Imperial College London

Dr James Kinross

Faculty of MedicineDepartment of Surgery & Cancer

Reader in General Surgery
 
 
 
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Contact

 

+44 (0)20 3312 1947j.kinross

 
 
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Location

 

1029Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

272 results found

Yiu A, Lam K, Simister C, Clarke J, Kinross Jet al., 2024, Adoption of routine surgical video recording: a nationwide Freedom of Information act request across England and Wales, EClinicalMedicine, ISSN: 2589-5370

Journal article

Challoner BR, Woolston A, Lau D, Buzzetti M, Fong C, Barber LJ, Anandappa G, Crux R, Assiotis I, Fenwick K, Begum R, Begum D, Lund T, Sivamanoharan N, Sansano HB, Domingo-Arada M, Tran A, Pandha H, Church D, Eccles B, Ellis R, Falk S, Hill M, Krell D, Murugaesu N, Nolan L, Potter V, Saunders M, Shiu K-K, Guettler S, Alexander JL, Lázare-Iglesias H, Kinross J, Murphy J, von Loga K, Cunningham D, Chau I, Starling N, Ruiz-Bañobre J, Dhillon T, Gerlinger Met al., 2024, Genetic and immune landscape evolution in MMR-deficient colorectal cancer., J Pathol, Vol: 262, Pages: 226-239

Mismatch repair-deficient (MMRd) colorectal cancers (CRCs) have high mutation burdens, which make these tumours immunogenic and many respond to immune checkpoint inhibitors. The MMRd hypermutator phenotype may also promote intratumour heterogeneity (ITH) and cancer evolution. We applied multiregion sequencing and CD8 and programmed death ligand 1 (PD-L1) immunostaining to systematically investigate ITH and how genetic and immune landscapes coevolve. All cases had high truncal mutation burdens. Despite pervasive ITH, driver aberrations showed a clear hierarchy. Those in WNT/β-catenin, mitogen-activated protein kinase, and TGF-β receptor family genes were almost always truncal. Immune evasion (IE) drivers, such as inactivation of genes involved in antigen presentation or IFN-γ signalling, were predominantly subclonal and showed parallel evolution. These IE drivers have been implicated in immune checkpoint inhibitor resistance or sensitivity. Clonality assessments are therefore important for the development of predictive immunotherapy biomarkers in MMRd CRCs. Phylogenetic analysis identified three distinct patterns of IE driver evolution: pan-tumour evolution, subclonal evolution, and evolutionary stasis. These, but neither mutation burdens nor heterogeneity metrics, significantly correlated with T-cell densities, which were used as a surrogate marker of tumour immunogenicity. Furthermore, this revealed that genetic and T-cell infiltrates coevolve in MMRd CRCs. Low T-cell densities in the subgroup without any known IE drivers may indicate an, as yet unknown, IE mechanism. PD-L1 was expressed in the tumour microenvironment in most samples and correlated with T-cell densities. However, PD-L1 expression in cancer cells was independent of T-cell densities but strongly associated with loss of the intestinal homeobox transcription factor CDX2. This explains infrequent PD-L1 expression by cancer cells and may contribute to a higher recurrence risk of MMRd CRCs

Journal article

Abdelaziz MEMK, Zhao J, Gil Rosa B, Lee H-T, Simon D, Vyas K, Li B, Koguna H, Li Y, Demircali AA, Uvet H, Gencoglan G, Akcay A, Elriedy M, Kinross J, Dasgupta R, Takats Z, Yeatman E, Yang G-Z, Temelkuran Bet al., 2024, Fiberbots: Robotic fibers for high-precision minimally invasive surgery, Science Advances, Vol: 10, ISSN: 2375-2548

Precise manipulation of flexible surgical tools is crucial in minimally invasive surgical procedures, necessitating a miniature and flexible robotic probe that can precisely direct the surgical instruments. In this work, we developed a polymer-based robotic fiber with a thermal actuation mechanism by local heating along the sides of a single fiber. The fiber robot was fabricated by highly scalable fiber drawing technology using common low-cost materials. This low-profile (below 2 millimeters in diameter) robotic fiber exhibits remarkable motion precision (below 50 micrometers) and repeatability. We developed control algorithms coupling the robot with endoscopic instruments, demonstrating high-resolution in situ molecular and morphological tissue mapping. We assess its practicality and safety during in vivo laparoscopic surgery on a porcine model. High-precision motion of the fiber robot delivered endoscopically facilitates the effective use of cellular-level intraoperative tissue identification and ablation technologies, potentially enabling precise removal of cancer in challenging surgical sites.

