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  • Journal article
    Clarke J, Beaney T, Majeed A, Darzi A, Barahona Met al., 2020,

    Identifying naturally occurring communities of primary care providers in the English National Health Service in London

    , BMJ Open, Vol: 10, Pages: 1-7, ISSN: 2044-6055

    Objectives - Primary Care Networks (PCNs) are a new organisational hierarchy with wide-ranging responsibilities introduced in the National Health Service (NHS) Long Term Plan. The vision is that they represent ‘natural’ communities of general practices (GP practices) working together at scale and covering a geography that make sense to practices, other healthcare providers and local communities. Our study aims to identify natural communities of GP practices based on patient registration patterns using Markov Multiscale Community Detection, an unsupervised network-based clustering technique to create catchments for these communities.Design - Retrospective observational study using Hospital Episode Statistics – patient-level administrative records of inpatient, outpatient and emergency department attendances to hospital.Setting – General practices in the 32 Clinical Commissioning Groups of Greater London Participants - All adult patients resident in and registered to a GP practices in Greater London that had one or more outpatient encounters at NHS hospital trusts between 1st April 2017 and 31st March 2018.Main outcome measures The allocation of GP practices in Greater London to PCNs based on the registrations of patients resident in each Lower Super Output Area (LSOA) of Greater London. The population size and coverage of each proposed PCN. Results - 3,428,322 unique patients attended 1,334 GPs in 4,835 LSOAs in Greater London. Our model grouped 1,291 GPs (96.8%) and 4,721 LSOAs (97.6%), into 165 mutually exclusive PCNs. The median PCN list size was 53,490, with a lower quartile of 38,079 patients and an upper quartile of 72,982 patients. A median of 70.1% of patients attended a GP within their allocated PCN, ranging from 44.6% to 91.4%.Conclusions - With PCNs expected to take a role in population health management and with community providers expected to reconfigure around them, it is vital we recognise how PCNs represent their communities. O

  • Journal article
    van Dael J, Reader T, Gillespie A, Neves A, Darzi A, Mayer Eet al., 2020,

    Learning from complaints in healthcare: a realist review of academic literature, policy evidence, and frontline insights

    , BMJ Quality and Safety, Vol: 29, Pages: 684-695, ISSN: 2044-5415

    Introduction A global rise in patient complaints has been accompanied by growing research to effectively analyse complaints for safer, more patient-centric care. Most patients and families complain to improve the quality of healthcare, yet progress has been complicated by a system primarily designed for case-by-case complaint handling.Aim To understand how to effectively integrate patient-centric complaint handling with quality monitoring and improvement.Method Literature screening and patient codesign shaped the review’s aim in the first stage of this three-stage review. Ten sources were searched including academic databases and policy archives. In the second stage, 13 front-line experts were interviewed to develop initial practice-based programme theory. In the third stage, evidence identified in the first stage was appraised based on rigour and relevance, and selected to refine programme theory focusing on what works, why and under what circumstances.Results A total of 74 academic and 10 policy sources were included. The review identified 12 mechanisms to achieve: patient-centric complaint handling and system-wide quality improvement. The complaint handling pathway includes (1) access of information; (2) collaboration with support and advocacy services; (3) staff attitude and signposting; (4) bespoke responding; and (5) public accountability. The improvement pathway includes (6) a reliable coding taxonomy; (7) standardised training and guidelines; (8) a centralised informatics system; (9) appropriate data sampling; (10) mixed-methods spotlight analysis; (11) board priorities and leadership; and (12) just culture.Discussion If healthcare settings are better supported to report, analyse and use complaints data in a standardised manner, complaints could impact on care quality in important ways. This review has established a range of evidence-based, short-term recommendations to achieve this.

  • Journal article
    Soosaipillai G, Archer S, Ashrafian H, Darzi Aet al., 2020,

    Breaking bad news training in the COVID-19 era and beyond

    , Journal of Medical Education and Curricular Development, Vol: 7, Pages: 1-4, ISSN: 2382-1205

    COVID-19 has disrupted the status quo for healthcare education. As a result, redeployed doctors and nurses are caring for patients at the end of their lives and breaking bad news with little experience or training. This article aims to understand why redeployed doctors and nurses feel unprepared to break bad news through a content analysis of their training curricula. As digital learning has come to the forefront in health care education during this time, relevant digital resources for breaking bad news training are suggested.

