Imperial College London

Professor the Lord Darzi of Denham PC KBE FRS FMedSci HonFREng

Faculty of MedicineDepartment of Surgery & Cancer

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

1568 results found

Martin G, Khajuria A, Arora S, King D, Ashrafian H, Darzi Aet al., 2019, The impact of mobile technology on teamwork and communication in hospitals: a systematic review., J Am Med Inform Assoc, Vol: 26, Pages: 339-355

OBJECTIVES: Effective communication is critical to the safe delivery of care but is characterized by outdated technologies. Mobile technology has the potential to transform communication and teamwork but the evidence is currently uncertain. The objective of this systematic review was to summarize the quality and breadth of evidence for the impact of mobile technologies on communication and teamwork in hospitals. MATERIALS AND METHODS: Electronic databases (MEDLINE, PsycINFO, EMBASE, CINAHL Plus, HMIC, Cochrane Library, and National Institute of Health Research Health Technology Assessment) were searched for English language publications reporting communication- or teamwork-related outcomes from mobile technologies in the hospital setting between 2007 and 2017. RESULTS: We identified 38 publications originating from 30 studies. Only 11% were of high quality and none met best practice guidelines for mobile-technology-based trials. The studies reported a heterogenous range of quantitative, qualitative, and mixed-methods outcomes. There is a lack of high-quality evidence, but nonetheless mobile technology can lead to improvements in workflow, strengthen the quality and efficiency of communication, and enhance accessibility and interteam relationships. DISCUSSION: This review describes the potential benefits that mobile technology can deliver and that mobile technology is ubiquitous among healthcare professionals. Crucially, it highlights the paucity of high-quality evidence for its effectiveness and identifies common barriers to widespread uptake. Limitations include the limited number of participants and a wide variability in methods and reported outcomes. CONCLUSION: Evidence suggests that mobile technology has the potential to significantly improve communication and teamwork in hospital provided key organizational, technological, and security challenges are tackled and better evidence delivered.

JOURNAL ARTICLE

Camara M, Mayer E, Darzi A, Pratt Pet al., 2019, Intraoperative ultrasound for improved 3D tumour reconstruction in robot-assisted surgery: An evaluation of feedback modalities., Int J Med Robot, Vol: 15

BACKGROUND: Intraoperative ultrasound scanning induces deformation on the tissue in the absence of a feedback modality, which results in a 3D tumour reconstruction that is not directly representative of real anatomy. METHODS: A biomechanical model with different feedback modalities (haptic, visual, or auditory) was implemented in a simulation environment. A user study with 20 clinicians was performed to assess which modality resulted in the 3D tumour volume reconstruction that most resembled the reference configuration from the respective computed tomography (CT) scans. RESULTS: Integrating a feedback modality significantly improved the scanning performance across all participants and data sets. The optimal feedback modality to adopt varied depending on the evaluation. Nonetheless, using guidance with feedback is always preferred compared with none. CONCLUSIONS: The results demonstrated the urgency to integrate a feedback modality framework into clinical practice, to ensure an improved scanning performance. Furthermore, this framework enabled an evaluation that cannot be performed in vivo.

JOURNAL ARTICLE

Moussa OM, Ardissino M, Kulatilake P, Faraj A, Muttoni E, Darzi A, Ziprin P, Scholtz S, Purkayastha Set al., 2019, Effect of body mass index on depression in a UK cohort of 363 037 obese patients: A longitudinal analysis of transition., Clin Obes

With obesity levels increasing, it is important to consider the mental health risks associated with this condition to optimize patient care. Links between depression and obesity have been explored, but few studies focus on the risk profiles of patients across stratified body mass index (BMI) classes above 30 kg/m2 . This study aims to determine the impact of BMI on depression risk in patients with obesity and to investigate trends of depression in a large cohort of British patients with BMI > 30 kg/m2 . A nationwide primary care database, the Clinical Practice Research Datalink (CPRD), was analysed for diagnoses of obesity (BMI > 30 kg/m2 ). Obese patients were then sub-classified into seven BMI categories. Primary health care-based records of patients entered in the CPRD were analysed. A total of 363 037 patients had a BMI ≥ 30 kg/m2 ; of these patients 97 392 (26.8%) also had a diagnosis of depression. Absolute event rates over time and hazard risk of depression were analysed by BMI category. On Cox regression analysis of time to development of depression, the cumulative hazard increased significantly and linearly across BMI groups (P < 0.001). Compared to those with BMI 30 to 35 kg/m2 , patients with BMI 35 to 40 kg/m2 had a 20% higher risk of depression (hazard ratio [HR] 1.206, confidence interval [CI] 1.170-1.424), and those with BMI > 60 kg/m2 had a 98% higher risk (HR 1.988, CI 1.513-2.612). This study identified the prevalence and time course of depression in a cohort of obese patients in the United Kingdom. Findings suggest the risk of depression is directly proportional to BMI above 30 kg/m2 . Therefore, clinicians should note higher BMI levels confer increased risk of depression.

