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  • Journal article
    Archer S, Thibaut B, Dewa L, Ramtale S, D'Lima D, Simpson A, Murray K, Adam S, Darzi Aet al., 2020,

    Barriers and facilitators to incident reporting in mental healthcare settings: a qualitative study

    , Journal of Psychiatric and Mental Health Nursing, Vol: 27, Pages: 211-223, ISSN: 1351-0126

    IntroductionBarriers and facilitators to incident reporting have been widely researched in general healthcare. However, it is unclear if the findings are applicable to mental healthcare where care is increasingly complex.AimTo investigate if barriers and facilitators affecting incident reporting in mental healthcare are consistent with factors identified in other healthcare settings.MethodData were collected from focus groups (n=8) with 52 members of staff from across [a large Mental Health] Trust and analysed with thematic analysis.ResultsFive themes were identified during the analysis. Three themes (i)learning and improvement, (ii)time, and (iii)fear were consistent with the existing wider literature on barriers and facilitators to incident reporting. Two further themes (iv)interaction between patient diagnosis and incidents and (v)aftermath of an incident – prosecution specifically linked to the provision of mental healthcare.ConclusionsWhilst some barriers and facilitators to incident reporting identified in other settings are also prevalent in the mental healthcare setting, the increased incidence of violent and aggressive behaviour within mental healthcare presents a unique challenge for incident reporting.Clinical ImplicationsAlthough Interventions to improve incident reporting may be adapted/adopted from other settings, there is a need to develop specific interventions to improve reporting of violent and aggressive incidents.

  • Journal article
    Cresswell K, Sheikh A, Franklin BD, Krasuska M, Hung TN, Hinder S, Lane W, Mozaffar H, Mason K, Eason S, Potts HWW, Williams Ret al., 2020,

    Theoretical and methodological considerations in evaluating large-scale health information technology change programmes

  • Journal article
    Aufegger L, Serou N, Chen S, Franklin BDet al., 2020,

    Evaluating users' experiences of electronic prescribing systems in relation to patient safety: a mixed methods study

    , BMC Medical Informatics and Decision Making, Vol: 20, ISSN: 1472-6947

    BackgroundUser interface (UI) design features such as screen layout, density of information, and use of colour may affect the usability of electronic prescribing (EP) systems, with usability problems previously associated with medication errors. To identify how to improve existing systems, our aim was to explore prescribers’ perspectives of UI features of a commercially available EP system, and how these may affect patient safety.MethodsTwo studies were conducted, each including ten participants prescribing a penicillin for a test patient with a penicillin allergy. In study 1, eye-gaze tracking was used as a means to explore visual attention and behaviour during prescribing, followed by a self-reported EP system usability scale. In study 2, a think-aloud method and semi-structured interview were applied to explore participants’ thoughts and views on prescribing, with a focus on UI design and patient safety.ResultsStudy 1 showed high visual attention toward information on allergies and patient information, allergy pop-up alerts, and medication order review and confirmation, with less visual attention on adding medication. The system’s usability was rated ‘below average’. In study 2, participants highlighted EP design features and workflow, including screen layout and information overload as being important for patient safety, benefits of EP systems such as keeping a record of relevant information, and suggestions for improvement in relation to system design (colour, fonts, customization) and patient interaction.ConclusionsSpecific UI design factors were identified that may improve the usability and/or safety of EP systems. It is suggested that eye-gaze tracking and think-aloud methods are used in future experimental research in this area. Limitations include the small sample size; further work should include similar studies on other EP systems.