Journal article

Manoli E, Higginson J, Tolley N, Darzi A, Kinross J, Temelkuran B, Takats Zet al., 2024, Human robotic surgery with intraoperative tissue identification using rapid evaporation ionisation mass spectrometry, Scientific Reports, Vol: 14, ISSN: 2045-2322

Instantaneous, continuous, and reliable information on the molecular biology of surgical target tissue could significantly contribute to the precision, safety, and speed of the intervention. In this work, we introduced a methodology for chemical tissue identification in robotic surgery using rapid evaporative ionisation mass spectrometry. We developed a surgical aerosol evacuation system that is compatible with a robotic platform enabling consistent intraoperative sample collection and assessed the feasibility of this platform during head and neck surgical cases, using two different surgical energy devices. Our data showed specific, characteristic lipid profiles associated with the tissue type including various ceramides, glycerophospholipids, and glycerolipids, as well as different ion formation mechanisms based on the energy device used. This platform allows continuous and accurate intraoperative mass spectrometry-based identification of ablated/resected tissue and in combination with robotic registration of images, time, and anatomical positions can improve the current robot-assisted surgical platforms and guide surgical strategy.

Journal article

Kinross J, 2024, Microbiome is the key to preventing anastomotic leak in colorectal surgery, Gut, Vol: 73, Pages: 212-214, ISSN: 0017-5749

Journal article

Kanneganti A, Tan BYQ, Nik Ab Rahman NH, Leow AS-T, Denning M, Goh ET, Hao Lim LJ, Sia C-H, Chua YX, Kinross J, Tan M, Tan LF, Wan YM, Sharma A, Danuaji R, Komal Kumar RN, Sheng CK, Kheng CP, Abdul Karim SS, Abdul Ghani MN, Mahmud S, Chan YH, Sharma VK, Sim K, Suat Ooi SBet al., 2023, Safety attitudes, burnout and well-being among healthcare workers during the COVID-19 pandemic: an Indo-Pacific regional cross-sectional study., Singapore Med J, Vol: 64, Pages: 667-676

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact in Asia and has placed significant burden on already stretched healthcare systems. We examined the impact of COVID-19 on the safety attitudes among healthcare workers (HCWs), as well as their associated demographic and occupational factors, and measures of burnout, depression and anxiety. METHODS: A cross-sectional survey study utilising snowball sampling was performed involving doctors, nurses and allied health professions from 23 hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 July 2020. This survey collated demographic data and workplace conditions and included three validated questionnaires: the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory and Hospital Anxiety and Depression Scale. We performed multivariate mixed-model regression to assess independent associations with the SAQ total percentage agree rate (PAR). RESULTS: We obtained 3,163 responses. The SAQ total PARs were found to be 35.7%, 15.0%, 51.0% and 3.3% among the respondents from Singapore, Malaysia, India and Indonesia, respectively. Burnout scores were highest among respondents from Indonesia and lowest among respondents from India (70.9%-85.4% vs. 56.3%-63.6%, respectively). Multivariate analyses revealed that meeting burnout and depression thresholds and shifts lasting ≥12 h were significantly associated with lower SAQ total PAR. CONCLUSION: Addressing the factors contributing to high burnout and depression and placing strict limits on work hours per shift may contribute significantly towards improving safety culture among HCWs and should remain priorities during the pandemic.

Journal article

Lawson J, Martin G, Guha P, Gold M, Nimer A, Syed S, Kinross Jet al., 2023, Effect of mixed reality on delivery of emergency medical care in a simulated environment: a pilot randomized cross-over trial, JAMA Network Open, Vol: 6, Pages: 1-10, ISSN: 2574-3805