JOURNAL ARTICLE

Jiao LR, Fajardo Puerta AB, Gall TMH, Sodergren MH, Frampton AE, Pencavel T, Nagendran M, Habib NA, Darzi A, Pai M, Thomas R, Tait Pet al., 2019, Rapid Induction of Liver Regeneration for Major Hepatectomy (REBIRTH): A Randomized Controlled Trial of Portal Vein Embolisation versus ALPPS Assisted with Radiofrequency., Cancers (Basel), Vol: 11, ISSN: 2072-6694

To avoid liver insufficiency following major hepatic resection, portal vein embolisation (PVE) is used to induce liver hypertrophy pre-operatively. Associating liver partition with portal vein ligation for staged hepatectomy assisted with radiofrequency (RALPPS) was introduced as an alternative method. A randomized controlled trial comparing PVE with RALPPS for the pre-operative manipulation of liver volume in patients with a future liver remnant volume (FLRV) ≤25% (or ≤35% if receiving preoperative chemotherapy) was conducted. The primary endpoint was increase in size of the FLRV. The secondary endpoints were length of time taken for the volume gain, morbidity, operation length and post-operative liver function. Between July 2015 and October 2017, 57 patients were randomised to RALPPS (n = 29) and PVE (n = 28). The mean percentage of increase in the FLRV was 80.7 ± 13.7% after a median 20 days following RALPPS compared to 18.4 ± 9.8% after 35 days (p < 0.001) following PVE. Twenty-four patients after RALPPS and 21 after PVE underwent stage-2 operation. Final resection was achieved in 92.3% and 66.6% patients in RALPPS and PVE, respectively (p = 0.007). There was no difference in morbidity, and one 30-day mortality after RALPPS (p = 0.991) was reported. RALPPS is more effective than PVE in increasing FLRV and the number of patients for surgical resection.

JOURNAL ARTICLE

Pucher PH, Johnston MJ, Archer S, Whitby J, Dawson PM, Arora S, Darzi Aet al., 2019, Informing the Consent Process for Surgeons: A Survey Study of Patient Preferences, Perceptions, and Risk Tolerance, JOURNAL OF SURGICAL RESEARCH, Vol: 235, Pages: 298-302, ISSN: 0022-4804

JOURNAL ARTICLE

Grant Y, Al-Khudairi R, St John E, Barschkett M, Cunningham D, Al-Mufti R, Hogben K, Thiruchelvam P, Hadjiminas DJ, Darzi A, Carter AW, Leff DRet al., 2019, Patient-level costs in margin re-excision for breast-conserving surgery, 19th Annual Meeting of the American-Society-of-Breast-Surgeons, Publisher: WILEY, Pages: 384-394, ISSN: 0007-1323

CONFERENCE PAPER

Arhi CS, Markar S, Burns EM, Bouras G, Bottle A, Hanna G, Aylin P, Ziprin P, Darzi Aet al., 2019, Delays in referral from primary care are associated with a worse survival in patients with esophagogastric cancer., Dis Esophagus