  • Journal article
    Franklin BD, Abel G, Shojania KG, 2020,

    Medication non-adherence: an overlooked target for quality improvement interventions

    , BMJ QUALITY & SAFETY, Vol: 29, Pages: 271-273, ISSN: 2044-5415
  • Journal article
    Posthuma LM, Downey C, Visscher MJ, Ghazali DA, Joshi M, Ashrafian H, Khan S, Darzi A, Goldstone J, Preckel Bet al., 2020,

    Remote wireless vital signs monitoring on the ward for early detection of deteriorating patients: A case series

  • Journal article
    Zhao M, Oude Vrielink TJC, Kogkas A, Runciman M, Elson D, Mylonas Get al., 2020,

    LaryngoTORS: a novel cable-driven parallel robotic system for transoral laser phonosurgery

    , IEEE Robotics and Automation Letters, Vol: 5, Pages: 1516-1523, ISSN: 2377-3766

    Transoral laser phonosurgery is a commonly used surgical procedure in which a laser beam is used to perform incision, ablation or photocoagulation of laryngeal tissues. Two techniques are commonly practiced: free beam and fiber delivery. For free beam delivery, a laser scanner is integrated into a surgical microscope to provide an accurate laser scanning pattern. This approach can only be used under direct line of sight, which may cause increased postoperative pain to the patient and injury, is uncomfortable for the surgeon during prolonged operations, the manipulability is poor and extensive training is required. In contrast, in the fiber delivery technique, a flexible fiber is used to transmit the laser beam and therefore does not require direct line of sight. However, this can only achieve manual level accuracy, repeatability and velocity, and does not allow for pattern scanning. Robotic systems have been developed to overcome the limitations of both techniques. However, these systems offer limited workspace and degrees-of-freedom (DoF), limiting their clinical applicability. This work presents the LaryngoTORS, a robotic system that aims at overcoming the limitations of the two techniques, by using a cable-driven parallel mechanism (CDPM) attached at the end of a curved laryngeal blade for controlling the end tip of the laser fiber. The system allows autonomous generation of scanning patterns or user driven freepath scanning. Path scan validation demonstrated errors as low as 0.054±0.028 mm and high repeatability of 0.027±0.020 mm (6×2 mm arc line). Ex vivo tests on chicken tissue have been carried out. The results show the ability of the system to overcome limitations of current methods with high accuracy and repeatability using the superior fiber delivery approach.

  • Journal article
    Fusari G, Gibbs E, Hoskin L, Dickens D, Leis M, Taylor E, Jones F, Darzi Aet al., 2020,

    Protocol for a feasibility study of OnTrack: a digital system for upper limb rehabilitation after stroke.

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

    INTRODUCTION: Arm weakness is a common problem after stroke (affecting 450 000 people in the UK) leading to loss of independence. Repetitive activity is critical for recovery but research shows people struggle with knowing what or how much to do, and keeping track of progress. Working with more than 100 therapists (occupational therapists and physiotherapists) and patients with stroke, we codeveloped the OnTrack intervention-consisting of software for smart devices and coaching support-that has the potential to address this problem. This is a protocol to assess the feasibility of OnTrack for evaluation in a randomised control trial. METHODS AND ANALYSIS: A mixed-method, single-arm study design will be used to evaluate the feasibility of OnTrack for hospital and community use. A minimum sample of 12 participants from a stroke unit will be involved in the study for 14 weeks. During week 1, 8 and 14 participants will complete assessments relating to their arm function, arm impairment and activation. During weeks 2-13, participants will use OnTrack to track their arm movement in real time, receive motivational messages and face-to-face sessions to address problems, gain feedback on activity and receive self-management skills coaching. All equipment will be loaned to study participants. A parallel process evaluation will be conducted to assess the intervention's fidelity, dose and reach, using a mixed-method approach. A public and patient involvement group will oversee the study and help with interpretation and dissemination of qualitative and quantitative data findings. ETHICS AND DISSEMINATION: Ethical approval granted by the National Health Service Health Research Authority, Health and Care Research Wales, and the London-Surrey Research Ethics Committee (ref. 19/LO/0881). Trial results will be submitted for publication in peer review journals, presented at international conferences and disseminated among stroke communities. The results of this trial will inform

  • Journal article
    Goiana-da-Silva F, Severo M, Cruz-E-Silva D, Gregório MJ, Allen L, Muc M, Morais Nunes A, Torres D, Miraldo M, Ashrafian H, Rito A, Wickramasinghe K, Breda J, Darzi A, Araújo F, Lopes Cet al., 2020,

