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  • Journal article
    Sounderajah V, Patel V, Varatharajan L, Harling L, Normahani P, Symons J, Barlow J, Darzi A, Ashrafian Het al., 2020,

    Are disruptive innovations recognised in the healthcare literature? A systematic review

    , BMJ Innovations, Vol: 7, Pages: 208-216, ISSN: 2055-8074

    The study aims to conduct a systematic review to characterise the spread and use of the concept of ‘disruptive innovation’ within the healthcare sector. We aim to categorise references to the concept over time, across geographical regions and across prespecified healthcare domains. From this, we further aim to critique and challenge the sector-specific use of the concept. PubMed, Medline, Embase, Global Health, PsycINFO, Maternity and Infant Care, and Health Management Information Consortium were searched from inception to August 2019 for references pertaining to disruptive innovations within the healthcare industry. The heterogeneity of the articles precluded a meta-analysis, and neither quality scoring of articles nor risk of bias analyses were required. 245 articles that detailed perceived disruptive innovations within the health sector were identified. The disruptive innovations were categorised into seven domains: basic science (19.2%), device (12.2%), diagnostics (4.9%), digital health (21.6%), education (5.3%), processes (17.6%) and technique (19.2%). The term has been used with increasing frequency annually and is predominantly cited in North American (78.4%) and European (15.2%) articles. The five most cited disruptive innovations in healthcare are ‘omics’ technologies, mobile health applications, telemedicine, health informatics and retail clinics. The concept ‘disruptive innovation’ has diffused into the healthcare industry. However, its use remains inconsistent and the recognition of disruption is obscured by other types of innovation. The current definition does not accommodate for prospective scouting of disruptive innovations, a likely hindrance to policy makers. Redefining disruptive innovation within the healthcare sector is therefore crucial for prospectively identifying cost-effective innovations.

  • Report
    Riley S, Walters C, Wang H, Eales O, Ainslie K, Atchison C, Fronterre C, Diggle PJ, Ashby D, Donnelly C, Cooke G, Barclay W, Ward H, Darzi A, Elliott Pet al., 2020,

    REACT-1 round 7 updated report: regional heterogeneity in changes in prevalence of SARS-CoV-2 infection during the second national COVID-19 lockdown in England

    , REACT-1 round 7 updated report: regional heterogeneity in changes in prevalence of SARS-CoV-2 infection during the second national COVID-19 lockdown in England, London, Publisher: Imperial College London

    BackgroundEngland exited a four-week second national lockdown on 2nd December 2020 initiated in response to the COVID-19 pandemic. Prior results showed that prevalence dropped during the first half of lockdown, with greater reductions in higher-prevalence northern regions.MethodsREACT-1 is a series of community surveys of SARS-CoV-2 RT-PCR swab-positivity in England, designed to monitor the spread of the epidemic and thus increase situational awareness. Round 7 of REACT-1 commenced swab-collection on 13th November 2020. A prior interim report included data from 13th to 24th November 2020 for 105,122 participants. Here, we report data for the entire round with swab results obtained up to 3rd December 2020.ResultsBetween 13th November and 3rd December (round 7) there were 1,299 positive swabs out of 168,181 giving a weighted prevalence of 0.94% (95% CI 0.87%, 1.01%) or 94 per 10,000 people infected in the community in England. This compares with a prevalence of 1.30% (1.21%, 1.39%) from 16th October to 2nd November 2020 (round 6), a decline of 28%. Prevalence during the latter half of round 7 was 0.91% (95% CI, 0.81%, 1.03%) compared with 0.96% (0.87%, 1.05%) in the first half. The national R number in round 7 was estimated at 0.96 (0.88, 1.03) with a decline in prevalence observed during the first half of this period no longer apparent during the second half at the end of lockdown. During round 7 there was a marked fall in prevalence in West Midlands, a levelling off in some regions and a rise in London. R numbers at regional level ranged from 0.60 (0.41, 0.80) in West Midlands up to 1.27 (1.04, 1.54) in London, where prevalence was highest in the east and south-east of the city. Nationally, between 13th November and 3rd December, the highest prevalence was in school-aged children especially at ages 13-17 years at 2.04% (1.69%, 2.46%), or approximately 1 in 50.ConclusionBetween the previous round and round 7 (during lockdown), there was a fall in prevalence of SARS-C

  • 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,


    , The Lancet, Vol: 396, Pages: 1805-1805, ISSN: 0140-6736
  • 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
    Geeson C, Wei L, Franklin BD, 2020,

    Analysis of pharmacist-identified medication-related problems at two United Kingdom hospitals: a prospective observational study

    , INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Vol: 28, Pages: 643-651, ISSN: 0961-7671
  • 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
    Harkanen M, Franklin BD, Murrells T, Rafferty AM, Vehvilainen-Julkunen Ket al., 2020,

    Factors contributing to reported medication administration incidents in patients' homes - A text mining analysis

    , JOURNAL OF ADVANCED NURSING, Vol: 76, Pages: 3573-3583, ISSN: 0309-2402
  • 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
    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.

This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.

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