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Journal articleKim JA, Wales DJ, Yang G-Z, 2020,
Optical spectroscopy for in vivo medical diagnosis-a review of the state of the art and future perspectives
, Progress in Biomedical Engineering, Vol: 2, ISSN: 2516-1091When light is incident to a biological tissue surface, combinations of optical processes occur, such as reflection, absorption, elastic and non-elastic scattering, and fluorescence. Analysis of these light interactions with the tissue provides insight into the metabolic and pathological state of the tissue. Furthermore, in vivo diagnosis of diseases using optical spectroscopy enables in situ rapid clinical decisions without invasive biopsies. For in vivo scenarios, incident light can be delivered in a highly localized manner to tissue via optical fibers, which are placed within the working channels of minimally invasive clinical tools, such as endoscopes. There has been extensive development in the accuracy and specificity of these optical spectroscopy techniques since the earliest in vivo examples were published in the academic literature in the early '90s, and there are now commercially available systems that have undergone medical and clinical trials. In this review, several types of optical spectroscopy techniques (elastic optical scattering spectroscopy, fluorescence spectroscopy, Raman spectroscopy, and multimodal spectroscopy) for the diagnosis and monitoring of diseases states of tissue in an in vivo setting are introduced and explored. Examples of the latest and most impactful works for each technique are then critically reviewed. Finally, current challenges and unmet clinical needs are discussed, followed by future opportunities, such as point-based spectroscopies for robot-guided surgical interventions.
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Journal articleMaurice J, Lett A, Skinner C, et al., 2020,
Transcutaneous fluorescence spectroscopy as a tool for non-invasive monitoring of gut function: first clinical experiences
, Scientific Reports, Vol: 10, ISSN: 2045-2322Gastro-intestinal function plays a vital role in conditions ranging from inflammatory bowel disease and HIV through to sepsis and malnutrition. However, the techniques that are currently used to assess gut function are either highly invasive or unreliable. Here we present an alternative, non-invasive sensing modality for assessment of gut function based on fluorescence spectroscopy. In this approach, patients receive an oral dose of a fluorescent contrast agent and a fibre-optic probe is used to make fluorescence measurements through the skin. This provides a readout of the degree to which fluorescent dyes have permeated from the gut into the blood stream. We present preliminary results from our first measurements in human volunteers demonstrating the potential of the technique for non-invasive monitoring of multiple aspects of gastro-intestinal health.
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Journal articleAufegger L, Alabi M, Darzi A, et al., 2020,
Sharing leadership: current attitudes, barriers and needs of clinical and non-clinical managers in UK’s integrated care system
, BMJ Leader, Vol: 4, Pages: 128-134, ISSN: 2398-631XBackground As systems become more complex, shared leadership (SL) has been suggested to have a dominant role in improving cross-functional working tailored to organisational needs. Little, however, is known about the benefits of SL in healthcare management, especially for UK’s recently formed integrated care system (ICS). The aim of this study was to understand current attitudes, barriers and needs of clinical and non-clinical managers sharing leadership responsibilities in the ICS.Method Twenty clinical and non-clinical leaders in 15 organisations were interviewed to understand current cross-functional leadership collaborations, and the potential SL may have on the recently established ICS in the National Health Service (NHS). The data were transcribed and analysed thematically.Results Findings showed perceptions and experiences of clinical and non-clinical healthcare management in relation to: (1) motivation to execute a leadership position, including the need to step up and a sense of duty; (2) attitudes towards interdisciplinary working, which is reflected in conflicts due to different values and expertise; (3) SL skills and behaviours, including the need for mutual understanding and cooperative attitudes by means of effective communication and collaboration; and (4) barriers to achieve SL in the ICS, such as bureaucracy, and a lack of time and support.Conclusions SL may help improve current leadership cultures within the NHS; however, for SL to have a tangible impact, it needs to be delivered as part of leadership development for doctors in postgraduate training, and development programmes for aspiring, emerging and established leaders, with clear lines of communication.
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Journal articleDavids J, Manivannan S, Darzi A, et al., 2020,
Simulation for skills training in neurosurgery: a systematic review, meta-analysis, and analysis of progressive scholarly acceptance.
, Neurosurgical Review, Vol: 44, Pages: 1853-1867, ISSN: 0344-5607At a time of significant global unrest and uncertainty surrounding how the delivery of clinical training will unfold over the coming years, we offer a systematic review, meta-analysis, and bibliometric analysis of global studies showing the crucial role simulation will play in training. Our aim was to determine the types of simulators in use, their effectiveness in improving clinical skills, and whether we have reached a point of global acceptance. A PRISMA-guided global systematic review of the neurosurgical simulators available, a meta-analysis of their effectiveness, and an extended analysis of their progressive scholarly acceptance on studies meeting our inclusion criteria of simulation in neurosurgical education were performed. Improvement in procedural knowledge and technical skills was evaluated. Of the identified 7405 studies, 56 studies met the inclusion criteria, collectively reporting 50 simulator types ranging from cadaveric, low-fidelity, and part-task to virtual reality (VR) simulators. In all, 32 studies were included in the meta-analysis, including 7 randomised controlled trials. A random effects, ratio of means effects measure quantified statistically significant improvement in procedural knowledge by 50.2% (ES 0.502; CI 0.355; 0.649, p < 0.001), technical skill including accuracy by 32.5% (ES 0.325; CI - 0.482; - 0.167, p < 0.001), and speed by 25% (ES - 0.25, CI - 0.399; - 0.107, p < 0.001). The initial number of VR studies (n = 91) was approximately double the number of refining studies (n = 45) indicating it is yet to reach progressive scholarly acceptance. There is strong evidence for a beneficial impact of adopting simulation in the improvement of procedural knowledge and technical skill. We show a growing trend towards the adoption of neurosurgical simulators, although we have not fully gained progressive scholarly acceptance for VR-based simulation technologies in neurosurgical education.