    Projected impact of the Portuguese sugar-sweetened beverages tax on obesity incidence across different age groups: a modelling study

    , PLoS Medicine, Vol: 17, Pages: 1-17, ISSN: 1549-1277

    BackgroundExcessive consumption of sugar has a well-established link with obesity. Preliminary results show that a tax levied on sugar-sweetened beverages (SSBs) by the Portuguese government in 2017 led to a drop in sales and reformulation of these products. This study models the impact the market changes triggered by the tax levied on SSBs had on obesity incidence across various age groups in Portugal.Methods and findingsWe performed a national market analysis and population-wide modelling study using market data for the years 2014–2018 from the Portuguese Association of Non-Alcoholic Drinks (GlobalData and Nielsen Consumer Panel), dietary data from a national survey (IAN-AF 2015–2016), and obesity incidence data from several cohort studies. Dietary energy density from SSBs was calculated by dividing the energy content (kcal/gram) of all SSBs by the total food consumption (in grams). We used the potential impact fraction (PIF) equation to model the projected impact of the tax-triggered change in sugar consumption on obesity incidence, through both volume reduction and reformulation. Results showed a reduction of 6.6 million litres of SSBs sold per year. Product reformulation led to a decrease in the average energy density of SSBs by 3.1 kcal/100 ml. This is estimated to have prevented around 40–78 cases of obesity per year between 2016 and 2018, with the biggest projected impact observed in adolescents 10 to <18 years old. The model shows that the implementation of this tax allowed for a 4 to 8 times larger projected impact against obesity than would be achieved though reformulation alone. The main limitation of this study is that the model we used includes data from various sources, which can result in biases—despite our efforts to mitigate them—related to the methodological differences between these sources.ConclusionsThe tax triggered both a reduction in demand and product reformulation. These, together, can reduce obesity levels

  • Journal article
    Mazzucato M, Li HL, Darzi A, 2020,

    Is it time to nationalise the pharmaceutical industry?

    , BMJ: British Medical Journal, Vol: 368, Pages: 1-3, ISSN: 0959-535X
  • Conference paper
    Dryden S, Anastasova S, Satta G, Thompson AJ, Leff DR, Darzi AWet al., 2020,

    Toward point-of-care uropathogen detection using SERS active filters

    , Optical Diagnostics and Sensing XX: Toward Point-of-Care Diagnostics, Publisher: SPIE, Pages: 1124705-1-1124705-7

    150 million people worldwide suffer one or more urinary tract infections (UTIs) annually. UTIs are a significant health burden: societal costs of UTI exceed $3.5 billion in the U.S. alone; 5% of sepsis cases arise from a urinary source; and UTIs are a prominent contributor toward antimicrobial resistance (AMR). Current diagnostic frameworks exacerbate this burden by providing inaccurate and delayed diagnosis. Rapid point-of-care bacterial identification will allow for early precision treatment, fundamentally altering the UTI paradigm. Raman spectroscopy has a proven ability to provide rapid bacterial identification but is limited by weak bacterial signal and a susceptibility to background fluorescence. These limitations may be overcome using surface enhanced Raman spectroscopy (SERS), provided close and consistent application of bacteria to the SERS-active surface can be achieved. Physical filtration provides a means of capturing uropathogens, separating them from the background solution and acting as SERS-active surface. This work demonstrates that filters can provide a means of aggregating bacteria, thereby allowing subsequent enhancement of the acquired Raman signal using metallic nanoparticles. 60 bacterial suspensions of common uropathogens were vacuum filtered onto commercial polyvinylidene fluoride membrane filters and Raman signals were enhanced by the addition of silver nanoparticles directly onto the filter surface. SERS spectra were acquired using a commercial Raman spectrometer (Ocean Optics, Inc.). Principal Component – Linear Discriminant Analysis provided discrimination of infected from control samples (accuracy: 88.75%, 95% CI: 79.22-94.59%, p-value <0.05). Amongst infected samples uropathogens were classified with 80% accuracy. This study has demonstrated that combining Raman spectroscopy with membrane filtration and SERS can provide identification of infected samples and rapid bacterial classification.

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