NICE referral guidelines for suspected cancer were introduced to improve prognosis by reducing referral delays. However, over 20% of patients with esophagogastric cancer experience three or more consultations before referral. In this retrospective cohort study, we hypothesize that such a delay is associated with a worse survival compared with patients referred earlier. By utilizing Clinical Practice Research Datalink, a national primary care linked database, the first presentation, referral date, a number of consultations before referral and stage for esophagogastric cancer patients were determined. The risk of a referral after one or two consultations compared with three or more consultations was calculated for age and the presence of symptom fulfilling the NICE criteria. The risk of death according to the number of consultations before referral was determined, while accounting for stage and surgical management. 1307 patients were included. Patients referred after one (HR 0.80 95% CI 0.68-0.93 p = 0.005) or two consultations (HR 0.81 95% CI 0.67-0.98 p = 0.034) demonstrated significantly improved prognosis compared with those referred later. The risk of death was also lower for patients who underwent a resection, were younger or had an earlier stage at diagnosis. Those presenting with a symptom fulfilling the NICE criteria (OR 0.27 95% CI 0.21-0.35 p < 0.0001) were more likely to be referred earlier. This is the first study to demonstrate an association between a delay in referral and worse prognosis in esophagogastric patients. These findings should prompt further research to reduce primary care delays.

JOURNAL ARTICLE

Shah N, Martin G, Archer S, Arora S, King D, Darzi Aet al., 2019, Exploring mobile working in healthcare: clinical perspectives on transitioning to a mobile first culture of work, International Journal of Medical Informatics, ISSN: 1386-5056

JOURNAL ARTICLE

Arhi CS, Burns EM, Bouras G, Aylin P, Ziprin P, Darzi Aet al., 2019, Complications after discharge and delays in adjuvant chemotherapy following colonic resection: a cohort study of linked primary and secondary care data., Colorectal Dis, Vol: 21, Pages: 307-314

AIM: By understanding the reasons for delays in adjuvant chemotherapy (AC) after colonic resection, there is the potential to improve patient outcome. The aim of this study is to determine the extent and impact of complications after hospital discharge on delays to AC. METHOD: The study cohort included patients from Hospital Episode Statistics (HES) who had a colorectal cancer resection; linkage to primary care data was provided by the Clinical Practice Research Datalink (CPRD). Complications during the index hospital stay (from HES) and after discharge (from CPRD) were compared. The risk of late AC treatment (8 weeks or later) following a complication, stoma at the index procedure or emergency admission was described after accounting for age and Charlson score. A Cox hazards model determined the association of these factors with overall survival (OS). RESULTS: A total of 1266 patients underwent AC following colon cancer resection, of whom 598 (47.2%) received treatment within 8 weeks. Patients receiving late AC had a significantly higher proportion of re-operations (7.0% vs 3.3% P < 0.005) and wound infections (5.5% vs 3.7% P = 0.042), with 96% of the latter only being noted in CPRD. In multivariate analysis, the risk of AC delay significantly increased following a complication (OR 1.53, 95% CI 1.16-2.03, P = 0.003) or a stoma at the index operation. AC delay was associated with worse OS [hazard ratio (HR) 1.44, 95% CI 1.16-1.79, P = 0.001], as was an emergency admission (HR 1.59, 95% CI 1.21-1.98, P < 0.0005). However, the presence of a complication did not independently reduce OS (HR 1.15, 95%CI 0.89-1.48, P = 0.295). CONCLUSION: The true extent and impact of complications following colonic resection is underestimated when only secondary care data are used.

JOURNAL ARTICLE

Warren L, Clarke J, Arora S, Barahona M, Arebi N, Darzi Aet al., Transitions of care across hospital settings in patients with inflammatory bowel disease, World Journal of Gastroenterology, 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

Camara M, Dawda S, Mayer E, Darzi A, Pratt Pet al., 2019, Subject-specific modelling of pneumoperitoneum: model implementation, validation and human feasibility assessment., Int J Comput Assist Radiol Surg

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

Poynter L, Mirnezami R, Galea D, Veselkov K, Nicholson J, Takats Z, Darzi A, Kinross J, Mirnezami Aet al., 2019, Network mapping of molecular biomarkers influencing radiation response in rectal cancer, Clinical Colorectal Cancer, ISSN: 1533-0028