Importance Mixed-reality (MR) technology has the potential to enhance care delivery, but there remains a paucity of evidence for its efficacy and feasibility.Objective To assess the efficacy and feasibility of MR technology to enhance emergency care delivery in a simulated environment.Design, Setting, and Participants This pilot randomized crossover trial was conducted from September to November 2021 at a single center in a high-fidelity simulated environment with participants block randomized to standard care (SC) or MR-supported care (MR-SC) groups. Participants were 22 resident-grade physicians working in acute medical and surgical specialties prospectively recruited from a single UK Academic Health Sciences Centre. Data were analyzed from September to December 2022.Intervention Participants resuscitated a simulated patient who was acutely unwell, including undertaking invasive procedures. Participants completed 2 scenarios and were randomly assigned to SC or MR-SC for the first scenario prior to crossover. The HoloLens 2 MR device provided interactive holographic content and bidirectional audiovisual communication with senior physicians in the MR-SC group.Main Outcomes and Measures The primary outcome was error rate assessed via the Imperial College Error Capture (ICECAP) multidimensional error-capture tool. Secondary outcomes included teamwork (Observational Teamwork Assessment for Surgery [OTAS]; range, 0-6 and Teamwork Skills Assessment for Ward Care [T-SAW-C]; range, 1-5), scenario completion, stress and cognitive load (NASA Task Load Index [NASA-TLX; range 0-100]), and MR device user acceptability.Results A total of 22 physicians (15 males [68.2%]; median [range] age, 28 [25-34] years) were recruited. MR technology significantly reduced the mean (SD) number of errors per scenario compared with SC (5.16 [3.34] vs 8.30 [3.09] errors; P = .003), with substantial reductions in procedural (0.79 [0.75] vs 1.52 [1.20] errors; P = 

Journal article

Voorde JV, Steven RT, Najumudeen AK, Ford CA, Dexter A, Gonzalez-Fernandez A, Nikula CJ, Xiang Y, Ford L, Stavrakaki SM, Gilroy K, Zeiger LB, Pennel K, Hatthakarnkul P, Elia EA, Nasif A, Murta T, Manoli E, Mason S, Gillespie M, Lannagan TRM, Vlahov N, Ridgway RA, Nixon C, Raven A, Mills M, Athineos D, Kanellos G, Nourse C, Gay DM, Hughes M, Burton A, Yan B, Sellers K, Wu V, De Ridder K, Shokry E, Uribe AH, Clark W, Clark G, Kirschner K, Thienpont B, Li VSW, Maddocks ODK, Barry ST, Goodwin RJA, Kinross J, Edwards J, Yuneva MO, Sumpton D, Takats Z, Campbell AD, Bunch J, Sansom OJet al., 2023, Metabolic profiling stratifies colorectal cancer and reveals adenosylhomocysteinase as a therapeutic target, NATURE METABOLISM, Vol: 5, Pages: 1303-+

Journal article

Alexander J, Posma J, Scott A, Poynter L, Mason S, Herendi L, Roberts L, McDonald J, Cameron S, Darzi A, Goldin R, Takats Z, Marchesi J, Teare J, Kinross Jet al., 2023, Pathobionts in the tumour microbiota predict survival following resection for colorectal cancer, Microbiome, Vol: 11, Pages: 1-14, ISSN: 2049-2618

Background and aimsThe gut microbiota is implicated in the pathogenesis of colorectal cancer (CRC). We aimed to map the CRC mucosal microbiota and metabolome and define the influence of the tumoral microbiota on oncological outcomes.MethodsA multicentre, prospective observational study was conducted of CRC patients undergoing primary surgical resection in the UK (n = 74) and Czech Republic (n = 61). Analysis was performed using metataxonomics, ultra-performance liquid chromatography-mass spectrometry (UPLC-MS), targeted bacterial qPCR and tumour exome sequencing. Hierarchical clustering accounting for clinical and oncological covariates was performed to identify clusters of bacteria and metabolites linked to CRC. Cox proportional hazards regression was used to ascertain clusters associated with disease-free survival over median follow-up of 50 months.ResultsThirteen mucosal microbiota clusters were identified, of which five were significantly different between tumour and paired normal mucosa. Cluster 7, containing the pathobionts Fusobacterium nucleatum and Granulicatella adiacens, was strongly associated with CRC (PFDR = 0.0002). Additionally, tumoral dominance of cluster 7 independently predicted favourable disease-free survival (adjusted p = 0.031). Cluster 1, containing Faecalibacterium prausnitzii and Ruminococcus gnavus, was negatively associated with cancer (PFDR = 0.0009), and abundance was independently predictive of worse disease-free survival (adjusted p = 0.0009). UPLC-MS analysis revealed two major metabolic (Met) clusters. Met 1, composed of medium chain (MCFA), long-chain (LCFA) and very long-chain (VLCFA) fatty acid species, ceramides and lysophospholipids, was negatively associated with CRC (PFDR = 2.61 × 10−11); Met 2, composed of phosphatidylcholine species, nucleosides and amino acids, was strongly associated with CRC (PFDR&

