Imperial College London

Professor the Lord Darzi of Denham PC KBE FRS FMedSci HonFREng

Faculty of MedicineDepartment of Surgery & Cancer

Co-Director of IGHI, Professor of Surgery
 
 
 
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Contact

 

+44 (0)20 3312 1310a.darzi

 
 
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Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

1771 results found

Warren L, Harrison M, Arora S, Darzi Aet al., 2019, Working with patients and the public to design an electronic health record interface: A qualitative mixed-methods study, BMC Medical Informatics and Decision Making, Vol: 19, ISSN: 1472-6947

BackgroundEnabling patients to be active users of their own medical records may promote the delivery of safe, efficient care across settings. Patients are rarely involved in designing digital health record systems which may make them unsuitable for patient use. We aimed to develop an evidence-based electronic health record (EHR) interface and participatory design process by involving patients and the public.MethodsParticipants were recruited to multi-step workshops involving individual and group design activities. A mixture of quantitative and qualitative questionnaires and observational methods were used to collect participant perspectives on interface design and feedback on the workshop design process.Results48 recruited participants identified several design principles and components of a patient-centred electronic medical record interface. Most participants indicated that an interactive timeline would be an appropriate way to depict a medical history. Several key principles and design components, including the use of specific colours and shapes for clinical events, were identified. Participants found the workshop design process utilised to be useful, interesting, enjoyable and beneficial to their understanding of the challenges of information exchange in healthcare.ConclusionPatients and the public should be involved in EHR interface design if these systems are to be suitable for use by patient-users. Workshops, as used in this study, can provide an engaging format for patient design input. Design principles and components highlighted in this study should be considered when patient-facing EHR design interfaces are being developed.

Journal article

Goiana-Da-Silva K, Cruz-e-Silva D, Allen L, Calhau C, Rito A, Bento A, Miraldo M, Darzi Aet al., 2019, Portugal’s voluntary food reformulation agreement and the WHO reformulation targets, Journal of Global Health, Vol: 9, ISSN: 2047-2978

Journal article

Aggarwal R, Winter Beatty J, Kinross J, von Roon A, Darzi A, Purkayastha Set al., 2019, Initial Experience With a New Robotic Surgical System for Cholecystectomy., Surg Innov

Background. Laparoscopic cholecystectomy has been the gold standard treatment for symptomatic cholelithiasis for more than 3 decades. Robotic techniques are gaining traction in surgery, and recently, the Senhance™ robotic system was introduced. The system offers advantages over other robotic systems such as improved ergonomics, haptic feedback, eye tracking, and usability of standard laparoscopic trocars and reusable instruments. The Senhance was evaluated to understand the feasibility, benefits, and drawbacks of its use in cholecystectomy. Study Design. A prospectively maintained database of the first 20 patients undergoing cholecystectomy with the Senhance was reviewed at a single hospital. Data including operative time, console time, set up time, and adverse events were collected, with clinical outcome and operative time as primary outcome measures. A cohort of 20 patients having laparoscopic cholecystectomy performed by the same surgeon was used as a comparator group. Results. The 2 groups had comparable demographic data (age, sex, and body mass index). In the Senhance group, 19 of the 20 procedures (95%) were completed robotically. The median (interquartile range) total operating, docking, and console times were 86.5 (60.5-106.5), 11.5 (9-13), and 30.8 (23.5-35) minutes, respectively. In the laparoscopic group, the median (interquartile range) operating time was 31.5 (26-41) minutes. Postoperatively, only one patient had a surgical complication, namely a wound infection treated with antibiotics. Conclusion. Our results suggest that Senhance-assisted cholecystectomy is safe, feasible, and effective, but currently has longer operative times. Further prospective and randomized trials are required to determine whether this approach can offer any other benefits over other minimally invasive surgical techniques.

Journal article

Feather C, Appelbaum N, Clarke J, Franklin B, Sinha R, Pratt P, Maconochie I, Darzi Aet al., Medication errors during simulated paediatric resuscitations: a prospective, observational human reliability analysis, BMJ Open, ISSN: 2044-6055