  • Journal article
    Kinross JM, Mason SE, Mylonas G, Darzi Aet al., 2020,

    Next-generation robotics in gastrointestinal surgery

    , Nature Reviews Gastroenterology and Hepatology, Vol: 17, Pages: 430-440, ISSN: 1759-5045

    The global numbers of robotic gastrointestinal surgeries are increasing. However, the evidence base for robotic gastrointestinal surgery does not yet support its widespread adoption or justify its cost. The reasons for its continued popularity are complex, but a notable driver is the push for innovation — robotic surgery is seen as a compelling solution for delivering on the promise of minimally invasive precision surgery — and a changing commercial landscape delivers the promise of increased affordability. Novel systems will leverage the robot as a data-driven platform, integrating advances in imaging, artificial intelligence and machine learning for decision support. However, if this vision is to be realized, lessons must be heeded from current clinical trials and translational strategies, which have failed to demonstrate patient benefit. In this Perspective, we critically appraise current research to define the principles on which the next generation of gastrointestinal robotics trials should be based. We also discuss the emerging commercial landscape and define existing and new technologies.

  • Journal article
    Kassanos P, Berthelot M, Kim JA, Rosa BMG, Seichepine F, Anastasova S, Sodergren MH, Leff DR, Lo B, Darzi A, Yang G-Zet al., 2020,

    Smart sensing for surgery from tethered devices to wearables and implantables

    , IEEE Systems Man and Cybernetics Magazine, Vol: 6, Pages: 39-48, ISSN: 2333-942X

    Recent developments in wearable electronics have fueled research into new materials, sensors, and microelectronic technologies for the realization of devices that have increased functionality and performance. This is further enhanced by advances in fabr ication methods and printing techniques, stimulating research on implantables and the advancement of existing medical devices. This article provides an overview of new designs, embodiments, fabrication methods, instrumentation, and informatics as well as the challenges in developing and deploying such devices and clinical applications that can benefit from them. The need for and use of these technologies across the perioperative surgical-care pathway are highlighted, along with a vision for the future and how these tools can be adopted by potential end users and health-care systems.

  • Journal article
    Black A, Gage H, Norton C, Franklin BD, Murrells T, Courtenay Met al., 2020,

    A comparison between independent nurse prescribing and patient group directions in the safety and appropriateness of medication provision in United Kingdom sexual health services: A mixed methods study

    , INTERNATIONAL JOURNAL OF NURSING STUDIES, Vol: 107, ISSN: 0020-7489
  • Journal article
    Sun L, Joshi M, Khan SN, Ashrafian H, Darzi Aet al., 2020,

    Clinical impact of multi-parameter continuous non-invasive monitoring in hospital wards: a systematic review and meta-analysis

    , Journal of the Royal Society of Medicine, Vol: 113, Pages: 217-224, ISSN: 0141-0768

    ObjectiveDelayed response to clinical deterioration as a result of intermittent vital sign monitoring is a cause of preventable morbidity and mortality. This review focuses on the clinical impact of multi-parameter continuous non-invasive monitoring of vital signs (CoNiM) in non-intensive care unit patients.DesignSystematic review and meta-analysis of primary studies. Embase, MEDLINE, HMIC, PsycINFO and Cochrane were searched from April 1964 to 18 June 2019 with no language restriction.SettingThe search was limited to hospitalised, non-intensive care unit adult patients who had two or more vital signs continuously monitored.ParticipantsAll primary studies that evaluated the clinical impact of using multi-parameter CoNiM in adult hospital wards outside of the intensive care unit.Main outcome measuresClinical impact of multi-parameter CoNiM.

  • Journal article
    Sounderajah V, Ashrafian H, Aggarwal R, De Fauw J, Denniston AK, Greaves F, Karthikesalingam A, King D, Liu X, Markar SR, McInnes MDF, Panch T, Pearson-Stuttard J, Ting DSW, Golub RM, Moher D, Bossuyt PM, Darzi Aet al., 2020,

    Developing specific reporting guidelines for diagnostic accuracy studies assessing AI interventions: The STARD-AI Steering Group

    , Nature Medicine, Vol: 26, Pages: 807-808, ISSN: 1078-8956
  • Journal article
    Ramdas K, Darzi A, Jain S, 2020,

    'Test, re-test, re-test': using inaccurate tests to greatly increase the accuracy of COVID-19 testing

    , Nature Methods, Vol: 26, Pages: 810-811, ISSN: 1548-7091
  • Journal article
    Wheeler C, Furniss D, Galal-Edeen GH, Blandford A, Franklin BDet al., 2020,

    Patients' Perspectives on the Quality and Safety of Intravenous Infusions: A Qualitative Study

    , JOURNAL OF PATIENT EXPERIENCE, Vol: 7, Pages: 380-385, ISSN: 2374-3743

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