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  • Conference paper
    Zhao M, Oude Vrielink J, Kogkas A, Runciman M, Elson D, Mylonas Get al., 2020,

    LaryngoTORS: A Novel Cable-Driven Parallel Robot for Transoral Laser Surgery

    , International Conference on Robotics and Automation (ICRA)
  • Conference paper
    Zhao M, Zhang H, Mylonas GP, Elson DSet al., 2020,

    Cable-driven parallel robot assisted confocal imaging of the larynx

    LaryngoTORS, a transoral laryngeal surgery robot, can manipulate instruments accurately. Confocal imaging has potentials in laryngeal cancer diagnosis but suffer from high scanning requirement. This work studies using LaryngoTORS to assist confocal imaging of larynx.

  • Journal article
    Markiewicz O, Lavelle M, Lorencatto F, Judah G, Ashrafian H, Darzi Aet al., 2020,

    Threats to safe transitions from hospital to home: a consensus study in North West London primary care

    , British Journal of General Practice, Vol: 70, Pages: e9-e19, ISSN: 0960-1643

    Background Transitions between healthcare settings are vulnerable points for patients.Aim To identify key threats to safe patient transitions from hospital to primary care settings.Design and setting Three-round web-based Delphi consensus process among clinical and non-clinical staff from 39 primary care practices in North West London, England.Method Round 1 was a free-text idea-generating round. Rounds 2 and 3 were consensus-obtaining rating rounds. Practices were encouraged to complete the questionnaires at team meetings. Aggregate ratings of perceived level of importance for each threat were calculated (1–3: ‘not important’, 4–6: ‘somewhat important’, 7–9: ‘very important’). Percentage of votes cast for each patient or medication group were recorded; consensus was defined as ≥75%.Results A total of 39 practices completed round 1, 36/39 (92%) completed round 2, and 30/36 (83%) completed round 3. Round 1 identified nine threats encompassing problems involving communication, service organisation, medication provision, and patients who were most at risk. ‘Poor quality of handover instructions from secondary to primary care teams’ achieved the highest rating (mean rating at round 3 = 8.43) and a 100% consensus that it was a ‘very important’ threat. Older individuals (97%) and patients with complex medical problems taking >5 medications (80%) were voted the most vulnerable. Anticoagulants (77%) were considered to pose the greatest risk to patients.Conclusion This study identified specific threats to safe patient transitions from hospital to primary care, providing policymakers and healthcare providers with targets for quality improvement strategies. Further work would need to identify factors underpinning these threats so that interventions can be tailored to the relevant behavioural and environmental contexts in which these threats arise.

  • Journal article
    Fontana G, Ghafur S, Torne L, Goodman J, Darzi Aet al., 2020,

    Ensuring that the NHS realises fair financial value from its data

    , The Lancet Digital Health, Vol: 2, Pages: e10-e12, ISSN: 2589-7500
  • Journal article
    Thibaut B, Dewa L, Ramtale S, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer Set al., 2019,

    Patient safety in inpatient mental health settings: a systematic review

    , BMJ Open, Vol: 9, Pages: 1-19, ISSN: 2044-6055

    Objectives: Patients in inpatient mental health settings face similar risks to those in other areas of health care (e.g. medication errors). In addition, some unsafe behaviours associated with serious mental health problems (e.g. self-harm), and the measures taken to address these (e.g. restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. Design: Systematic review and meta-synthesis. Embase, CINAHL, HMIC, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to “mental health”, “patient safety”, “inpatient setting” and “research”. Study quality was assessed using the Hawker checklist. Data was extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random effects model.Results: Of the 57,637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150,000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. Conclusions: Patient safety in inpatient mental health settings is under researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety which require investment in research, policy development, and translation into clinical practice.

  • Journal article
    Joshi M, Ashrafian H, Arora S, Khan S, Cooke G, Darzi Aet al., 2019,

    Digital alerting and outcomes in patients with sepsis: Systematic review and meta-analysis