Introduction: Medication errors during paediatric resuscitation are thought to be common. However, there is little evidence about the individual process steps that contribute to such medication errors in this context.Objectives: To describe the incidence, nature and severity of medication errors in simulated paediatric resuscitations, and to employ human reliability analysis to understand the contribution of discrepancies in individual process steps to the occurrence of these errors.Methods: We conducted a prospective observational study of simulated resuscitations subjected to video micro-analysis, identification of medication errors, severity assessment and human reliability analysis in a large English teaching hospital. Fifteen resuscitation teams of two doctors and two nurses each conducted one of two simulated paediatric resuscitation scenarios. Results: At least one medication error was observed in every simulated case, and a large magnitude (>25% discrepant) or clinically significant error in 11 of 15 cases. Medication errors were observed in 29% of 180 simulated medication administrations, 40% of which considered to be moderate or severe. These errors were the result of 884 observed discrepancies at a number of steps in the drug ordering, preparation and administration stages of medication use, 8% of which made a major contribution to a resultant medication error. Most errors were introduced by discrepancies during drug preparation and administration. Conclusions: Medication errors were common with a considerable proportion likely to result in patient harm. There is an urgent need to optimise existing systems and to commission research into new approaches to increase the reliability of human interactions during administration of medication in the paediatric emergency setting.

Journal article

Thibaut B, Dewa L, Ramtale S, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer Set al., Patient safety in inpatient mental health settings: a systematic review, BMJ Open, ISSN: 2044-6055

Objectives: Patients in inpatient mental health settings face similar risks to those in other areas of health care (e.g. medication errors). In addition, some unsafe behaviours associated with serious mental health problems (e.g. self-harm), and the measures taken to address these (e.g. restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. Design: Systematic review and meta-synthesis. Embase, CINAHL, HMIC, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to “mental health”, “patient safety”, “inpatient setting” and “research”. Study quality was assessed using the Hawker checklist. Data was extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random effects model.Results: Of the 57,637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150,000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. Conclusions: Patient safety in inpatient mental health settings is under researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety which require investment in research, policy development, and translation into clinical practice.

Journal article

Warren L, Clarke J, Arora S, Darzi Aet al., Improving data sharing between acute hospitals in England: An overview of health record system distribution and retrospective observational analysis of inter-hospital transitions of care, BMJ Open, ISSN: 2044-6055

ObjectivesTo determine the frequency of use and spatial distribution of health record systems in the English National Health Service (NHS). To quantify transitions of care between acute hospital trusts and health record systems to guide improvements to data sharing and interoperability.DesignRetrospective observational study using Hospital Episode Statistics.SettingAcute hospital trusts in the NHS in England.ParticipantsAll adult patients resident in England that had one or more inpatient, outpatient or accident and emergency encounters at acute NHS hospital trusts between April 2017 and April 2018.Primary and secondary outcome measuresFrequency of use and spatial distribution of health record systems. Frequency and spatial distribution of transitions of care between hospital trusts and health record systems.Results21,286,873 patients were involved in 121,351,837 encounters at 152 included trusts. 117 (77.0%) hospital trusts were using electronic health records (EHR). There was limited regional alignment of EHR systems. On 11,017,767 (9.1%) occasions, patients attended a hospital using a different health record system to their previous hospital attendance. 15,736,863 (73.9%) patients had two or more encounters with the included trusts and 3,931,255 (25.0%) of those attended two or more trusts. Over half (53.6%) of these patients had encounters shared between just 20 pairs of hospitals. Only two of these pairs of trusts used the same EHR system.ConclusionsEach year, millions of patients in England attend two or more different hospital trusts. Most of the pairs of trusts that commonly share patients do not use the same record systems. This research highlights significant barriers to inter-hospital data sharing and interoperability. Findings from this study can be used to improve electronic health record system coordination and develop targeted approaches to improve interoperability. The methods used in this study could be used in other healthcare systems that face the

Journal article

El-Khani U, Ashrafian H, Rasheed S, Veen H, Darwish A, Nott D, Darzi Aet al., The patient safety practices of emergency medical teams in disaster zones: a systematic analysis, BMJ Global Health, ISSN: 2059-7908

Introduction: Disaster zone medical relief has been criticised for poor quality care, lack of standardisation and accountability. Traditional patient safety practices of Emergency Medical Teams (EMT) in disaster zones were not well understood. Improving the quality of healthcare in disaster zones has gained importance within global health policy. Ascertaining patient safety practices of EMTs in disaster zones may identify areas of practice that can be improved. Methods: A systematic search of OvidSP, Embase and Medline databases, key journals of interest, key grey-literature texts, the databases of the World Health Organisation (WHO), Médecins Sans Frontieres (MSF) and the International Committee of the Red Cross (ICRC), and Google Scholar were performed. Descriptive studies, case reports, case series, prospective trials and opinion pieces were included with no limitation on date or language of publication.Results: There were 9,685 records, evenly distributed between the peer-reviewed and grey literature. Of these, 30 studies and 9 grey literature texts met the inclusion criteria and underwent qualitative synthesis. From these articles, 302 patient safety statements were extracted. Thematic analysis categorised these statements into 84 themes (total frequency 632). The most frequent themes were limb injury (9%), medical records (5.4%), surgery decision making (4.6%), medicines safety (4.4%) and protocol (4.4%)Conclusion: Patient safety practices of EMTs in disaster zones are weighted towards acute clinical care, particularly surgery. The management of Non-Communicable Disease (NCD) is underrepresented. There is widespread recognition of the need to improve medical record keeping. High-quality data and institutional level patient safety practices are lacking. There is no consensus on disaster zone specific performance indicators. These deficiencies represent opportunities to improve patient safety in disaster zones.

