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  • Journal article
    Camara M, Dawda S, Mayer E, Darzi A, Pratt Pet al., 2019,

    Subject-specific modelling of pneumoperitoneum: model implementation, validation and human feasibility assessment

    , International Journal of Computer Assisted Radiology and Surgery, Vol: 14, Pages: 841-850, ISSN: 1861-6429

    PURPOSE: The aim of this study is to propose a model that simulates patient-specific anatomical changes resulting from pneumoperitoneum, using preoperative data as input. The framework can assist the surgeon through a real-time visualisation and interaction with the model. Such could further facilitate surgical planning preoperatively, by defining a surgical strategy, and intraoperatively to estimate port positions. METHODS: The biomechanical model that simulates pneumoperitoneum was implemented within the GPU-accelerated NVIDIA FleX position-based dynamics framework. Datasets of multiple porcine subjects before and after abdominal insufflation were used to generate, calibrate and validate the model. The feasibility of modelling pneumoperitoneum in human subjects was assessed by comparing distances between specific landmarks from a patient abdominal wall, to the same landmark measurements on the simulated model. RESULTS: The calibration of simulation parameters resulted in a successful estimation of an optimal set parameters. A correspondence between the simulation pressure parameter and the experimental insufflation pressure was determined. The simulation of pneumoperitoneum in a porcine subject resulted in a mean Hausdorff distance error of 5-6 mm. Feasibility of modelling pneumoperitoneum in humans was successfully demonstrated. CONCLUSION: Simulation of pneumoperitoneum provides an accurate subject-specific 3D model of the inflated abdomen, which is a more realistic representation of the intraoperative scenario when compared to preoperative imaging alone. The simulation results in a stable and interactive framework that performs in real time, and supports patient-specific data, which can assist in surgical planning.

  • Journal article
    Smalley K, Aufegger L, Flott K, Holt G, Mayer E, Darzi Aet al., 2019,

    Which behaviour change techniques are most effective in improving healthcare utilisation in COPD self-management programmes? A protocol for a systematic review

    , BMJ Open Respiratory Research, Vol: 6, ISSN: 2052-4439

    IntroductionSelf-management interventions are often presented as a way to improve the quality of care for patients with chronic illness. However self-management is quite broadly-defined and it remains unclear which types of interventions are most successful. This review will use the Theoretical Domains Framework (TDF) as a lens through which to categorise self-management interventions regarding which programmes are most likely to be effective, and under which circumstances. The aim of this study is to (1) describe the types of self-management programmes that have been developed in chronic obstructive pulmonary disease (COPD); and identify the common elements between these to better classify the self-management. (2) Evaluate the effect that self-management programmes have on COPD patients’ healthcare behaviour, by classifying those programmes by the behaviour change techniques used. Methods and analysisA systematic search of the literature will be performed in MEDLINE, EMBASE, HMIC, and PsycINFO. This review will be limited to randomised controlled trials (RCTs) and quasi-experimental studies. The review will follow PRISMA-P guidelines, and will provide a PRISMA checklist and flowchart. Risk of bias in individual studies will be assessed using the Cochrane Risk of Bias criteria, and the quality of included studies will be evaluated using the GRADE criteria, and will be reported in a Summary of Findings table.The primary analysis will be a catalogue of the interventions based on the components of the TDF that were utilised in the intervention. A matrix comparing included behaviour change techniques to improvements in utilisation will summarise the primary outcomes. Ethics and dissemination Not applicable, as this is a secondary review of the literature.Registration detailsPROSPERO: CRD42018104753

  • Journal article
    Moylan A, Appelbaum N, Clarke J, Feather C, Tairraz AF, Maconochie I, Darzi Aet al., 2019,

    Assessing the agreement of 5 ideal body weight calculations for selecting medication dosages for children with obesity

    , JAMA Pediatrics, ISSN: 2168-6203
  • Journal article
    Goiana-da-Silva F, Cruz-e-Silva D, Carrico M, Teixeira NR, Darzi A, Araujo Fet al., 2019,

    Changing the channel: television health campaigns in Portugal

    , Lancet Public Health, Vol: 4, Pages: E179-E179, ISSN: 2468-2667
  • Journal article
    McLeod M, Karampatakis GD, Heyligen L, McGinley A, Franklin BDet al., 2019,

    The impact of implementing a hospital electronic prescribing and administration system on clinical pharmacists' activities - a mixed methods study