Journal article

Stackhouse AA, Rafi D, Walls R, Dodd RV, Badger K, Davies DJ, Brown C, Cowell A, Meeran K, Halse O, Kinross J, Lupton M, Hughes E, Sam SAet al., 2023, Knowledge attainment and engagement among medical students: a comparison of three forms of online learning, Advances in Medical Education and Practice, Vol: 14, Pages: 373-380, ISSN: 1179-7258

Objective: This study compared knowledge attainment and student enjoyment and engagement between clinical case vignette, patient-testimony videos and mixed reality (MR) teaching via the Microsoft HoloLens 2, all delivered remotely to third year medical students. The feasibility of conducting MR teaching on a large scale was also assessed.Setting & Participants: Medical students in Year 3 at Imperial College London participated in three online teaching sessions, one in each format. All students were expected to attend these scheduled teaching sessions and to complete the formative assessment. Inclusion of their data used as part of the research trial was optional.Primary and Secondary Outcome Measures: The primary outcome measure was performance on a formative assessment, which served to compare knowledge attainment between three forms of online learning. Moreover, we aimed to explore student engagement with each form of learning via a questionnaire, and also feasibility of applying MR as a teaching tool on a large scale. Comparisons between performances on the formative assessment between the three groups were investigated using a repeated measures two-way ANOVA. Engagement and enjoyment were also analysed in the same manner.Results: A total of 252 students participated in the study. Knowledge attainment of students using MR was comparable with the other two methods. Participants reported higher enjoyment and engagement (p< 0.001) for the case vignette method, compared with MR and video-based teaching. There was no difference in enjoyment or engagement ratings between MR and the video-based methods.Conclusion: This study demonstrated that the implementation of MR is an effective, acceptable, and feasible way of teaching clinical medicine to undergraduate students on a large scale. However, case-based tutorials were found to be favoured most by students. Future work could further explore the best uses for MR teaching within the medical curriculum.

Journal article

Martin G, Guha P, Lawson J, Minty I, Kinross Jet al., 2023, Can mixed reality technologies teach surgical skills better than traditional methods? A prospective randomised feasibility study, BMC Medical Education, Vol: 23, Pages: 1-8, ISSN: 1472-6920

BackgroundBasic surgical skills teaching is often delivered with didactic audio-visual content, and new digital technologies may allow more engaging and effective ways of teaching to be developed. The Microsoft HoloLens 2 (HL2) is a multi-functional mixed reality headset. This prospective feasibility study sought to assess the device as a tool for enhancing technical surgical skills training.MethodsA prospective randomised feasibility study was conducted. 36 novice medical students were trained to perform a basic arteriotomy and closure using a synthetic model. Participants were randomised to receive a structured surgical skills tutorial via a bespoke mixed reality HL2 tutorial (n = 18), or via a standard video-based tutorial (n = 18). Proficiency scores were assessed by blinded examiners using a validated objective scoring system and participant feedback collected.ResultsThe HL2 group showed significantly greater improvement in overall technical proficiency compared to the video group (10.1 vs. 6.89, p = 0.0076), and a greater consistency in skill progression with a significantly narrower range of scores (SD 2.48 vs. 4.03, p = 0.026). Participant feedback showed the HL2 technology to be more interactive and engaging with minimal device related problems experienced.ConclusionsThis study has demonstrated that mixed reality technology may provide a higher quality educational experience, improved skill progression and greater consistency in learning when compared to traditional teaching methodologies for basic surgical skills. Further work is required to refine, translate, and evaluate the scalability and applicability of the technology across a broad range of skills-based disciplines.

Journal article

Paine H, Jones F, Kinross J, 2023, Preparing the Bowel (Microbiome) for Surgery: Surgical Bioresilience, CLINICS IN COLON AND RECTAL SURGERY, Vol: 36, Pages: 138-145, ISSN: 1531-0043

Journal article

Zwezerijnen-Jiwa FH, Sivov H, Paizs P, Zafeiropoulou K, Kinross Jet al., 2023, A systematic review of microbiome-derived biomarkers for early colorectal cancer detection, NEOPLASIA, Vol: 36, ISSN: 1476-5586

Journal article

Chrysostomou D, Roberts LA, Marchesi JR, Kinross JMet al., 2023, Gut Microbiota Modulation of Efficacy and Toxicity of Cancer Chemotherapy and Immunotherapy, GASTROENTEROLOGY, Vol: 164, Pages: 198-213, ISSN: 0016-5085