Journal article

CONSORT-AI and SPIRIT-AI Steering Group, 2019, Author Correction: Reporting guidelines for clinical trials evaluating artificial intelligence interventions are needed., Nat Med

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Journal article

Arhi CS, Ziprin P, Bottle A, Burns EM, Aylin P, Darzi Aet al., 2019, Colorectal cancer patients under the age of 50 experience delays in primary care leading to emergency diagnoses: a population-based study, Colorectal Disease, Vol: 21, Pages: 1270-1278, ISSN: 1462-8910

AIM: The incidence of colorectal cancer in the under 50s is increasing. In this national population-based study we aim to show that missed opportunities for diagnosis in primary care are leading to referral delays and emergency diagnoses in young patients. METHOD: We compared the interval before diagnosis, presenting symptom(s) and the odds ratio (OR) of an emergency diagnosis for those under the age of 50 with older patients sourced from the cancer registry with linkage to a national database of primary-care records. RESULTS: The study included 7315 patients, of whom 508 (6.9%) were aged under 50 years, 1168 (16.0%) were aged 50-59, 2294 (31.4%) were aged 60-69 and 3345 (45.7%) were aged 70-79 years. Young patients were more likely to present with abdominal pain and via an emergency, and had the lowest percentage of early stage cancer. They experienced a longer interval between referral and diagnosis (12.5 days) than those aged 60-69, reflecting the higher proportion of referrals via the nonurgent pathway (33.3%). The OR of an emergency diagnosis did not differ with age if a red-flag symptom was noted at presentation, but increased significantly for young patients if the symptom was nonspecific. CONCLUSION: Young patients present to primary care with symptoms outside the national referral guidelines, increasing the likelihood of an emergency diagnosis.

Journal article

Oliver N, Johnston D, Godsland I, Srivanichakorn W, Majeed A, Darzi Aet al., A pragmatic and scalable strategy using mobile technology to promote sustained lifestyle changes to prevent Type 2 diabetes in India and the UK – a randomised controlled trial, Diabetologia, ISSN: 0012-186X

Aims/hypothesis This randomised controlled trial was performed in India and UK in people with prediabetes to study whether mobile phone short message services can be used to motivate and educate people to follow lifestyle modification, to prevent type 2 diabetes.Methods The study was performed in people with prediabetes (n=2062, control: n=1031; intervention: n=1031) identified by glycosylated haemoglobin A1c42 and 47mmol/mol (6.0% and 6.4%). Participants were recruited from public and private sector organisations in India and by the NHS Health Checks programme in the UK. Allocation to the study groups was performed using a computer generated sequence (1:1) in India and by stratified randomisation in permuted blocks in the UK. Investigators in both countries remained blinded throughout the study period. All participants received advice on healthy lifestyle at baseline. The intervention group in addition received supportive text messages using mobile phone short messaging services2-3 times per week. Participants were assessed at intervals for 2years. The primary outcome was conversion to diabetes and secondary outcomes included anthropometry, biochemistry, dietary and physical activity change, blood pressure and quality of life. Results At 2years follow-up, in the intention-to-treat population the hazard ratio for development of diabetes calculated using a discrete-time proportional hazards model was 0.89,95%CI(0.74-1.07) p=0.22. There were no significant differences in the secondary outcomes.Conclusions/Interpretation This trial in 2 countries with varied ethnic and cultural backgrounds showed no significant reduction in the progression in diabetes in 2 years by lifestyle modification using short messaging services (Hazard Ratio 0.89, 95% CI 0.74 – 1.07, p=0.22)

Journal article

Patel R, Ashcroft J, Patel A, Ashrafian H, Woods A, Singh H, Darzi A, Leff Det al., The impact of transcranial direct current stimulation on upper-limb motor performance in healthy adults: A systematic review and meta-analysis, Frontiers in Neuroscience, ISSN: 1662-453X

