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  • Journal article
    Archer SA, Pinto A, Vuik S, Bicknell C, Faiz O, Byrne B, Johnston M, Skapinakis P, Athanasiou T, Vincent C, Darzi Aet al., 2019,

    Surgery, complications and quality of life: a longitudinal cohort study exploring the role of psychosocial factors

    , Annals of Surgery, Vol: 270, Pages: 95-101, ISSN: 0003-4932

    Objective:To determine if psychosocial factors moderate the relationship between surgical complications and quality of life (QoL).Summary Background:Patients who experience surgical complications have significantly worse post-operative QoL than patients with an uncomplicated recovery. Psychosocial factors, such as coping style and level of social support influence how people deal with stressful events, but it is unclear if they impact on QoL following a surgical complication. These findings can inform the development of appropriate interventions that support patients post-operatively. Methods:This is a longitudinal cohort study; data were collected at pre-op, 1 month post-op, 4 months post-op and 12 months post-op. A total of 785 patients undergoing major elective gastro-intestinal, vascular or cardio-thoracic surgery were recruited from 28 National Health Service (NHS) sites in England and Scotland took part in the study.Results:Patients who experience major surgical complications report significantly reduced levels of physical and mental QoL (p<0.05) but they make a full recovery over time. Findings indicate that a range of psychosocial factors such as the use of humor as a coping style and the level of health care professional support may moderate the impact of surgical complications on QoL.Conclusion:Surgical complications alongside other socio-demographic and psychosocial factors contribute to changes in QoL; the results from this exploratory study suggest that interventions that increase the availability of healthcare professional support and promote more effective coping strategies prior to surgery may be useful, particularly in the earlier stages of recovery where QoL is most severely compromised. However, these relationships should be further explored in longitudinal studies that include other types of surgery and employ rigorous recruitment and follow up procedures.

  • Journal article
    Aufegger L, Bicknell C, Soane E, Ashrafian H, Darzi Aet al., 2019,

    Understanding health management and safety decisions using signal processing and machine learning

    , BMC Medical Research Methodology, Vol: 19, ISSN: 1471-2288

    BackgroundSmall group research in healthcare is important because it deals with interaction and decision-making processes that can help to identify and improve safer patient treatment and care. However, the number of studies is limited due to time- and resource-intensive data processing. The aim of this study was to examine the feasibility of using signal processing and machine learning techniques to understand teamwork and behaviour related to healthcare management and patient safety, and to contribute to literature and research of teamwork in healthcare.MethodsClinical and non-clinical healthcare professionals organised into 28 teams took part in a video- and audio-recorded role-play exercise that represented a fictional healthcare system, and included the opportunity to discuss and improve healthcare management and patient safety. Group interactions were analysed using the recurrence quantification analysis (RQA; Knight et al., 2016), a signal processing method that examines stability, determinism, and complexity of group interactions. Data were benchmarked against self-reported quality of team participation and social support. Transcripts of group conversations were explored using the topic modelling approach (Blei et al., 2003), a machine learning method that helps to identify emerging themes within large corpora of qualitative data.ResultsGroups exhibited stable group interactions that were positively correlated with perceived social support, and negatively correlated with predictive behaviour. Data processing of the qualitative data revealed conversations focused on: (1) the management of patient incidents; (2) the responsibilities among team members; (3) the importance of a good internal team environment; and (4) the hospital culture.ConclusionsThis study has shed new light on small group research using signal processing and machine learning methods. Future studies are encouraged to use these methods in the healthcare context, and to conduct further research

  • Journal article
    Dilley J, Camara M, Omar I, Carter A, Pratt P, Vale J, Darzi A, Mayer EKet 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.