Journal article

Ford L, Chalau V, Naguleswaran A, McKenzie J, Mason S, Manoli E, Goldin R, Takats Z, Elson D, Kinross Jet al., 2023, Feasibility Analysis of iEndoscope for Real-Time Data Driven Pathology Using Novel MS and Optical Technology, Mass Spectrometry and Advances in the Clinical Lab

Conference paper

Atanda O, West J, Stables T, Johnson C, Merrifield R, Kinross Jet al., 2023, Flow rate accuracy of infusion devices within healthcare settings: a systematic review, Therapeutic Advances in Drug Safety, Vol: 14, Pages: 1-11, ISSN: 2042-0986

Background:One in five patients admitted to the hospital treated with intravenous (IV) fluid therapy suffer complications due to inappropriate administration. Errors have been reported in 13–84% of the preparation and administration of IV medications. The safe delivery of IV fluids requires precise rate administration.Objectives:This systematic review aims to determine the accuracy of infusion sets and devices and examine the factors that affect the flow rate accuracy of devices.Data Sources and Methods:Six databases (CINAHL, MEDLINE PubMed, EMBASE, Web of Science and Cochrane Database of systematic reviews) were systematically searched. Search terms included infusion pumps, infusion devices, flow rate accuracy, fluid administration rate, gravity-led infusion set and fluid balance. Studies were included if they examined infusion devices’ flow rate accuracy and drop rates for fluids or non-oncological drugs. Findings were tabulated and synthesised qualitatively. The quality of the studies was examined based on the design of the studies due to their heterogeneity.Results:Eight studies were included: Four studies were conducted on human subjects in the hospital environment; studies recruited 182 participants between the ages of 18 and 94 years. Two studies examined flow rate accuracy in recruited patients across 509 observations and 2387 drip hours. No trials prospectively assessed the accuracy of infusion pumps in the clinical domain, and no studies were reported on patient safety outcomes. Four studies examined the impact of mechanical and physiological factors on the flow rate accuracies of infusion devices. Height and back pressure simulated vibrating conditions, the viscosity of IV fluid and the positions of patients were reported to have a significant impact on infusion volume and flow rates of infusion devices. Additionally, giving sets that vary from the manufacturer’s specifications are reported to increase error percent by 10–20

Journal article

Conefrey C, Ochieng C, Hoffman C, Elliott D, Avery K, Bennett J, Blencowe N, Duff S, Kinross J, McNair A, Messenger D, Pullybank A, Singh B, King A, Squire SE, Blazeby J, Main B, Rooshenas Let al., 2022, Managing surgical demand when needs outstrip resource: qualitative investigation of colorectal cancer surgery provision in the first wave of the COVID-19 pandemic., BRITISH JOURNAL OF SURGERY, Vol: 110, Pages: 92-97, ISSN: 0007-1323

Journal article

Machutta K, Xiao J, Winters CA, Perrott J, Chidambaram S, Kinross JM, Morgan RB, Subramanian T, Cifu AS, Alverdy JCet al., 2022, Defeating cancel culture in surgical site infection research: a plea to include microbial cultures and antibiotic sensitivity data., Surgical Infections, Vol: 23, Pages: 902-907, ISSN: 1096-2964

Background: Despite advances in infection control measures, surgical site infections (SSIs) remain a real and present danger to patients. In most studies addressing SSI prevention measures, recommendations are often made in the absence of information such as culture results, the antibiotic agents used for prophylaxis, and antibiotic sensitivity data. The aim of this study is to document this latter claim by reviewing studies published in the last five years in highly read and cited surgical journals. Methods: A systematic review evaluating SSIs from four highly cited surgical journals, Annals of Surgery, the British Journal of Surgery, JAMA Surgery, and the Journal of the American College of Surgeons was conducted for articles published between 2016 and 2021. We focused our analysis on the following key features: how SSI is defined; bacterial culture information; antibiotic sensitivity data; and identification of the antibiotic chosen for prophylaxis. We hypothesized that, in most cases among the journals queried, this information would be unavailable. Results: Of the 71 studies included, 32 diagnosed SSIs based on criteria developed by the U.S. Centers for Disease Control and Prevention while five provided no definition of SSI. Of the 27 articles recommending increasing antibiotic usage, only one study performed antibiotic sensitivity testing to guide the antibiotic choice. Of 71 studies reviewed, only one reported all key features we considered to be important for SSI antibiotic decision-making; 46 reported none of the key features. Conclusions: Among publications addressing SSIs in four highly cited surgical journals, key information regarding diagnosis and with which to base antibiotic recommendations, is routinely unavailable.

