Publications
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van Dael J, Reader TW, Gillespie AT, et al., 2022, Do national policies for complaint handling in English hospitals support quality improvement? Lessons from a case study, Journal of the Royal Society of Medicine, Vol: 115, Pages: 390-398, ISSN: 0141-0768
ObjectivesA range of public inquiries in the English National Health Service have indicated repeating failings in complaint handling, and patients are often left dissatisfied. The complex, bureaucratic nature of complaints systems is often cited as an obstacle to meaningful investigation and learning, but a detailed examination of how such bureaucratic rules, regulations, and infrastructure shape complaint handling, and where change is most needed, remains relatively unexplored. We sought to examine how national policies structure local practices of complaint handling, how they are understood by those responsible for enacting them, and if there are any discrepancies between policies-as-intended and their reality in local practice.DesignCase study involving staff interviews and documentary analysis.SettingA large acute and multi-site NHS Trust in England.ParticipantsClinical, managerial, complaints, and patient advocacy staff involved in complaint handling at the participating NHS Trust (n=20).Main outcome measuresNot applicable.ResultsFindings illustrate four areas of practice where national policies and regulations can have adverse consequences within local practices, and partly function to undermine an improvement-focused approach to complaints. These include muddled routes for raising formal complaints, investigative procedures structured to scrutinize the ‘validity’ of complaints, futile data collection systems, and adverse incentives and workarounds resulting from bureaucratic performance targets.ConclusionThis study demonstrates how national policies and regulations for complaint handling can impede, rather than promote, quality improvement in local settings. Accordingly, we propose a number of necessary reforms, including patient involvement in complaints investigations, the establishment of independent investigation bodies, and more meaningful data analysis strategies to uncover and address systemic causes behind recurring complaints.
Chadeau-Hyam M, Tang D, Eales O, et al., 2022, Omicron SARS-CoV-2 epidemic in England during February 2022: A series of cross-sectional community surveys, The Lancet Regional Health Europe, Vol: 21, Pages: 1-11, ISSN: 2666-7762
BackgroundThe Omicron wave of COVID-19 in England peaked in January 2022 resulting from the rapid transmission of the Omicron BA.1 variant. We investigate the spread and dynamics of the SARS-CoV-2 epidemic in the population of England during February 2022, by region, age and main SARS-CoV-2 sub-lineage.MethodsIn the REal-time Assessment of Community Transmission-1 (REACT-1) study we obtained data from a random sample of 94,950 participants with valid throat and nose swab results by RT-PCR during round 18 (8 February to 1 March 2022).FindingsWe estimated a weighted mean SARS-CoV-2 prevalence of 2.88% (95% credible interval [CrI] 2.76–3.00), with a within-round effective reproduction number (R) overall of 0.94 (0·91–0.96). While within-round weighted prevalence fell among children (aged 5 to 17 years) and adults aged 18 to 54 years, we observed a level or increasing weighted prevalence among those aged 55 years and older with an R of 1.04 (1.00–1.09). Among 1,616 positive samples with sublineages determined, one (0.1% [0.0–0.3]) corresponded to XE BA.1/BA.2 recombinant and the remainder were Omicron: N=1047, 64.8% (62.4–67.2) were BA.1; N=568, 35.2% (32.8–37.6) were BA.2. We estimated an R additive advantage for BA.2 (vs BA.1) of 0.38 (0.34–0.41). The highest proportion of BA.2 among positives was found in London.InterpretationIn February 2022, infection prevalence in England remained high with level or increasing rates of infection in older people and an uptick in hospitalisations. Ongoing surveillance of both survey and hospitalisations data is required.FundingDepartment of Health and Social Care, England.