Background: Transcranial direct current stimulation (tDCS) has previously been reported to33 improve facets of upper limb motor performance such as accuracy and strength. However, the34 magnitude of motor performance improvement has not been reviewed by contemporaneous35 systematic review or meta-analysis of sham versus active tDCS.3637 Objective: To systematically review and meta-analyse the existing evidence regarding the38 benefits of tDCS on upper limb motor performance in healthy adults.3940 Methods: A systematic search was conducted to obtain relevant articles from three databases41 (MEDLINE, EMBASE, and PsycINFO) yielding 3200 abstracts. Following independent42 assessment by 2 reviewers, a total of 86 articles were included for review, of which 37 were43 deemed suitable for meta-analysis.4445 Results: Meta-analyses were performed for four outcome measures, namely: reaction time46 (RT), execution time (ET), time to task failure (TTF) and force. Further qualitative review was47 performed for accuracy and error. Statistically significant improvements in RT (effect size -48 0.01; 95% CI -0.02 to 0.001, p=0.03) and ET (effect size -0.03; 95% CI -0.05 to -0.01, p=0.017)49 were demonstrated compared to sham. In exercise tasks, increased force (effect size 0.10; 95%50 CI 0.08 to 0.13, p<0.001) and a trend towards improved TTF was also observed.5152 Conclusions: This meta-analysis provides evidence attesting to the impact of tDCS on upper53 limb motor performance in healthy adults. Improved performance is demonstrable in reaction54 time, task completion time, elbow flexion tasks and accuracy. Considerable heterogeneity55 exists amongst the literature, further confirming the need for a standardised approach to56 reporting tDCS studies.

Journal article

Beyer-Berjot L, Patel V, Sirimanna P, Hashimoto DA, Berdah S, Darzi A, Aggarwal Ret al., 2019, Implementation of a Surgical Simulation Care Pathway Approach to Training in Emergency Abdominal Surgery, WORLD JOURNAL OF SURGERY, ISSN: 0364-2313

Journal article

Archer S, Thibaut B, Dewa L, Ramtale S, D'Lima D, Simpson A, Murray K, Adam S, Darzi Aet al., 2019, Barriers and facilitators to incident reporting in mental healthcare settings: a qualitative study, Journal of Psychiatric and Mental Health Nursing, 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

Mason S, Manoli E, Poynter L, Alexander J, Paizs P, Adebesin A, Goldin R, Darzi A, Takats Z, Kinross Jet al., 2019, Mass spectrometry transanal minimally invasive surgery (MS-TAMIS) to promote organ preservation in rectal cancer, Surgical Endoscopy: surgical and interventional techniques, ISSN: 0930-2794

BACKGROUND: Transanal minimally invasive surgery (TAMIS) is deployed for organ preservation in early rectal cancer and significant rectal polyps. Rapid evaporative ionisation mass spectrometry (REIMS) provides biochemical tissue analysis, which could be applied intraoperatively to give real-time tissue feedback to the surgeon and decrease the risk of an involved margin. However, the accuracy and feasibility of this approach have not been established. METHODS: In this prospective observational study, patients undergoing resection of rectal adenomas or carcinomas were recruited. An electrosurgical handpiece analysed tissues ex vivo using diathermy, with the aerosol aspirated into a Xevo G2-S ToF mass spectrometer. The relative abundance of lipids underwent predictive statistical modelling and leave-one-patient-out cross-validation. The outcomes of interest were the ability of REIMS to differentiate normal, adenomatous and cancerous tissue, or any disease subtype from normal. REIMS was coupled with TAMIS for in vivo sampling, assessing the accuracy of tissue recognition and distinguishing bowel wall layers. RESULTS: Forty-seven patients were included, yielding 266 spectra (121 normal, 109 tumour and 36 adenoma). REIMS differentiates normal, adenomatous and cancerous rectal tissues with 86.8% accuracy, and normal and adenomatous tissue with 92.4% accuracy and 91.4% accuracy when differentiating disease from normal. We have performed the first five in-man mass spectrometry augmented TAMIS (MS-TAMIS). In real time, MS-TAMIS can differentiate rectal mucosa and submucosa based on their relative abundance of triglycerides and glycerophospholipids. The ex vivo accuracy distinguishing diseased and normal tissues is maintained in vivo at 90%, with negative predictive value of 95%. The system identified a deep and lateral involved tumour margin during TAMIS. CONCLUSIONS: REIMS distinguishes rectal tissue types based on underlying lipid biology, and this can be translated in vivo

Journal article

Joshi M, Ashrafian H, Arora S, Khan S, Cooke G, Darzi Aet al., A systematic review and meta-analysis of digital alerting and outcomes in patients with sepsis, JMIR mHealth and uHealth, ISSN: 2291-5222