IntroductionPre-operative radiotherapy (RT) has an important role in the management of locally advanced rectal cancer (RC). Tumour regression following RT shows marked variability and robust molecular methods are needed with which to predict likely response. The aim of this study was to review the current published literature and employ Gene Ontology (GO) analysis to define key molecular biomarkers governing radiation response in RC.MethodsA systematic review of electronic bibliographic databases (MEDLINE, Embase) was performed for original articles published between 2000 and 2015. Biomarkers were then classified according to biological function and incorporated into a hierarchical GO tree. Both significant and non-significant results were included in the analysis. Significance was binarized based on uni- and multivariate statistics. Significance scores were calculated for each biological domain (or node), and a direct acyclic graph was generated for intuitive mapping of biological pathways and markers involved in rectal cancer radiation response.Results72 individual biomarkers, across 74 studies, were identified through review. On highest order classification, molecular biomarkers falling within the domains of response to stress, cellular metabolism and pathways inhibiting apoptosis were found to be the most influential in predicting radiosensitivity.ConclusionsHomogenising biomarker data from original articles using controlled GO terminology demonstrates that cellular mechanisms of response to radiotherapy in RC - in particular the metabolic response to radiotherapy - may hold promise in developing radiotherapeutic biomarkers with which to predict, and in the future modulate, radiation response.

JOURNAL ARTICLE

Runciman M, Darzi A, Mylonas G, Soft robotics in minimally invasive surgery, Soft Robotics, 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

Joshi M, Ashrafian H, Aufegger L, Khan S, Arora S, Cooke G, Darzi Aet al., 2019, Wearable sensors to improve detection of patient deterioration, EXPERT REVIEW OF MEDICAL DEVICES, Vol: 16, Pages: 145-154, ISSN: 1743-4440

JOURNAL ARTICLE

Dilley JWR, Hughes-Hallett A, Pratt PJ, Pucher PH, Camara M, Darzi AW, Mayer EKet al., 2019, Perfect Registration Leads to Imperfect Performance: A Randomized Trial of Multimodal Intraoperative Image Guidance., Ann Surg, Vol: 269, Pages: 236-242

OBJECTIVE: To compare surgical safety and efficiency of 2 image guidance modalities, perfect augmented reality (AR) and side-by-side unregistered image guidance (IG), against a no guidance control (NG), when performing a simulated laparoscopic cholecystectomy (LC). BACKGROUND: Image guidance using AR offers the potential to improve understanding of subsurface anatomy, with positive ramifications for surgical safety and efficiency. No intra-abdominal study has demonstrated any advantage for the technology. Perfect AR cannot be provided in the operative setting in a patient; however, it can be generated in the simulated setting. METHODS: Thirty-six experienced surgeons performed a baseline LC using the LapMentor simulator before randomization to 1 of 3 study arms: AR, IG, or NG. Each performed 3 further LC. Safety and efficiency-related simulator metrics, and task workload (SURG-TLX) were collected. RESULTS: The IG group had a shorter total instrument path length and fewer movements than NG and AR groups. Both IG and NG took a significantly shorter time than AR to complete dissection of Calot triangle. Use of IG and AR resulted in significantly fewer perforations and serious complications than the NG group. IG had significantly fewer perforations and serious complications than the AR group. Compared with IG, AR guidance was found to be significantly more distracting. CONCLUSION: Side-by-side unregistered image guidance (IG) improved safety and surgical efficiency in a simulated setting when compared with AR or NG. IG provides a more tangible opportunity for integrating image guidance into existing surgical workflow as well as delivering the safety and efficiency benefits desired.

JOURNAL ARTICLE

Satava RM, Stefanidis D, Levy JS, Smith R, Martin JR, Monfared S, Timsina LR, Darzi AW, Moglia A, Brand TC, Dorin RP, Dumon KR, Francone TD, Georgiou E, Goh AC, Marcet JE, Martino MA, Sudan R, Vale J, Gallagher AGet al., 2019, Proving the Effectiveness of the Fundamentals of Robotic Surgery (FRS) Skills Curriculum: A Single-blinded, Multispecialty, Multi-institutional Randomized Control Trial., Ann Surg