  • Journal article
    Cohen D, Vlaev I, Heitmueller A, Parston G, Schmidtke KA, Darzi Aet al., 2019,

    Validation of behavioral simulations: a case study on enhancing collaboration between partnership organizations

    , Journal of Public Health, Vol: 27, Pages: 367-378, ISSN: 1741-3842

    AimThe current article provides a detailed account of a behavioral simulation called Lateral Play. Lateral Play aimed to enhance collaborations and optimize shared decision-making across organizations within a newly formed partnership. The current article aims to enhance appreciation of the behavioral simulation methodology and encourage its use.Subjects and MethodsHealth service leaders from different organizations within a newly formed partnership gathered in the simulated community and took up roles similar to their real-life positions. The simulation presented participants with problems and opportunities similar to those that they would experience in real life, such as the need to consolidate services and create new care pathways. To evaluate Lateral Play’s effectiveness, self-reported and observational data were collected. These data include information about participants’ reactions, learning and behavior, and the newly formed partnership’s organizational results.ResultsLateral Play allowed health leaders to better understand how they could enhance collaborations and optimize shared decision-making across their newly formed partnership. The data suggest that simulations can promote effective collaborations.ConclusionsUse of behavioral simulations should be encouraged to promote policy awareness and understanding, refine implementation strategies and improve outcomes in newly formed partnerships.

  • Conference paper
    Patel N, Kogkas A, Ben Glover AD, Mylonas Get al., 2019,


    , Annual Meeting of the British-Society-of-Gastroenterology (BSG), Publisher: BMJ PUBLISHING GROUP, Pages: A38-A39, ISSN: 0017-5749
  • Journal article
    Martin G, Clarke J, Liew F, Arora S, King D, Paul A, Darzi Aet al., 2019,

    Evaluating the impact of organisational digital maturity on clinical outcomes in secondary care in England

    , npj Digital Medicine, Vol: 2, ISSN: 2398-6352

    All healthcare systems are increasingly reliant on health information technology to support the delivery of high-quality, efficient and safe care. Data on its effectiveness are however limited. We therefore sought to examine the impact of organisational digital maturity on clinical outcomes in secondary care within the English National Health Service. We conducted a retrospective analysis of routinely collected administrative data for 13,105,996 admissions across 136 hospitals in England from 2015 to 2016. Data from the 2016 NHS Clinical Digital Maturity Index were used to characterise organisational digital maturity. A multivariable regression model including 12 institutional covariates was utilised to examine the relationship between one measure of organisational digital maturity and five key clinical outcome measures. There was no significant relationship between organisational digital maturity and risk-adjusted 30-day mortality, 28-day readmission rates or complications of care. In multivariable analysis risk-adjusted long length of stay and harm-free care were significantly related to aspects of organisational digital maturity; digitally mature hospitals may not only deliver more harm-free care episodes but also may have a significantly increased risk of patients experiencing a long length of stay. Organisational digital maturity is to some extent related to selected clinical outcomes in secondary care in England. Digital maturity is, however, also strongly linked to other institutional factors that likely play a greater role in influencing clinical outcomes. There is a need to better understand how health IT impacts care delivery and supports other drivers of hospital quality.

  • Journal article
    Warren L, Clarke J, Arora S, Barahona M, Arebi N, Darzi Aet al., 2019,

    Transitions of care across hospital settings in patients with inflammatory bowel disease

    , World Journal of Gastroenterology, Vol: 25, Pages: 2122-2132, ISSN: 1007-9327

    BACKGROUNDInflammatory bowel disease (IBD) is a chronic, inflammatory disorder characterised by both intestinal and extra-intestinal pathology. Patients may receive both emergency and elective care from several providers, often in different hospital settings. Poorly managed transitions of care between providers can lead to inefficiencies in care and patient safety issues. To ensure that the sharing of patient information between providers is appropriate, timely, accurate and secure, effective data-sharing infrastructure needs to be developed. To optimise inter-hospital data-sharing for IBD patients, we need to better understand patterns of hospital encounters in this group.AIMTo determine the type and location of hospital services accessed by IBD patients in England.METHODSThis was a retrospective observational study using Hospital Episode Statistics, a large administrative patient data set from the National Health Service in England. Adult patients with a diagnosis of IBD following admission to hospital were followed over a 2-year period to determine the proportion of care accessed at the same hospital providing their outpatient IBD care, defined as their ‘home provider’. Secondary outcome measures included the geographic distribution of patient-sharing, regional and age-related differences in accessing services, and type and frequency of outpatient encounters.RESULTSOf 95055 patients accessed hospital services on 1760156 occasions over a 2-year follow-up period. The proportion of these encounters with their identified IBD ‘home provider’ was 73.3%, 87.8% and 83.1% for accident and emergency, inpatient and outpatient encounters respectively. Patients living in metropolitan centres and younger patients were less likely to attend their ‘home provider’ for hospital services. The most commonly attended specialty services were gastroenterology, general surgery and ophthalmology.CONCLUSIONTransitions of care between secondary care sett