    , BMC Health Services Research, Vol: 19, Pages: 1-15, ISSN: 1472-6963

    BackgroundThe increasing adoption of hospital electronic prescribing and medication administration (ePA) systems has driven a wealth of research around the impact on patient safety. Yet relatively little research has sought to understand the effects on staff, particularly pharmacists. We aimed to investigate the effects of ePA on pharmacists’ activities, including interactions with patients and health professionals, and their perceptions of medication safety risks.MethodsA mixed methods study comprising quantitative direct observations of ward pharmacists before and after implementation of ePA in an English hospital, and semi-structured interviews post-ePA. Quantitative data comprised multi-dimensional work activity sampling to establish the proportion of time ward pharmacists spent on different tasks, with whom and where. These data were extrapolated to estimate task duration. Qualitative interviews with pharmacists explored perceived impact on (i) ward activities, (ii) interactions with patients and different health professionals, (iii) locations where tasks were carried out, and (iv) medication errors.ResultsObservations totalled 116 h and 50 min. Task duration analysis suggested screening inpatient medication increased by 16 mins per 10 patients reviewed (p = 0.002), and searching for paper drug charts or computer decreased by 2 mins per 10 patients reviewed (p = 0.001). Pharmacists mainly worked alone (58% of time pre- and 65% post-ePA, p = 0.17), with patient interactions reducing from 5 to 2% of time (p = 0.03). Seven main themes were identified from the interviews, underpinned by a core explanatory concept around the enhanced and shifting role of the ward pharmacist post-ePA. Pharmacists perceived there to be a number of valuable safety features with ePA. However, paradoxically, some of these may have also inadvertently contributed to medication errors.ConclusionThis study provides quantitative and qualitative

  • Conference paper
    Kim JA, Wales DJ, Thompson AJ, Yang G-Zet al., 2019,

    Towards development of fibre-optic surface enhanced Raman spectroscopy probes using 2-photon polymerisation for rapid detection of bacteria

    , Plasmonics in Biology and Medicine XVI, Publisher: SPIE, ISSN: 0277-786X

    In this study, a variety of direct laser written surface-enhanced Raman spectroscopy (SERS) micro-structures, designed for bacteria detection, are presented. Various SERS micro-structures were designed to achieve both a high density of plasmonic hot spots and a strong probability of interaction between the hot spots and the target bacterial cells. Twophoton polymerization was used for initial fabrication of the polymeric skeletons of the SERS micro-structures, which were then coated with a 50 nm-thick gold layer via e-beam evaporation. The micro-structures were fabricated on glass coverslips and were assessed using a confocal Raman microscope. To this end, Rhodamine 6G was used as an analyte under 785 nm laser illumination. The optimal SERS micro-structures showed approximately 7×103 enhancement in Raman signal (analytical enhancement factor, AEF) at a wavenumber of 600 cm-1. Real-time detection of E. coli in solution was demonstrated using the fabricated SERS platform with low laser powers and a short acquisition time (785 nm, 5 mW, 50 ms).

  • Journal article
    Goiana-da-Silva F, Cruz-e-Silva D, Gregorio MJ, Nunes AM, Calhau C, Hercberg S, Rito A, Bento A, Cruz D, Almeida F, Darzi A, Araujo Fet al., 2019,

    Nutri-score: A public health tool to improve eating habits in Portugal

    , Acta Médica Portuguesa, Vol: 32, Pages: 175-178, ISSN: 1646-0758
  • Journal article
    Hemming K, Carroll K, Thompson J, Forbes A, Taljaard Met al., 2019,

    Quality of stepped-wedge trial reporting can be reliably assessed using an updated CONSORT: crowd-sourcing systematic review

