD progression to CKD 5, heart failure, hypertension and retinopathy compared to CKD3aA1 or CKD3aA2 at 5 years post diagnosis. The lack of uACR testing upon diagnosis and poor prescribing of RAASi, in those wit
Che Bakri NA, Kwasnicki R, Giannas E, et al., 2023, The Use of Wearable Activity Monitors to Measure the Upper Limb Physical Activity after Axillary Lymph Node Dissection and Sentinel Lymph Node Biopsy, Annals of Surgical Oncology, ISSN: 1068-9265
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’.
Higginson JA, Breik O, Thompson AH, et al., 2023, Diagnostic accuracy of intraoperative margin assessment techniques in surgery for head and neck squamous cell carcinoma: a meta-analysis, Oral Oncology, Vol: 142, Pages: 1-13, ISSN: 1368-8375
BACKGROUND: Positive margins following head and neck squamous cell carcinoma (HNSCC) surgery lead to significant morbidity and mortality. Existing Intraoperative Margin Assessment (IMA) techniques are not widely used due to limitations in sampling technique, time constraints and resource requirements. We performed a meta-analysis of the diagnostic performance of existing IMA techniques in HNSCC, providing a benchmark against which emerging techniques may be judged. METHODS: The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Studies were included if they reported diagnostic metrics of techniques used during HNSCC surgery, compared with permanent histopathology. Screening, manuscript review and data extraction was performed by multiple independent observers. Pooled sensitivity and specificity were estimated using the bivariate random effects model. RESULTS: From an initial 2344 references, 35 studies were included for meta-analysis. Sensitivity (Sens), specificity (Spec), diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUROC) were calculated for each group (n, Sens, Spec, DOR, AUROC): frozen section = 13, 0.798, 0.991, 309.8, 0.976; tumour-targeted fluorescence (TTF) = 5, 0.957, 0.827, 66.4, 0.944; optical techniques = 10, 0.919, 0.855, 58.9, 0.925; touch imprint cytology = 3, 0.925, 0.988, 51.1, 0.919; topical staining = 4, 0.918, 0.759, 16.4, 0.833. CONCLUSIONS: Frozen section and TTF had the best diagnostic performance. Frozen section is limited by sampling error. TTF shows promise but involves administration of a systemic agent. Neither is currently in widespread clinical use. Emerging techniques must demonstrate competitive diagnostic accuracy whilst allowing rapid, reliable, cost-effective results.
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