MINI: Question: Is the Fundamentals of Robotic Surgery (FRS) proficiency-based progression curriculum effective for teaching basic robotic surgery skills? FINDINGS: In an international multi-institutional, multispecialty, blinded, randomized control trial, implementation of the FRS skills curriculum using various simulation platforms led to improved performance of surgical trainees on a transfer test compared with controls.Meaning: The FRS is an effective simulation-based course for training to proficiency on basic robotic surgery skills before surgeons apply those skills clinically. OBJECTIVE: To demonstrate the noninferiority of the fundamentals of robotic surgery (FRS) skills curriculum over current training paradigms and identify an ideal training platform. SUMMARY BACKGROUND DATA: There is currently no validated, uniformly accepted curriculum for training in robotic surgery skills. METHODS: Single-blinded parallel-group randomized trial at 12 international American College of Surgeons (ACS) Accredited Education Institutes (AEI). Thirty-three robotic surgery experts and 123 inexperienced surgical trainees were enrolled between April 2015 and November 2016. Benchmarks (proficiency levels) on the 7 FRS Dome tasks were established based on expert performance. Participants were then randomly assigned to 4 training groups: Dome (n = 29), dV-Trainer (n = 30), and DVSS (n = 32) that trained to benchmarks and control (n = 32) that trained using locally available robotic skills curricula. The primary outcome was participant performance after training based on task errors and duration on 5 basic robotic tasks (knot tying, continuous suturing, cutting, dissection, and vessel coagulation) using an avian tissue model (transfer-test). Secondary outcomes included cognitive test scores, GEARS ratings, and robot familiarity checklist scores. RESULTS: All groups demonstrated significant performance improvement after skills training (P < 0.01). Participating residents and fello

JOURNAL ARTICLE

Garas G, Cingolani I, Panzarasa P, Darzi A, Athanasiou Tet al., 2019, Beyond IDEAL: the importance of surgical innovation metrics, LANCET, Vol: 393, Pages: 315-315, ISSN: 0140-6736

JOURNAL ARTICLE

Khanbhai M, Flott K, Darzi A, Mayer Eet al., 2019, Evaluating Digital Maturity and Patient Acceptability of Real-Time Patient Experience Feedback Systems: Systematic Review, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 21, ISSN: 1438-8871

JOURNAL ARTICLE

Goiana-da-Silva F, Cruz-e-Silva D, Miraldo M, Calhau C, Bento A, Cruz D, Almeida F, Darzi A, Araujo Fet al., 2019, Front-of-pack labelling policies and the need for guidance, LANCET PUBLIC HEALTH, Vol: 4, Pages: E15-E15, ISSN: 2468-2667

JOURNAL ARTICLE

Garas G, Cingolani I, Patel V, Panzarasa P, Alderson D, Darzi A, Athanasiou Tet al., 2018, Surgical Innovation in the Era of Global Surgery: A Network Analysis., Ann Surg

OBJECTIVE: To present a novel network-based framework for the study of collaboration in surgery and demonstrate how this can be used in practice to help build and nurture collaborations that foster innovation. BACKGROUND: Surgical innovation is a social process that originates from complex interactions among diverse participants. This has led to the emergence of numerous surgical collaboration networks. What is still needed is a rigorous investigation of these networks and of the relative benefits of various collaboration structures for research and innovation. METHODS: Network analysis of the real-world innovation network in robotic surgery. Hierarchical mixed-effect models were estimated to assess associations between network measures, research impact and innovation, controlling for the geographical diversity of collaborators, institutional categories, and whether collaborators belonged to industry or academia. RESULTS: The network comprised of 1700 organizations and 6000 links. The ability to reach many others along few steps in the network (closeness centrality), forging a geographically diverse international profile (network entropy), and collaboration with industry were all shown to be positively associated with research impact and innovation. Closed structures (clustering coefficient), in which collaborators also collaborate with each other, were found to have a negative association with innovation (P < 0.05 for all associations). CONCLUSIONS: In the era of global surgery and increasing complexity of surgical innovation, this study highlights the importance of establishing open networks spanning geographical boundaries. Network analysis offers a valuable framework for assisting surgeons in their efforts to forge and sustain collaborations with the highest potential of maximizing innovation and patient care.

JOURNAL ARTICLE

Clarke JM, Warren LR, Arora S, Barahona M, Darzi AWet al., 2018, Guiding interoperable electronic health records through patient-sharing networks, NPJ DIGITAL MEDICINE, Vol: 1, ISSN: 2398-6352

JOURNAL ARTICLE

Arhi CS, Bottle A, Burns EM, Clarke JM, Aylin P, Ziprin P, Darzi Aet al., 2018, Comparison of cancer diagnosis recording between the Clinical Practice Research Datalink, Cancer Registry and Hospital Episodes Statistics, CANCER EPIDEMIOLOGY, Vol: 57, Pages: 148-157, ISSN: 1877-7821