  • Journal article
    Aufegger L, Shariq O, Bicknell C, Ashrafian H, Darzi Aet al., 2019,

    Can shared leadership enhance clinical team management? A systematic review

    , Leadership in Health Services, Vol: 32, Pages: 309-335, ISSN: 1751-1879

    PurposeResearch in psychology or management science has shown that shared leadership (SL) enhances information sharing, fosters participation and empowers team members within the decision-making processes, ultimately improving the quality of performance outcomes. Little has been done and, thus, less is known of the value and use of SL in acute healthcare teams. The purpose of this study is to (1) explore, identify and critically assess patterns and behaviour of SL in acute healthcare teams; and (2) evaluate to what extent SL may benefit and accomplish safer care in acute patient treatment and healthcare delivery.Design/methodology/approachThe authors conducted a review that followed the PRISMA-P reporting guidelines. A variety of sources were searched in April 2018 for studies containing primary research that focused on SL in acute healthcare teams. The outcome of interest was a well-specified assessment of SL, and an evaluation of the extent SL may enhance team performance, lead to safer patient care and healthcare delivery in acute healthcare teams.FindingsAfter the study selection process, 11 out of 1,383 studies were included in the review. Studies used a qualitative, quantitative or mixed-methods approach. Emerging themes based on behavioural observations that contributed to SL were: shared mental model; social support and situational awareness; and psychological safety. High-performing teams showed more SL behaviour, teams with less seniority displayed more traditional leadership styles and SL was associated with increased team satisfaction.Research limitations/implicationsEvidence to date suggests that SL may be of benefit to improve performance outcomes in acute healthcare team settings. However, the discrepancy of SL assessments within existing studies and their small sample sizes highlights the need for a large, good quality randomized controlled trial to validate this indication.Originality/valueAlthough studies have acknowledged the relevance of SL in he

  • Journal article
    Sun Y, Lo B, 2019,

    An artificial neural network framework for gait based biometrics

    , IEEE Journal of Biomedical and Health Informatics, Vol: 23, Pages: 987-998, ISSN: 2168-2194

    OAPA As the popularity of wearable and implantable Body Sensor Network (BSN) devices increases, there is a growing concern regarding the data security of such power-constrained miniaturized medical devices. With limited computational power, BSN devices are often not able to provide strong security mechanisms to protect sensitive personal and health information, such as one's physiological data. Consequently, many new methods of securing Wireless Body Area Networks (WBANs) have been proposed recently. One effective solution is the Biometric Cryptosystem (BCS) approach. BCS exploits physiological and behavioral biometric traits, including face, iris, fingerprints, Electrocardiogram (ECG), and Photoplethysmography (PPG). In this paper, we propose a new BCS approach for securing wireless communications for wearable and implantable healthcare devices using gait signal energy variations and an Artificial Neural Network (ANN) framework. By simultaneously extracting similar features from BSN sensors using our approach, binary keys can be generated on demand without user intervention. Through an extensive analysis on our BCS approach using a gait dataset, the results have shown that the binary keys generated using our approach have high entropy for all subjects. The keys can pass both NIST and Dieharder statistical tests with high efficiency. The experimental results also show the robustness of the proposed approach in terms of the similarity of intra-class keys and the discriminability of the inter-class keys.

  • Journal article
    Ghafur S, Grass E, Jennings N, Darzi Aet al., 2019,

    The challenges of cybersecurity in health care: the UK National Health Service as a case study

    , The Lancet Digital Health, Vol: 1, Pages: e10-e12, ISSN: 2589-7500

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