Browse through all publications from the Institute of Global Health Innovation, which our Patient Safety Research Collaboration is part of. This feed includes reports and research papers from our Centre. 

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  • Journal article
    Warren L, Clarke J, Arora S, Barahona M, Arebi N, Darzi Aet al., 2019,

    Transitions of care across hospital settings in patients with inflammatory bowel disease

    , World Journal of Gastroenterology, Vol: 25, Pages: 2122-2132, ISSN: 1007-9327

    BACKGROUNDInflammatory bowel disease (IBD) is a chronic, inflammatory disorder characterised by both intestinal and extra-intestinal pathology. Patients may receive both emergency and elective care from several providers, often in different hospital settings. Poorly managed transitions of care between providers can lead to inefficiencies in care and patient safety issues. To ensure that the sharing of patient information between providers is appropriate, timely, accurate and secure, effective data-sharing infrastructure needs to be developed. To optimise inter-hospital data-sharing for IBD patients, we need to better understand patterns of hospital encounters in this group.AIMTo determine the type and location of hospital services accessed by IBD patients in England.METHODSThis was a retrospective observational study using Hospital Episode Statistics, a large administrative patient data set from the National Health Service in England. Adult patients with a diagnosis of IBD following admission to hospital were followed over a 2-year period to determine the proportion of care accessed at the same hospital providing their outpatient IBD care, defined as their ‘home provider’. Secondary outcome measures included the geographic distribution of patient-sharing, regional and age-related differences in accessing services, and type and frequency of outpatient encounters.RESULTSOf 95055 patients accessed hospital services on 1760156 occasions over a 2-year follow-up period. The proportion of these encounters with their identified IBD ‘home provider’ was 73.3%, 87.8% and 83.1% for accident and emergency, inpatient and outpatient encounters respectively. Patients living in metropolitan centres and younger patients were less likely to attend their ‘home provider’ for hospital services. The most commonly attended specialty services were gastroenterology, general surgery and ophthalmology.CONCLUSIONTransitions of care between secondary care sett

  • Journal article
    Aufegger L, Shariq O, Bicknell C, Ashrafian H, Darzi Aet al., 2019,

    Can shared leadership enhance clinical team management? A systematic review

    , Leadership in Health Services, Vol: 32, Pages: 309-335, ISSN: 1751-1879

    PurposeResearch in psychology or management science has shown that shared leadership (SL) enhances information sharing, fosters participation and empowers team members within the decision-making processes, ultimately improving the quality of performance outcomes. Little has been done and, thus, less is known of the value and use of SL in acute healthcare teams. The purpose of this study is to (1) explore, identify and critically assess patterns and behaviour of SL in acute healthcare teams; and (2) evaluate to what extent SL may benefit and accomplish safer care in acute patient treatment and healthcare delivery.Design/methodology/approachThe authors conducted a review that followed the PRISMA-P reporting guidelines. A variety of sources were searched in April 2018 for studies containing primary research that focused on SL in acute healthcare teams. The outcome of interest was a well-specified assessment of SL, and an evaluation of the extent SL may enhance team performance, lead to safer patient care and healthcare delivery in acute healthcare teams.FindingsAfter the study selection process, 11 out of 1,383 studies were included in the review. Studies used a qualitative, quantitative or mixed-methods approach. Emerging themes based on behavioural observations that contributed to SL were: shared mental model; social support and situational awareness; and psychological safety. High-performing teams showed more SL behaviour, teams with less seniority displayed more traditional leadership styles and SL was associated with increased team satisfaction.Research limitations/implicationsEvidence to date suggests that SL may be of benefit to improve performance outcomes in acute healthcare team settings. However, the discrepancy of SL assessments within existing studies and their small sample sizes highlights the need for a large, good quality randomized controlled trial to validate this indication.Originality/valueAlthough studies have acknowledged the relevance of SL in he

  • Journal article
    Ghafur S, Grass E, Jennings N, Darzi Aet al., 2019,

    The challenges of cybersecurity in health care: the UK National Health Service as a case study

    , The Lancet Digital Health, Vol: 1, Pages: e10-e12, ISSN: 2589-7500
  • 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
    Sun Y, Lo B, 2019,

    An artificial neural network framework for gait based biometrics

    , IEEE Journal of Biomedical and Health Informatics, Vol: 23, Pages: 987-998, ISSN: 2168-2194

    OAPA As the popularity of wearable and implantable Body Sensor Network (BSN) devices increases, there is a growing concern regarding the data security of such power-constrained miniaturized medical devices. With limited computational power, BSN devices are often not able to provide strong security mechanisms to protect sensitive personal and health information, such as one's physiological data. Consequently, many new methods of securing Wireless Body Area Networks (WBANs) have been proposed recently. One effective solution is the Biometric Cryptosystem (BCS) approach. BCS exploits physiological and behavioral biometric traits, including face, iris, fingerprints, Electrocardiogram (ECG), and Photoplethysmography (PPG). In this paper, we propose a new BCS approach for securing wireless communications for wearable and implantable healthcare devices using gait signal energy variations and an Artificial Neural Network (ANN) framework. By simultaneously extracting similar features from BSN sensors using our approach, binary keys can be generated on demand without user intervention. Through an extensive analysis on our BCS approach using a gait dataset, the results have shown that the binary keys generated using our approach have high entropy for all subjects. The keys can pass both NIST and Dieharder statistical tests with high efficiency. The experimental results also show the robustness of the proposed approach in terms of the similarity of intra-class keys and the discriminability of the inter-class keys.

  • 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
    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
    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
    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).

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