Journal article

Loeb M, Bartholomew A, Hashmi M, Tarhuni W, Hassany M, Youngster I, Somayaji R, Larios O, Kim J, Missaghi B, Vayalumkal JV, Mertz D, Chagla Z, Cividino M, Ali K, Mansour S, Castellucci LA, Frenette C, Parkes L, Downing M, Muller M, Glavin V, Newton J, Hookoom R, Leis JA, Kinross J, Smith S, Borhan S, Singh P, Pullenayegum E, Conly Jet al., 2022, Medical masks versus N95 respirators for preventing COVID-19 among health care workers: a randomized trial, Annals of Internal Medicine, Vol: 175, Pages: 1629-1638, ISSN: 0003-4819

Background:It is uncertain if medical masks offer similar protection against COVID-19 compared with N95 respirators.Objective:To determine whether medical masks are noninferior to N95 respirators to prevent COVID-19 in health care workers providing routine care.Design:Multicenter, randomized, noninferiority trial. (ClinicalTrials.gov: NCT04296643).Setting:29 health care facilities in Canada, Israel, Pakistan, and Egypt from 4 May 2020 to 29 March 2022.Participants:1009 health care workers who provided direct care to patients with suspected or confirmed COVID-19.Intervention:Use of medical masks versus fit-tested N95 respirators for 10 weeks, plus universal masking, which was the policy implemented at each site.Measurements:The primary outcome was confirmed COVID-19 on reverse transcriptase polymerase chain reaction (RT-PCR) test.Results:In the intention-to-treat analysis, RT-PCR–confirmed COVID-19 occurred in 52 of 497 (10.46%) participants in the medical mask group versus 47 of 507 (9.27%) in the N95 respirator group (hazard ratio [HR], 1.14 [95% CI, 0.77 to 1.69]). An unplanned subgroup analysis by country found that in the medical mask group versus the N95 respirator group RT-PCR–confirmed COVID-19 occurred in 8 of 131 (6.11%) versus 3 of 135 (2.22%) in Canada (HR, 2.83 [CI, 0.75 to 10.72]), 6 of 17 (35.29%) versus 4 of 17 (23.53%) in Israel (HR, 1.54 [CI, 0.43 to 5.49]), 3 of 92 (3.26%) versus 2 of 94 (2.13%) in Pakistan (HR, 1.50 [CI, 0.25 to 8.98]), and 35 of 257 (13.62%) versus 38 of 261 (14.56%) in Egypt (HR, 0.95 [CI, 0.60 to 1.50]). There were 47 (10.8%) adverse events related to the intervention reported in the medical mask group and 59 (13.6%) in the N95 respirator group.Limitation:Potential acquisition of SARS-CoV-2 through household and community exposure, heterogeneity between countries, uncertainty in the estimates of effect, differences in self-reported adherence, differences in baseline antibodies, and between-country differences in cir

Journal article

Lam K, Lo FP-W, An Y, Darzi A, Kinross JM, Purkayastha S, Lo Bet al., 2022, Deep Learning for Instrument Detection and Assessment of Operative Skill in Surgical Videos, IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS, Vol: 4, Pages: 1068-1071

Journal article

Mullish BH, Paizs P, Alexander J, Verigos E, McDonald JAK, Ford L, Maneta-Stavrakaki S, Sani M, Roberts LA, Chrysostomou D, Kinross J, Monaghan T, Marchesi JR, Kao D, Takats Zet al., 2022, Intestinal microbiota transplant for recurrent Clostridioides difficile infection restores microbial arylsulfatases and sulfatide degradation: a novel mechanism of efficacy?, UEG Week 2022, Pages: 823-823

Conference paper

Tailor V, Danckert N, Bhide A, Fernando R, Digesu A, Khullar V, Kinross J, Marchesi Jet al., 2022, Studying the faecal microbiome of women presenting to urogynaecology, Publisher: SPRINGER LONDON LTD, Pages: 2916-2916, ISSN: 0937-3462

Conference paper

Kinross J, 2022, Probiotics and synbiotics reduce infective complications from colorectal surgery, TECHNIQUES IN COLOPROCTOLOGY, Vol: 26, Pages: 687-689, ISSN: 1123-6337

Journal article

Lewis J, Askari A, Mehta A, Razak Y, Patel P, Misra R, Tilney H, Ahmed T, Ahmed M, Syeed A, Camilleri-Brennan J, Nicholls RJ, Kinross JMet al., 2022, A novel digital rectoscope for the triage of lower gastrointestinal symptoms in primary care: a prospective multicentre feasibility study., BJGP Open, Vol: 6