Background The diagnosis and management of sepsis remains a global healthcare challenge. Digital technologies have the potential to improve sepsis care. Objective This paper systematically reviews the evidence on the impact of electronic alerting systems on sepsis related outcomes. Study Selection Embase, Medline, HMIC, Psych Info and Cochrane were searched from April 1964 to 12thFebruary 2019 with no language restriction. All full text reports of studies identified as potentially eligible after title and abstract review were obtained for further review. The search was limited to adult inpatients. Relevant articles were hand-searched for remaining studies. Only studies with clear pre-and post-alerting phases were included. Primary outcomes were hospital length of stay [LOS] and intensive care LOS, secondary outcomes were time to antibiotics and mortality. Studies based solely on intensive care, case reports, narrative reviews, editorials and commentaries were excluded. All other trial designs were included. A qualitative assessment and meta-analysis was performed. Results This review identified 72 full text articles. From these, 16 studies met the inclusion criteria and were included in the final analysis. Of these, 8 studies reviewed hospital length of stay, 12 mortality outcomes, 5 studies explored time to antibiotics, 5 studies investigated ICU length of stay. Data Synthesis Both quantitative and qualitative assessments of the studies was performed. There was evidence of a significant benefit of electronic alerting on hospital length of stay, reduced by 1.31 days[p=0.014], and ICU length of stay, reduced by 0.766 days[p=0.007]. There was no significant difference association between electronic alerts and mortality [mean decrease 11.4%,p=0.769] or time to antibiotics [mean decrease 126 minutes, p=0.134]. Conclusion This review highlights that electronic alerts can significantly reduce hospital and ICU stay in patients with sepsis. Further studies including more

Journal article

Ghafur S, Kristensen S, honeyford K, Martin G, Darzi A, Aylin Pet al., 2019, A retrospective impact analysis of the WannaCry cyber-attack on the NHS, npj Digital Medicine, Vol: 2, ISSN: 2398-6352

A systematic analysis of Hospital Episodes Statistics (HES) data was done to determine the effects of the 2017 WannaCry attack on the National Health Service (NHS) by identifying the missed appointments, deaths, and fiscal costs attributable to the ransomware attack. The main outcomes measured were: outpatient appointments cancelled, elective and emergency admissions to hospitals, Accident & Emergency (A&E) attendances, and deaths in A&E. Compared with the baseline, there was no significant difference in the total activity across all trusts during the week of the WannaCry attack. Trusts had 1% more emergency admissions and 1% fewer A&E attendances per day during the WannaCry week compared with baseline. Hospitals directly infected with the ransomware, however, had significantly fewer emergency and elective admissions: a decrease of about 6% in total admissions per infected hospital per day was observed, with 4% fewer emergency admissions and 9% fewer elective admissions. No difference in mortality was noted. The total economic value of the lower activity at the infected trusts during this time was £5.9m including £4m in lost inpatient admissions, £0.6m from lost A&E activity, and £1.3m from cancelled outpatient appointments. Among hospitals infected with WannaCry ransomware, there was a significant decrease in the number of attendances and admissions, which corresponded to £5.9m in lost hospital activity. There was no increase in mortality reported, though this is a crude measure of patient harm. Further work is needed to appreciate the impact of a a cyber attack or IT failure on care delivery and patient safety.

Journal article

Liu X, Rivera SC, Faes L, Di Ruffano LF, Yau C, Keane PA, Ashrafian H, Darzi A, Vollmer SJ, Deeks J, Bachmann L, Holmes C, Chan AW, Moher D, Calvert MJ, Denniston AKet al., 2019, Reporting guidelines for clinical trials evaluating artificial intelligence interventions are needed, NATURE MEDICINE, Vol: 25, Pages: 1467-1468, ISSN: 1078-8956

Journal article

Garas G, Darzi A, Athanasiou T, 2019, Author response to: Resection margin status in pancreatic cancer surgery: is it really less important than the N status?, BRITISH JOURNAL OF SURGERY, Vol: 106, Pages: 1559-1560, ISSN: 0007-1323

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Garas G, Darzi A, Athanasiou T, 2019, Comment on: Relationship between surgeons and industry, BRITISH JOURNAL OF SURGERY, Vol: 106, Pages: 1560-1560, ISSN: 0007-1323

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Dawda S, Camara M, Pratt P, Vale J, Darzi A, Mayer Eet al., 2019, Patient-specific simulation of pneumoperitoneum for laparoscopic surgical planning, Journal of Medical Systems, Vol: 43, ISSN: 0148-5598