    , Journal of Clinical Epidemiology, Vol: 107, Pages: 77-88, ISSN: 0895-4356

    The Consolidated Standards Of Reporting Trials (CONSORT) extension for the stepped-wedge cluster randomised trial (SW-CRT) is a recently published reporting guideline for SW-CRTs. We assess the quality of reporting of a recent sample of SW-CRTs according to the 26 items in the new guideline using a novel crowd sourcing methodology conducted independently and in duplicate, with random assignment, by 50 reviewers. We assessed reliability of the quality assessments, proposing this as a novel way to assess robustness of items in reporting guidelines.Several items were well reported. Some items were very poorly reported, including several items that have unique requirements for the SW-CRT, such as the rationale for use of the design, description of the design, identification and recruitment of participants within clusters, and concealment of cluster allocation (not reported in more than 50% of the reports). Agreement across items was moderate (median percentage agreement was 76% [IQR 64 to 86]). Agreement was low for several items including the description of the trial design and why trial ended or stopped for example.When reporting SW-CRTs authors should pay particular attention to ensure clear reporting on the exact format of the design with justification, as well as how clusters and individuals were identified for inclusion in the study, and whether this was done before or after randomisation of the clusters, which are crucial for risk of bias assessments. Some items, including why the trial ended might either not be relevant to SW-CRTs, or might be unclearly described in the statement.

  • Journal article
    Martin G, Khajuria A, Arora S, King D, Ashrafian H, Darzi Aet al., 2019,

    The impact of mobile technology on teamwork and communication in hospitals: a systematic review

    , Journal of the American Medical Informatics Association, Vol: 26, Pages: 339-355, ISSN: 1067-5027

    Objectives: Effective communication is critical to the safe delivery of care but is characterized by outdated technologies. Mobile technology has the potential to transform communication and teamwork but the evidence is currently uncertain. The objective of this systematic review was to summarize the quality and breadth of evidence for the impact of mobile technologies on communication and teamwork in hospitals. Materials and Methods: Electronic databases (MEDLINE, PsycINFO, EMBASE, CINAHL Plus, HMIC, Cochrane Library, and National Institute of Health Research Health Technology Assessment) were searched for English language publications reporting communication- or teamwork-related outcomes from mobile technologies in the hospital setting between 2007 and 2017. Results: We identified 38 publications originating from 30 studies. Only 11% were of high quality and none met best practice guidelines for mobile-technology-based trials. The studies reported a heterogenous range of quantitative, qualitative, and mixed-methods outcomes. There is a lack of high-quality evidence, but nonetheless mobile technology can lead to improvements in workflow, strengthen the quality and efficiency of communication, and enhance accessibility and interteam relationships. Discussion: This review describes the potential benefits that mobile technology can deliver and that mobile technology is ubiquitous among healthcare professionals. Crucially, it highlights the paucity of high-quality evidence for its effectiveness and identifies common barriers to widespread uptake. Limitations include the limited number of participants and a wide variability in methods and reported outcomes. Conclusion: Evidence suggests that mobile technology has the potential to significantly improve communication and teamwork in hospital provided key organizational, technological, and security challenges are tackled and better evidence delivered.

  • Journal article
    Khanbhai MHF, Flott KM, Darzi A, Mayer Eet al., 2019,

    Evaluating digital maturity and patient acceptability of real-time patient experience feedback systems: a systematic review

    , Journal of Medical Internet Research, Vol: 21, ISSN: 1438-8871

    Background:One of the essential elements of a strategic approach to improving patients’ experience is to measure and report on patients’ experiences in real time. Real-time feedback (RTF) is increasingly being collected using digital technology; however, there are several factors that may influence the success of the digital system.Objective:The aim of this review was to evaluate the digital maturity and patient acceptability of real-time patient experience feedback systems.Methods:We systematically searched the following databases to identify papers that used digital systems to collect RTF: The Cochrane Library, Global Health, Health Management Information Consortium, Medical Literature Analysis and Retrieval System Online, EMBASE, PsycINFO, Web of Science, and CINAHL. In addition, Google Scholar and gray literature were utilized. Studies were assessed on their digital maturity using a Digital Maturity Framework on the basis of the following 4 domains: capacity/resource, usage, interoperability, and impact. A total score of 4 indicated the highest level of digital maturity.Results:RTF was collected primarily using touchscreens, tablets, and Web-based platforms. Implementation of digital systems showed acceptable response rates and generally positive views from patients and staff. Patient demographics according to RTF responses varied. An overrepresentation existed in females with a white predominance and in patients aged ≥65 years. Of 13 eligible studies, none had digital systems that were deemed to be of the highest level of maturity. Three studies received a score of 3, 2, and 1, respectively. Four studies scored 0 points. While 7 studies demonstrated capacity/resource, 8 demonstrated impact. None of the studies demonstrated interoperability in their digital systems.Conclusions:Patients and staff alike are willing to engage in RTF delivered using digital technology, thereby disrupting previous paper-based feedback. However, a lack of emphasis on di

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