BACKGROUND: Access to community rectoscopy might help to ease the burden on hospital services and reduce costs for the NHS. To assess this, a prospective multicentre observational phase I feasibility study of a novel digital rectoscope and telestration software for the triage of lower gastrointestinal (GI) symptoms was undertaken. AIM: To determine if digital rectoscopy is feasible, acceptable, and clinically safe. DESIGN & SETTING: Evaluation of clinician case reports and patient questionnaires from patients recruited from five primary care centres. METHOD: Adults meeting 2-week wait (2WW) criteria for suspected lower GI cancer, suspected new diagnosis, or flare-up of inflammatory bowel disease (IBD) were enrolled. Examinations were performed by primary care practitioners using the LumenEye rectoscope. The CHiP platform allowed immediate remote review by secondary care. A prospective analysis was performed of patient and clinician experiences, diagnostic accuracy, and cost. RESULTS: A total of 114 patients were recruited and 110 underwent the procedure (46 [42%] females and 64 [58%] males). No serious adverse events were reported. Eighty-two (74.5%) patients reported that examination was more comfortable than expected, while 104 (94.5%) felt the intervention was most convenient if delivered in the community. Clinicians were confident of their assessment in 100 (87.7%) examinations. Forty-eight (42.1%) patients subsequently underwent colonoscopy, flexible sigmoidoscopy, or computed tomography virtual colonoscopy (CTVC). The overall sensitivity and specificity of LumenEye in identifying rectal pathology was 90.0% and 88.9%. It was 100% and 100% for cancer, and 83.3% and 97.8% for polyps. Following LumenEye examination, 19 (17.3%) patients were discharged, with projected savings of 11 305 GBP. CONCLUSION: Digital rectoscopy in primary care is safe, acceptable, and can reduce referrals. A phase III randomised controlled trial is indicated to define its utility in r

Journal article

Minty I, Lawson J, Guha P, Luo X, Malik R, Cerneviciute R, Kinross J, Martin Get al., 2022, The use of mixed reality technology for the objective assessment of clinical skills: a validation study, BMC Medical Education, Vol: 22, ISSN: 1472-6920

BackgroundMixed Reality technology may provide many advantages over traditional teaching methods. Despite its potential, the technology has yet to be used for the formal assessment of clinical competency. This study sought to collect validity evidence and assess the feasibility of using the HoloLens 2 mixed reality headset for the conduct and augmentation of Objective Structured Clinical Examinations (OSCEs).MethodsA prospective cohort study was conducted to compare the assessment of undergraduate medical students undertaking OSCEs via HoloLens 2 live (HLL) and recorded (HLR), and gold-standard in-person (IP) methods. An augmented mixed reality scenario was also assessed.Results13 undergraduate participants completed a total of 65 OSCE stations. Overall inter-modality correlation was 0.81 (p=0.01), 0.98 (p=0.01) and 0.82 (p=0.01) for IP vs. HLL, HLL vs. HLR and IP vs. HLR respectively. Skill based correlations for IP vs. HLR were assessed for history taking (0.82, p=0.01), clinical examination (0.81, p=0.01), procedural (0.88, p=0.01) and clinical skills (0.92, p=0.01), and assessment of a virtual mixed reality patient (0.74, p=0.01). The HoloLens device was deemed to be usable and practical (Standard Usability Scale (SUS) score = 51.5), and the technology was thought to deliver greater flexibility and convenience, and have the potential to expand and enhance assessment opportunities. ConclusionsHoloLens 2 is comparable to traditional in-person examination of undergraduate medical students for both live and recorded assessments, and therefore is a valid and robust method for objectively assessing performance. The technology is in its infancy, and users need to develop confidence in its usability and reliability as an assessment tool. However, the potential to integrate additional functionality including holographic content, automated tracking and data analysis, and to facilitate remote assessment may allow the technology to enhance, expand and standardise examinati

Journal article

Winter Beatty J, Chidambaram S, Erridge S, Ortega PO, Sidhu HS, Souvatzi M, Sodergren M, Kinross J, Purkayastha Set al., 2022, O020 Does real-time surgical training on auxiliary screens affect performance and cognitive demands during surgery? a randomised crossover study on VR-simulated laparoscopic cholecystectomies., Annual Scientific Meeting of the Surgical-Research-Society, Publisher: Oxford University Press, ISSN: 0007-1323