Gas insufflation in laparoscopy deforms the abdomen and stretches the overlying skin. This limits the use of surgical image-guidance technologies and challenges the appropriate placement of trocars, which influences the operative ease and potential quality of laparoscopic surgery. This work describes the development of a platform that simulates pneumoperitoneum in a patient-specific manner, using preoperative CT scans as input data. This aims to provide a more realistic representation of the intraoperative scenario and guide trocar positioning to optimize the ergonomics of laparoscopic instrumentation. The simulation was developed by generating 3D reconstructions of insufflated and deflated porcine CT scans and simulating an artificial pneumoperitoneum on the deflated model. Simulation parameters were optimized by minimizing the discrepancy between the simulated pneumoperitoneum and the ground truth model extracted from insufflated porcine scans. Insufflation modeling in humans was investigated by correlating the simulation’s output to real post-insufflation measurements obtained from patients in theatre. The simulation returned an average error of 7.26 mm and 10.5 mm in the most and least accurate datasets respectively. In context of the initial discrepancy without simulation (23.8 mm and 19.6 mm), the methods proposed here provide a significantly improved picture of the intraoperative scenario. The framework was also demonstrated capable of simulating pneumoperitoneum in humans. This study proposes a method for realistically simulating pneumoperitoneum to achieve optimal ergonomics during laparoscopy. Although further studies to validate the simulation in humans are needed, there is the opportunity to provide a more realistic, interactive simulation platform for future image-guided minimally invasive surgery.

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Fernandes Neves Soares AL, Poovendran D, Freise L, Ghafur S, Flott K, Darzi A, Mayer Eet al., 2019, Healthcare professionals’ perspectives on the secondary use of health records to improve quality and safety of care: a qualitative study in England, Journal of Medical Internet Research, Vol: 21, ISSN: 1438-8871

Background: Healthcare professionals (HCP) are often patients’ first point of contact in what concerns the communication of the purposes, benefits, and risks of sharing electronic health records (EHR) for non-direct care purposes. Their engagement is fundamental to ensure patients’ buy-in and a successful implementation of healthcare data sharing schemes. However, their views on this subject are seldom evaluated. Objective: To explore HCP’ perspectives on the secondary uses of healthcare data in England. Specifically, we aimed to assess a) their knowledge on its purposes and b) the main concerns about data sharing processes.Methods: A total of 30 interviews were conducted between the 27th March and 7th April 2017 using an online interview platform, and following a topic guide with open-ended questions. The participants represented a variety of geographic locations across England (London, West Midlands, East of England, North East, Yorkshire and the Humber), covering both primary and secondary care services. The transcripts were compiled verbatim and systematically reviewed by two independent reviewers, using the framework analysis method to identify emerging themes.Results: HCP were knowledgeable about the possible secondary uses of data and highlighted its importance for 1) patient profiling and tailored care, 2) research, 3) quality assurance, 4) public health, and 5) service delivery planning purposes. Main concerns towards data sharing included 1) data accuracy, 2) patients’ willingness to share their records, 3) challenges on obtaining free and informed consent, 4) data security, 5) lack of adequacy / understanding of current policies, and 6) potential patient exposure and exploitation.Conclusions: These results suggest a high level of HCP understanding about the purposes of data sharing for secondary purposes, however, some concerns still remain. A better understanding of HCP’ knowledge and concerns could inform national communica

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Fontana G, Flott K, Dhingra-Kumar N, Durkin M, Darzi Aet al., 2019, Five reasons for optimism on World Patient Safety Day, The Lancet, Vol: 394, Pages: 993-995, ISSN: 0140-6736

Journal article

Symons J, Ashrafian H, Dunscombe R, Darzi Aet al., 2019, From EHR to PHR: Let’s get the UK record straight, BMJ Open, Vol: 9, Pages: 1-5, ISSN: 2044-6055

This article reflects on the changing nature of health information access and the transition of focus from electronic health records (EHRs) to personal health records (PHRs) along with the challenges and need for alignment of national initiatives for EHR and PHR in the National Health Service (NHS) of the United Kingdom (UK).The importance of implementing integrated EHRs as a route to enhance the quality of health delivery has been increasingly understood. EHRs however carry several limitations that include major fragmentation through multiple providers and protocols throughout the NHS. Questions over ownership and control of data further complicate the potential for fully utilising records. Analysing the previous initiatives and the current landscape, we identify that adopting a patient health record system can empower patients and allow better harmonisation of clinical data at a national level. We propose regional PHR “hubs” to provide a universal interface that integrates digital heath data at a regional level with further integration at a national level.We propose that these PHR “hubs” will reduce the complexity of connections, decrease governance challenges and interoperability issues while also providing a safe platform for high-quality scalable and sustainable digital solutions, including artificial intelligence (AI) across the UK NHS, serving as an exemplar for other countries which wish to realise the full value of healthcare records.

