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  • Journal article
    Orlovic M, Callender T, Riley J, Darzi A, Droney Jet al., 2020,

    Impact of advance care planning on dying in hospital: Evidence from urgent care records

    , PLoS One, Vol: 15, Pages: 1-12, ISSN: 1932-6203

    Place of death is an important outcome of end-of-life care. Many people do not have the opportunity to express their wishes and die in their preferred place of death. Advance care planning (ACP) involves discussion, decisions and documentation about how an individual contemplates their future death. Recording end-of-life preferences gives patients a sense of control over their future. Coordinate My Care (CMC) is London’s largest electronic palliative care register designed to provide effective ACP, with information being shared with urgent care providers. The aim of this study is to explore determinants of dying in hospital. Understanding advance plans and their outcomes can help in understanding the potential effects that implementation of electronic palliative care registers can have on the end-of-life care provided. Retrospective observational cohort analysis included 21,231 individuals aged 18 or older with a Coordinate My Care plan who had died between March 2011 and July 2019 with recorded place of death. Logistic regression was used to explore demographic and end-of-life preference factors associated with hospital deaths. 22% of individuals died in hospital and 73% have achieved preferred place of death. Demographic characteristics and end-of-life preferences have impact on dying in hospital, with the latter having the strongest influence. The likelihood of in-hospital death is substantially higher in patients without documented preferred place of death (OR = 1.43, 95% CI 1.26–1.62, p<0.001), in those who prefer to die in hospital (OR = 2.30, 95% CI 1.60–3.30, p<0.001) and who prefer to be cared in hospital (OR = 2.77, 95% CI 1.94–3.96, p<0.001). “Not for resuscitation” individuals (OR = 0.43, 95% CI 0.37–0.50, p<0.001) and who preferred symptomatic treatment (OR = 0.36, 95% CI 0.33–0.40, p<0.001) had a lower likelihood of in-hospital death. Effective advance care planning is necessary for improve

  • Journal article
    Joshi M, Ashrafian H, Khan S, Darzi Aet al., 2020,

    Sepsis

    , The Lancet, Vol: 396, Pages: 1805-1805, ISSN: 0140-6736
  • Journal article
    Saracino A, Oude-Vrielink TJC, Menciassi A, Sinibaldi E, Mylonas GPet al., 2020,

    Haptic Intracorporeal Palpation Using a Cable-Driven Parallel Robot: A User Study

    , IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, Vol: 67, Pages: 3452-3463, ISSN: 0018-9294
  • Journal article
    Neves AL, Lawrence-Jones A, Naar L, Greenfield G, Sanderson F, Hyde T, Wingfield D, Cassidy I, Mayer Eet al., 2020,

    Multidisciplinary teams must work together to co-develop inclusive digital primary care for older people

    , British Journal of General Practice, Vol: 70, Pages: 582-582, ISSN: 0960-1643
  • Journal article
    Suwa Y, Joshi M, Poynter L, Endo I, Ashrafian H, Darzi Aet al., 2020,

    Obese patients and robotic colorectal surgery: systematic review and meta-analysis

    , BJS Open, Vol: 4, Pages: 1042-1053, ISSN: 2474-9842

    BackgroundObesity is a major health problem, demonstrated to double the risk of colorectal cancer. The benefits of robotic colorectal surgery in obese patients remain largely unknown. This meta‐analysis evaluated the clinical and pathological outcomes of robotic colorectal surgery in obese and non‐obese patients.MethodsMEDLINE, Embase, Global Health, Healthcare Management Information Consortium (HMIC) and Midwives Information and Resources Service (MIDIRS) databases were searched on 1 August 2018 with no language restriction. Meta‐analysis was performed according to PRISMA guidelines. Obese patients (BMI 30 kg/m2 or above) undergoing robotic colorectal cancer resections were compared with non‐obese patients. Included outcome measures were: operative outcomes (duration of surgery, conversion to laparotomy, blood loss), postoperative complications, hospital length of stay and pathological outcomes (number of retrieved lymph nodes, positive circumferential resection margins and length of distal margin in rectal surgery).ResultsA total of 131 full‐text articles were reviewed, of which 12 met the inclusion criteria and were included in the final analysis. There were 3166 non‐obese and 1420 obese patients. A longer duration of surgery was documented in obese compared with non‐obese patients (weighted mean difference −21·99 (95 per cent c.i. −31·52 to −12·46) min; P < 0·001). Obese patients had a higher rate of conversion to laparotomy than non‐obese patients (odds ratio 1·99, 95 per cent c.i. 1·54 to 2·56; P < 0·001). Blood loss, postoperative complications, length of hospital stay and pathological outcomes were not significantly different in obese and non‐obese patients.ConclusionRobotic surgery in obese patients results in a significantly longer duration of surgery and higher conversion rates than in non‐obese patients. Further studies should focus on bette