Conference paper

Lam K, Abramoff M, Balibrea J, Bishop S, Brady R, Callcut R, Chand M, Collins J, Diener M, Eisenmann M, Fermont K, Galvao Neto M, Hager G, Hinchliffe R, Horgan A, Jannin P, Langerman A, Logishetty K, Mahadik A, Maier-Hein L, Martin Antona E, Mascagni P, Mathew R, Mueller-Stich B, Neumuth T, Nickel F, Park A, Pellino G, Rudzicz F, Shah S, Slack M, Smith M, Soomro N, Speidel S, Stoyanov D, Tilney H, Wagner M, Darzi A, Kinross J, Purkayastha Set al., 2022, A Delphi consensus statement for digital surgery, npj Digital Medicine, Vol: 5, Pages: 1-9, ISSN: 2398-6352

The use of digital technology is increasing rapidly across surgical specialities, yet there is noconsensus for the term ‘digital surgery’. This is critical as digital health technologies present technical, governance, and legal challenges which are unique to the surgeon and surgical patient. We aim to define the term digital surgery and the ethical issues surrounding its clinical application, and to identify barriers and research goals for future practice. 38 international experts, across the fields of surgery, AI, industry, law, ethics and policy, participated in a four-round Delphi exercise. Issues were generated by an expert panel and public panel through a scoping questionnaire around key themes identified from the literature and voted upon in two subsequent questionnaire rounds. Consensus was defined if >70% of the panel deemed the statement important and <30% unimportant. A final online meeting was held to discuss consensus statements. The definition of digital surgery as the use of technology for the enhancement of preoperative planning, surgical performance, therapeutic support, or training, to improve outcomes and reduce harm achieved 100% consensus agreement. We highlight key ethical issues concerning data, privacy, confidentiality and public trust, consent, law; litigation and liability, and commercial partnerships within digital surgery and identify barriers and research goals for future practice. Developers and users of digital surgery must not only have an awareness of the ethical issues surrounding digital applications in healthcare, but also the ethical considerations unique to digital surgery. Future research into these issues must involve all digital surgery stakeholders including patients.

Journal article

Patel R, Suwa Y, Kinross J, von Roon A, Woods AJ, Darzi A, Singh H, Leff DRet al., 2022, Neuroenhancement of surgeons during robotic suturing, Surgical Endoscopy: surgical and interventional techniques, Vol: 36, Pages: 4803-4814, ISSN: 0930-2794

BackgroundThe initial phases of robotic surgical skills acquisition are associated with poor technical performance, such as low knot-tensile strength (KTS). Transcranial direct-current stimulation (tDCS) can improve force and accuracy in motor tasks but research in surgery is limited to open and laparoscopic tasks in students. More recently, robotic surgery has gained traction and is now the most common approach for certain procedures (e.g. prostatectomy). Early-phase robotic suturing performance is dependent on prefrontal cortex (PFC) activation, and this study aimed to determine whether performance can be improved with prefrontal tDCS.MethodsFifteen surgical residents were randomized to either active then sham tDCS or sham then active tDCS, in two counterbalanced sessions in a double-blind crossover study. Within each session, participants performed a robotic suturing task repeated in three blocks: pre-, intra- and post-tDCS. During the intra-tDCS block, participants were randomized to either active tDCS (2 mA for 15 min) to the PFC or sham tDCS. Primary outcome measures of technical quality included KTS and error scores.ResultsSignificantly faster completion times were observed longitudinally, regardless of active (p < 0.001) or sham stimulation (p < 0.001). KTS was greater following active compared to sham stimulation (median: active = 44.35 N vs. sham = 27.12 N, p < 0.001). A significant reduction in error scores from “pre-” to “post-” (p = 0.029) were only observed in the active group.ConclusiontDCS could reduce error and enhance KTS during robotic suturing and warrants further exploration as an adjunct to robotic surgical training.

Journal article

Sani M, Ford L, Simon D, Xiang Y, McKenzie J, Stavrakaki SM, Paizs P, Huq T, Higginson J, Alexander J, Takats Z, Kinross Jet al., 2022, A prospective pilot study of desorption electrospray ionisation mass spectrometry (DESI-MS) for the early detection of colorectal adenoma., Annual Meeting of the American-Association-for-Cancer-Research (AACR), Publisher: AMER ASSOC CANCER RESEARCH, ISSN: 0008-5472

Conference paper

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