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Kurek N, Darzi A, 2019, The ageing surgeon, BMJ Quality and Safety, ISSN: 2044-5415

Journal article

Garas G, Cingolani I, Patel V, Panzarasa P, Darzi A, Athanasiou Tet al., 2019, Evaluating the implications of Brexit for research collaboration and policy: A network analysis and simulation study, BMJ Open, Vol: 9, Pages: 1-11, ISSN: 2044-6055

Objective To evaluate the role of the European Union (EU) as a research collaborator in the United Kingdom (UK)’s success as a global leader in healthcare research and innovation and quantify the impact that Brexit may have. Design Network and regression analysis of scientific collaboration, followed by simulation models based on alternative scenarios. Setting International real world collaboration network among all countries involved in robotic surgical research and innovation.Participants 772 organisations from industry and academia nested within 56 countries and connected through 2,397 collaboration links.Main outcome measures Research impact measured through citations, innovation value measured through the innovation index, and an array of attributes of social networks to measure brokerage and geographical entropy at national and international levels.Results Globally, the UK ranks third in robotic surgical innovation, and the EU constitutes its prime collaborator. Brokerage opportunities and collaborators’ geographical diversity are associated with a country’s research impact (c=211.320 and 244.527, respectively;p-value<0·01) and innovation (c=18.819 and 30.850, respectively;p-value<0·01). Replacing EU collaborators with United States (US)’ ones is the only strategy that could benefit the UK, but on the condition that US collaborators are chosen among the top-performing ones, which is likely to be very difficult and costly, at least in the short term. Conclusions This study suggests what has long been argued, namely that the UK-EU research partnership has been mutually beneficial and that its continuation represents the best possible outcome for both negotiating parties. However, the uncertainties raised by Brexit necessitate looking beyond the EU for potential research partners. In the short-term, the UK’s best strategy might be to try and maintain its academic links with the EU. In the longer-term, strategic r

Journal article

Miraldo M, Goiana-da-Silva F, Cruz-e-Silva D, Morais Nunes A, Carriço M, Costa F, Darzi A, Araujo Fet al., 2019, Disrupting the landscape: how the Portuguese National Health Service built an omnichannel communication platfor, Public Health Panorama, Vol: 5, Pages: 314-323, ISSN: 2412-544X

Noncommunicable diseases (NCDs) are the leading causes of death, disease and disability in the WHO European Region and are largely preventable. The private sector has long been using marketing to influence and change people’s lifestyles. In some cases, particularly the food sector, health-compromising content is prioritized over health-promoting content. However, this case study aims to illustrate how governments working on tight budgets can partner with private media companies to their own advantage in order to increase the impact of health messages and thus improve the health literacy of the population. The omnichannel communication platform and associated campaigns initiated by the Portuguese government and described in this case study serve as a practical example of a national health literacy initiative successfully reaching a wide audience. Indeed, the Portuguese National Health Service entered high on the list of the most impactful communication campaigns in Portugal.This might have implications for other countries as although further progress is required to analyse any impact of the campaigns, this example showcases the potential advantages of partnering with the media in that by using the same communication channels as multinational food and tobacco companies, governments may be able to level the playing field in terms of influence through marketing and communication, which might help to reverse unhealthy lifestyles among their populations.

Journal article

Vlaev I, King D, Darzi A, Dolan Pet al., 2019, Changing health behaviors using financial incentives: a review from behavioral economics, BMC Public Health, Vol: 19, ISSN: 1471-2458

BackgroundIncentives are central to economics and are used across the public and private sectors to influence behavior. Recent interest has been shown in using financial incentives to promote desirable health behaviors and discourage unhealthy ones.Main textIf we are going to use incentive schemes to influence health behaviors, then it is important that we give them the best chance of working. Behavioral economics integrates insights from psychology with the laws of economics and provides a number of robust psychological phenomena that help to better explain human behavior. Individuals’ decisions in relation to incentives may be shaped by more subtle features – such as loss aversion, overweighting of small probabilities, hyperbolic discounting, increasing payoffs, reference points – many of which have been identified through research in behavioral economics. If incentives are shown to be a useful strategy to influence health behavior, a wider discussion will need to be had about the ethical dimensions of incentives before their wider implementation in different health programmes.ConclusionsPolicy makers across the world are increasingly taking note of lessons from behavioral economics and this paper explores how key principles could help public health practitioners design effective interventions both in relation to incentive designs and more widely.