    , JMIR mHealth and uHealth, Vol: 21, ISSN: 2291-5222

    Background The diagnosis and management of sepsis remains a global healthcare challenge. Digital technologies have the potential to improve sepsis care. Objective This paper systematically reviews the evidence on the impact of electronic alerting systems on sepsis related outcomes. Study Selection Embase, Medline, HMIC, Psych Info and Cochrane were searched from April 1964 to 12thFebruary 2019 with no language restriction. All full text reports of studies identified as potentially eligible after title and abstract review were obtained for further review. The search was limited to adult inpatients. Relevant articles were hand-searched for remaining studies. Only studies with clear pre-and post-alerting phases were included. Primary outcomes were hospital length of stay [LOS] and intensive care LOS, secondary outcomes were time to antibiotics and mortality. Studies based solely on intensive care, case reports, narrative reviews, editorials and commentaries were excluded. All other trial designs were included. A qualitative assessment and meta-analysis was performed. Results This review identified 72 full text articles. From these, 16 studies met the inclusion criteria and were included in the final analysis. Of these, 8 studies reviewed hospital length of stay, 12 mortality outcomes, 5 studies explored time to antibiotics, 5 studies investigated ICU length of stay. Data Synthesis Both quantitative and qualitative assessments of the studies was performed. There was evidence of a significant benefit of electronic alerting on hospital length of stay, reduced by 1.31 days[p=0.014], and ICU length of stay, reduced by 0.766 days[p=0.007]. There was no significant difference association between electronic alerts and mortality [mean decrease 11.4%,p=0.769] or time to antibiotics [mean decrease 126 minutes, p=0.134]. Conclusion This review highlights that electronic alerts can significantly reduce hospital and ICU stay in patients with sepsis. Further studies including more

  • Journal article
    Geeson C, Wei L, Franklin BD, 2019,

    High-risk medicines associated with clinically relevant medication-related problems in UK hospitals: A prospective observational study

    , BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Vol: 86, Pages: 165-169, ISSN: 0306-5251
  • Journal article
    Warren L, Harrison M, Arora S, Darzi Aet al., 2019,

    Working with patients and the public to design an electronic health record interface: A qualitative mixed-methods study

    , BMC Medical Informatics and Decision Making, Vol: 19, ISSN: 1472-6947

    BackgroundEnabling patients to be active users of their own medical records may promote the delivery of safe, efficient care across settings. Patients are rarely involved in designing digital health record systems which may make them unsuitable for patient use. We aimed to develop an evidence-based electronic health record (EHR) interface and participatory design process by involving patients and the public.MethodsParticipants were recruited to multi-step workshops involving individual and group design activities. A mixture of quantitative and qualitative questionnaires and observational methods were used to collect participant perspectives on interface design and feedback on the workshop design process.Results48 recruited participants identified several design principles and components of a patient-centred electronic medical record interface. Most participants indicated that an interactive timeline would be an appropriate way to depict a medical history. Several key principles and design components, including the use of specific colours and shapes for clinical events, were identified. Participants found the workshop design process utilised to be useful, interesting, enjoyable and beneficial to their understanding of the challenges of information exchange in healthcare.ConclusionPatients and the public should be involved in EHR interface design if these systems are to be suitable for use by patient-users. Workshops, as used in this study, can provide an engaging format for patient design input. Design principles and components highlighted in this study should be considered when patient-facing EHR design interfaces are being developed.

  • Journal article
    Goiana-Da-Silva K, Cruz-e-Silva D, Allen L, Calhau C, Rito A, Bento A, Miraldo M, Darzi Aet al., 2019,

    Portugal’s voluntary food reformulation agreement and the WHO reformulation targets

    , Journal of Global Health, Vol: 9, ISSN: 2047-2978
  • Journal article
    Warren L, Clarke J, Arora S, Darzi Aet al., 2019,

    Improving data sharing between acute hospitals in England: An overview of health record system distribution and retrospective observational analysis of inter-hospital transitions of care

    , BMJ Open, Vol: 9, ISSN: 2044-6055

    ObjectivesTo determine the frequency of use and spatial distribution of health record systems in the English National Health Service (NHS). To quantify transitions of care between acute hospital trusts and health record systems to guide improvements to data sharing and interoperability.DesignRetrospective observational study using Hospital Episode Statistics.SettingAcute hospital trusts in the NHS in England.ParticipantsAll adult patients resident in England that had one or more inpatient, outpatient or accident and emergency encounters at acute NHS hospital trusts between April 2017 and April 2018.Primary and secondary outcome measuresFrequency of use and spatial distribution of health record systems. Frequency and spatial distribution of transitions of care between hospital trusts and health record systems.Results21,286,873 patients were involved in 121,351,837 encounters at 152 included trusts. 117 (77.0%) hospital trusts were using electronic health records (EHR). There was limited regional alignment of EHR systems. On 11,017,767 (9.1%) occasions, patients attended a hospital using a different health record system to their previous hospital attendance. 15,736,863 (73.9%) patients had two or more encounters with the included trusts and 3,931,255 (25.0%) of those attended two or more trusts. Over half (53.6%) of these patients had encounters shared between just 20 pairs of hospitals. Only two of these pairs of trusts used the same EHR system.ConclusionsEach year, millions of patients in England attend two or more different hospital trusts. Most of the pairs of trusts that commonly share patients do not use the same record systems. This research highlights significant barriers to inter-hospital data sharing and interoperability. Findings from this study can be used to improve electronic health record system coordination and develop targeted approaches to improve interoperability. The methods used in this study could be used in other healthcare systems that face the

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