JOURNAL ARTICLE

Normahani P, Kwasnicki R, Bicknell C, Allen L, Jenkins MP, Gibbs R, Cheshire N, Darzi A, Riga Cet al., 2018, Wearable Sensor Technology Efficacy in Peripheral Vascular Disease (wSTEP) A Randomized Controlled Trial, ANNALS OF SURGERY, Vol: 268, Pages: 1113-1118, ISSN: 0003-4932

JOURNAL ARTICLE

Goiana-da-Silva F, Cruz-e-Silva D, Gregorio MJ, Miraldo M, Darzi A, Araujo Fet al., 2018, The future of the sweetened beverages tax in Portugal, LANCET PUBLIC HEALTH, Vol: 3, Pages: E562-E562, ISSN: 2468-2667

JOURNAL ARTICLE

Smalley K, Aufegger L, Flott K, Holt G, Mayer E, Darzi Aet al., Which behaviour change techniques are most effective in improving healthcare utilisation in COPD self-management programmes?, BMJ Open Respiratory Research, 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

Markar SR, Arhi C, Wiggins T, Vidal-Diez A, Karthikesalingam A, Darzi A, Lagergren J, Hanna GBet al., 2018, Reintervention After Antireflux Surgery for Gastroesophageal Reflux Disease in England., Ann Surg

BACKGROUND: After antireflux surgery, highly variable rates of recurrent gastroesophageal reflux disease (GERD) have been reported. OBJECTIVE: To identify the occurrence and risk factors of recurrent GERD requiring surgical reintervention or medication. METHODS: The Hospital Episode Statistics database was used to identify adults in England receiving primary antireflux surgery for GERD in 2000 to 2012 with follow-up through 2014, and the outcome was surgical reintervention. In a subset of participants, the Clinical Practice Research Datalink was additionally used to assess proton pump inhibitor therapy for at least 6 months (medical reintervention). Risk factors were assessed using multivariable Cox regression providing adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs). RESULTS: Among 22,377 patients who underwent primary antireflux surgery in the Hospital Episode Statistics dataset, 811 (3.6%) had surgical reintervention, with risk factors being age 41 to 60 years (HR = 1.22, 95% CI 1.03-1.44), female sex (HR = 1.5; 95% CI 1.3-1.74), white ethnicity (HR = 1.71, 95% CI 1.06-2.77), and low hospital annual volume of antireflux surgery (HR = 1.32, 95% CI 1.04-1.67). Among 2005 patients who underwent primary antireflux surgery in the Clinical Practice Research Datalink dataset, 189 (9.4%) had surgical reintervention and 1192 (59.5%) used proton pump inhibitor therapy, with risk factors for the combined outcome being age >60 years (HR = 2.38, 95% CI 1.81-3.13) and preoperative psychiatric morbidity (HR = 1.58, 95% CI 1.25-1.99). CONCLUSION: At least 3.6% of patients may require surgical reintervention and 59.5% medical therapy following antireflux surgery in England. The influence of patient characteristics and hospital volume highlights the need for patient selection and surgical experience in successful antireflux surgery.

JOURNAL ARTICLE

Gowers SAN, Hamaoui K, Vallant N, Hanna GB, Darzi A, Casanova D, Papalois V, Boutelle MGet al., 2018, An improved rapid sampling microdialysis system for human and porcine organ monitoring in a hospital setting, ANALYTICAL METHODS, Vol: 10, Pages: 5273-5281, ISSN: 1759-9660

JOURNAL ARTICLE

Goiana Silva F, Cruz-e-Silva D, Miraldo M, Calhau C, Bento A, Cruz D, Almeida F, Darzi A, Ara├║jo Fet al., Supporting member states develop consumer-friendly front of pack labelling policies: guidance from the World Health Organization, Lancet Public Health, ISSN: 2468-2667

JOURNAL ARTICLE

Ashcroft J, Patel R, Singh H, Darzi A, Leff Det al., The Impact of Transcranial direct current stimulation (tDCS) on a surgical knot-tying task, Surgery and Cancer Research Afternoon Abstract

CONFERENCE PAPER

Arhi C, Ziprin P, Bottle A, Burns E, Aylin P, Darzi Aet al., 2018, Young colorectal cancer patients experience referral delays in primary care leading to emergency diagnoses, National-Cancer-Research-Institute (NCRI) Cancer Conference, Publisher: NATURE PUBLISHING GROUP, Pages: 4-4, ISSN: 0007-0920

CONFERENCE PAPER

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