Journal article

Modi HN, Singh H, Fiorentino F, Orihuela-Espina F, Athanasiou T, Yang G-Z, Darzi A, Leff DRet al., 2019, Association of residents' neural signatures with stress resilience during surgery, JAMA Surgery, Vol: 154, ISSN: 2168-6254

Importance: Intraoperative stressors may compound cognitive load, prompting performance decline and threatening patient safety. However, not all surgeons cope equally well with stress, and the disparity between performance stability and decline under high cognitive demand may be characterized by differences in activation within brain areas associated with attention and concentration such as the prefrontal cortex (PFC). Objective: To compare PFC activation between surgeons demonstrating stable performance under temporal stress with those exhibiting stress-related performance decline. Design, Setting, and Participants: Cohort study conducted from July 2015 to September 2016 at the Imperial College Healthcare National Health Service Trust, England. One hundred two surgical residents (postgraduate year 1 and greater) were invited to participate, of which 33 agreed to partake. Exposures: Participants performed a laparoscopic suturing task under 2 conditions: self-paced (SP; without time-per-knot restrictions), and time pressure (TP; 2-minute per knot time restriction). Main Outcomes and Measures: A composite deterioration score was computed based on between-condition differences in task performance metrics (task progression score [arbitrary units], error score [millimeters], leak volume [milliliters], and knot tensile strength [newtons]). Based on the composite score, quartiles were computed reflecting performance stability (quartile 1 [Q1]) and decline (quartile 4 [Q4]). Changes in PFC oxygenated hemoglobin concentration (HbO2) measured at 24 different locations using functional near-infrared spectroscopy were compared between Q1 and Q4. Secondary outcomes included subjective workload (Surgical Task Load Index) and heart rate. Results: Of the 33 participants, the median age was 33 years, the range was 29 to 56 years, and 27 were men (82%). The Q1 residents demonstrated task-induced increases in HbO2 across the bilateral ventrolateral PFC (VLPFC) and right dorsolateral P

Journal article

Runciman M, Darzi A, Mylonas G, 2019, Soft robotics in minimally invasive surgery, Soft Robotics, Vol: 6, Pages: 423-443, ISSN: 2169-5172

Soft robotic devices have desirable traits for applications in minimally invasive surgery (MIS) but many interdisciplinary challenges remain unsolved. To understand current technologies, we carried out a keyword search using the Web of Science and Scopus databases, applied inclusion and exclusion criteria, and compared several characteristics of the soft robotic devices for MIS in the resulting articles. There was low diversity in the device designs and a wide-ranging level of detail regarding their capabilities. We propose a standardised comparison methodology to characterise soft robotics for various MIS applications, which will aid designers producing the next generation of devices.

Journal article

Mason SE, Poynter L, Takats Z, Darzi A, Kinross JMet al., 2019, Optical technologies for endoscopic real-time histologic assessment of colorectal polyps: a meta-analysis, American Journal of Gastroenterology, Vol: 114, Pages: 1219-1230, ISSN: 1572-0241

OBJECTIVES: Accurate, real-time, endoscopic risk stratification of colorectal polyps would improve decision-making and optimize clinical efficiency. Technologies to manipulate endoscopic optical outputs can be used to predict polyp histology in vivo; however, it remains unclear how accuracy has progressed and whether it is sufficient for routine clinical implementation. METHODS: A meta-analysis was conducted by searching MEDLINE, Embase, and the Cochrane Library. Studies were included if they prospectively deployed an endoscopic optical technology for real-time in vivo prediction of adenomatous colorectal polyps. Polyposis and inflammatory bowel diseases were excluded. Bayesian bivariate meta-analysis was performed, presenting 95% confidence intervals (CI). RESULTS: One hundred two studies using optical technologies on 33,123 colorectal polyps were included. Digital chromoendoscopy differentiated neoplasia (adenoma and adenocarcinoma) from benign polyps with sensitivity of 92.2% (90.6%-93.9% CI) and specificity of 84.0% (81.5%-86.3% CI), with no difference between constituent technologies (narrow-band imaging, Fuji intelligent Chromo Endoscopy, iSCAN) or with only diminutive polyps. Dye chromoendoscopy had sensitivity of 92.7% (90.1%-94.9% CI) and specificity of 86.6% (82.9%-89.9% CI), similarly unchanged for diminutive polyps. Spectral analysis of autofluorescence had sensitivity of 94.4% (84.0%-99.1% CI) and specificity of 50.9% (13.2%-88.8% CI). Endomicroscopy had sensitivity of 93.6% (85.3%-98.3% CI) and specificity of 92.5% (81.8%-98.1% CI). Computer-aided diagnosis had sensitivity of 88.9% (74.2%-96.7% CI) and specificity of 80.4% (52.6%-95.7% CI). Prediction confidence and endoscopist experience alone did not significantly improve any technology. The only subgroup to demonstrate a negative predictive value for adenoma above 90% was digital chromoendoscopy, making high confidence predictions of diminutive recto-sigmoid polyps. Chronologic meta-analyses show a

Journal article

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