  • Journal article
    Grimes TC, Garfield S, Kelly D, Cahill J, Cromie S, Wheeler C, Franklin BDet al., 2020,

    Household medication safety practices during the COVID-19 pandemic: a descriptive qualitative study protocol

    , BMJ Open, Vol: 10, Pages: 1-6, ISSN: 2044-6055

    Introduction Those who are staying at home and reducing contact with other people during the COVID-19 pandemic are likely to be at greater risk of medication-related problems than the general population. This study aims to explore household medication practices by and for this population, identify practices that benefit or jeopardise medication safety and develop best practice guidance about household medication safety practices during a pandemic, grounded in individual experiences.Methods and analysis This is a descriptive qualitative study using semistructured interviews, by telephone or video call. People who have been advised to ‘cocoon’/‘shield’ and/or are aged 70 years or over and using at least one long-term medication, or their caregivers, will be eligible for inclusion. We will recruit 100 patient/carer participants: 50 from the UK and 50 from Ireland. Recruitment will be supported by our patient and public involvement (PPI) partners, personal networks and social media. Individual participant consent will be sought, and interviews audio/video recorded and/or detailed notes made. A constructivist interpretivist approach to data analysis will involve use of the constant comparative method to organise the data, along with inductive analysis. From this, we will iteratively develop best practice guidance about household medication safety practices during a pandemic from the patient’s/carer’s perspective.Ethics and dissemination This study has Trinity College Dublin, University of Limerick and University College London ethics approvals. We plan to disseminate our findings via presentations at relevant patient/public, professional, academic and scientific meetings, and for publication in peer-reviewed journals. We will create a list of helpful strategies that participants have reported and share this with participants, PPI partners and on social media.

  • Journal article
    Neves AL, Freise L, Laranjo L, Carter A, Darzi A, Mayer Eet al., 2020,

    Impact of providing patients access to electronic health records on quality and safety of care: a systematic review and meta-analysis

    , BMJ Quality and Safety, Vol: 29, Pages: 1019-1032, ISSN: 2044-5415

    Objective To evaluate the impact of sharing electronic health records (EHRs) with patients and map it across six domains of quality of care (ie, patient-centredness, effectiveness, efficiency, timeliness, equity and safety).Design Systematic review and meta-analysis.Data sources CINAHL, Cochrane, Embase, HMIC, Medline/PubMed and PsycINFO, from 1997 to 2017.Eligibility criteria Randomised trials focusing on adult subjects, testing an intervention consisting of sharing EHRs with patients, and with an outcome in one of the six domains of quality of care.Data analysis The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Title and abstract screening were performed by two pairs of investigators and assessed using the Cochrane Risk of Bias Tool. For each domain, a narrative synthesis of the results was performed, and significant differences in results between low risk and high/unclear risk of bias studies were tested (t-test, p<0.05). Continuous outcomes evaluated in four studies or more (glycated haemoglobin (HbA1c), systolic blood pressure (SBP) and diastolic blood pressure (DBP)) were pooled as weighted mean difference (WMD) using random effects meta-analysis. Sensitivity analyses were performed for low risk of bias studies, and long-term interventions only (lasting more than 12 months).Results Twenty studies were included (17 387 participants). The domain most frequently assessed was effectiveness (n=14), and the least were timeliness and equity (n=0). Inconsistent results were found for patient-centredness outcomes (ie, satisfaction, activation, self-efficacy, empowerment or health literacy), with 54.5% of the studies (n=6) demonstrating a beneficial effect. Meta-analyses showed a beneficial effect in effectiveness by reducing absolute values of HbA1c (unit: %; WMD=−0.316; 95% CI −0.540 to −0.093, p=0.005, I2=0%), which remained significant in the sensitivity analyses for low risk of bias s

  • Report
    Thompson D, Leis M, Davies N, Viner Ret al., 2020,

    Building healthy societies: A framework for integrating health and health promotion into education

    , Publisher: The World Innovation Summit for Health (WISH)

    The report explores how health activities can be implemented into education systems to deliver improved health outcomes.

  • Report
    Roland J, Lawrance E, Insel T, Christensen Het al., 2020,

    The digital mental health revolution: Transforming care through innovation and scale-up

    , Publisher: The World Innovation Summit for Health (WISH)

    The report reviews how to prepare and navigate innovations and their potential to address critical health needs.

  • Journal article
    Shaw A, Flott K, Fontana G, Durkin M, Darzi Aet al., 2020,

    No patient safety without health worker safety Comment

    , The Lancet, Vol: 396, Pages: 1541-1543, ISSN: 0140-6736

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