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Journal articleAlwan NA, Attree E, Blair JM, et al., 2020,
From doctors as patients: a manifesto for tackling persisting symptoms of covid-19
, BMJ-BRITISH MEDICAL JOURNAL, Vol: 370, ISSN: 0959-535X- Author Web Link
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- Citations: 37
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Conference papervan Dael J, Gillespie AT, Reader TW, et al., 2020,
Patient and staff perceptions of safety and risk: triangulating patient complaints and staff incident reports towards a dual perspective on adverse events
, Society for Social Medicine & Population Health, Publisher: BMJ PUBLISHING GROUP, Pages: A40-A40, ISSN: 0143-005XBackground Incident reporting systems in healthcare are historically based on staff descriptions of adverse events. An increasing body of literature suggests patients provide critical insights to risk and error, but their potential has not sufficiently been investigated at the incident level. This study aims to examine to what extent patient complaints and staff incident reports discuss identical incidents, and how their perspectives could be integrated for more comprehensive safety analysis.Methods Deterministic data linkage was performed on all complaints (n=5,265) and staff incident reports (‘PSIs’) (n=81,077) between April 2014 and March 2019 at a multisite hospital in London. A total of 402 complaints covered at least one incident also identified in the PSIs, and were included in the study. All incidents reported in complaints and staff incident reports were codified based on problem domain; problem severity; stage of care; staff group implicated; reported harm; and descriptive level (eg, description of human factors and root causes); adapted from the Healthcare Complaints Analysis Tool (HCAT) and the National Reporting and Learning System (NRLS). Aggregated coding outputs informed targeted qualitative analysis of free text incident reports for an in-depth exploration of key overlap and discrepancies in patient and staff descriptions of unsafe care.Results Our preliminary results indicate staff and patients reported similar problem themes for 81.1% of overlapping incidents (of which 66.5% clinical, followed by 27.1% institutional, and 6.4% relational), but commonly differed in their description of contributing factors and root causes (eg, different time points in patient journey). Alongside overlapping incidents, patients reported an average of 1.4 additional incidents in their complaint, of which 23.6% were high severity. Additional patient-reported incidents included blind spot clinical issues (36.7%; eg care continuity; care omissions) or relatio
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Journal articleGarfield S, Furniss D, Husson F, et al., 2020,
How can patient-held lists of medication enhance patient safety? A mixed-methods study with a focus on user experience
, BMJ Quality & Safety, Vol: 29, Pages: 764-773, ISSN: 2044-5415Background Patients often carry medication lists to mitigate information loss across healthcare settings. We aimed to identify mechanisms by which these lists could be used to support safety, key supporting features, and barriers and facilitators to their use.Methods We used a mixed-methods design comprising two focus groups with patients and carers, 16 semistructured interviews with healthcare professionals, 60 semistructured interviews with people carrying medication lists, a quantitative features analysis of tools available for patients to record their medicines and usability testing of four tools. Findings were triangulated using thematic analysis. Distributed cognition for teamwork models were used as sensitising concepts.Results We identified a wide range of mechanisms through which carrying medication lists can improve medication safety. These included improving the accuracy of medicines reconciliation, allowing identification of potential drug interactions, facilitating communication about medicines, acting as an aide-mémoire to patients during appointments, allowing patients to check their medicines for errors and reminding patients to take and reorder their medicines. Different tools for recording medicines met different needs. Of 103 tools examined, none met the core needs of all users. A key barrier to use was lack of awareness by patients and carers that healthcare information systems can be fragmented, a key facilitator was encouragement from healthcare professionals.Conclusion Our findings suggest that patients and healthcare professionals perceive patient-held medication lists to have a wide variety of benefits. Interventions are needed to raise awareness of the potential role of these lists in enhancing patient safety. Such interventions should empower patients and carers to identify a method that suits them best from a range of options and avoid a ‘one size fits all’ approach.
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Journal articleGhafur S, Van Dael J, Leis M, et al., 2020,
Public perceptions on data sharing: key insights from the UK and the USA
, The Lancet Digital Health, Vol: 2, Pages: E444-E446, ISSN: 2589-7500 -
Journal articleBarakat S, Franklin BD, 2020,
An Evaluation of the Impact of Barcode Patient and Medication Scanning on Nursing Workflow at a UK Teaching Hospital
, PHARMACY, Vol: 8- Author Web Link
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- Citations: 7
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Journal articleCursi F, Mylonas GP, Kormushev P, 2020,
Adaptive kinematic modelling for multiobjective control of a redundant surgical robotic tool
, Robotics, Vol: 9, Pages: 68-68, ISSN: 2218-6581Accurate kinematic models are essential for effective control of surgical robots. For tendon driven robots, which are common for minimally invasive surgery, the high nonlinearities in the transmission make modelling complex. Machine learning techniques are a preferred approach to tackle this problem. However, surgical environments are rarely structured, due to organs being very soft and deformable, and unpredictable, for instance, because of fluids in the system, wear and break of the tendons that lead to changes of the system’s behaviour. Therefore, the model needs to quickly adapt. In this work, we propose a method to learn the kinematic model of a redundant surgical robot and control it to perform surgical tasks both autonomously and in teleoperation. The approach employs Feedforward Artificial Neural Networks (ANN) for building the kinematic model of the robot offline, and an online adaptive strategy in order to allow the system to conform to the changing environment. To prove the capabilities of the method, a comparison with a simple feedback controller for autonomous tracking is carried out. Simulation results show that the proposed method is capable of achieving very small tracking errors, even when unpredicted changes in the system occur, such as broken joints. The method proved effective also in guaranteeing accurate tracking in teleoperation.
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