Alboksmaty A, Beaney T, Elkin S, et al., 2022, Effectiveness and safety of pulse oximetry in remote patient monitoring of patients with COVID-19, European Journal of Public Health, Vol: 32, Pages: 1-1, ISSN: 1101-1262
ContextA surge of COVID cases globally is often portrayed as “very likely”, which overwhelms health systems and challenges their capacities. A mitigation strategy is seen by remotely monitoring COVID patients in out-of-hospital settings to determine the risk of deterioration.Description of the problemWe need an indicator to enable remote monitoring of COVID patients at home that can be measured by a handy tool; pulse oximetry which measures peripheral blood oxygen saturation (SpO2). Evidence shows that SpO2 is a reliable indicator of deterioration among COVID patients. The UK initiated a national programme (COVID Oximetry @ Home (CO@H)) to assess the theory. The concept can be potentially applied in other countries in various settings. As part of CO@H, we conducted a systematic review of the evidence on the safety and effectiveness of pulse oximetry in remote monitoring of COVID patients.ResultsOur review confirms the safety and potential effectiveness of pulse oximetry in remote home monitoring among COVID patients. We identified 13 research projects involving 2,908 participants that assessed the proposed strategy. Evidence shows the need to monitor at-rest and post-exertional SpO2. At-rest SpO2 of ≤ 92% or a decrease of 5% or more in post-exertional SpO2 should indicate care escalation. The recommended method for measuring at-rest SpO2 is after 5-10 min of rest, and assessing post-exertional SpO2 is after conducting a 1-min sit-to-stand test. We could not find explicit evidence on the impact on health service use compared with other models of care.LessonsRemote monitoring of COVID patients could alleviate the pressure on health systems and save hospital resources. Monitoring SpO2 by pulse oximetry can be widely applied, including in resource-limited settings, as the tool is affordable, reliable, and easy to use.Key messages• Adopting relevant health technologies in remote patient monitoring is critical to combat the pandemic.• Pu
Wei J, Monfort Sanchez E, Avery J, et al., 2022, Non-invasive assessment of intestinal permeability in healthy volunteers using transcutaneous fluorescence spectroscopy, Methods and Applications in Fluorescence, Vol: 10, Pages: 1-9, ISSN: 2050-6120
The permeability of the intestinal barrier is altered in a multitude of gastrointestinal conditions such as Crohn's and coeliac disease. However, the clinical utility of gut permeability is currently limited due to a lack of reliable diagnostic tests. To address this issue, we report a novel technique for rapid, non-invasive measurement of gut permeability based on transcutaneous ('through-the-skin') fluorescence spectroscopy. In this approach, participants drink an oral dose of a fluorescent dye (fluorescein) and a fibre-optic fluorescence spectrometer is attached to the finger to detect permeation of the dye from the gut into the blood stream in a non-invasive manner. To validate this technique, clinical trial measurements were performed in 11 healthy participants. First, after 6 h of fasting, participants ingested 500 mg of fluorescein dissolved in 100 ml of water and fluorescence measurements were recorded at the fingertip over the following 3 h. All participants were invited back for a repeat study, this time ingesting the same solution but with 60 g of sugar added (known to transiently increase intestinal permeability). Results from the two study datasets (without and with sugar respectively) were analysed and compared using a number of analysis procedures. This included both manual and automated calculation of a series of parameters designed for assessment of gut permeability. Calculated values were compared using Student's T-tests, which demonstrated significant differences between the two datasets. Thus, transcutaneous fluorescence spectroscopy shows promise in non-invasively discriminating between two differing states of gut permeability, demonstrating potential for future clinical use.
Fusari G, Gibbs E, Hoskin L, et al., 2022, What is the feasibility and patient acceptability of a digital system for arm and hand rehabilitation after stroke? A mixed methods, single-arm feasibility study of the ‘OnTrack’ intervention for hospital and home use, BMJ Open, Vol: 12, Pages: 1-12, ISSN: 2044-6055
Objectives:Arm weakness is common after stroke; repetitive activity is critical for recovery but people struggle with knowing what to do, volume, and monitoring progress. We studied the feasibility and acceptability ofOnTrack, a digital intervention supporting arm and hand rehabilitation in acute and home settings.Design:A mixed method, single-arm study evaluating the feasibility of OnTrack for hospital and home use. An independent process evaluation assessed the intervention’s fidelity, dose and reach. Amendments to the protocol were necessary after Covid-19.Setting:Acute stroke services and home settings in North West London.Participants:12 adults with a stroke diagnosis <6 months previously (first or recurrent) requiring arm rehabilitation in hospital and/or home.Intervention:12 weeks using the OnTrack system comprising arm tracking and coaching support for self-management.Primary and secondary outcome measures:Recruitment, retention and completion rates; compliance and adherence to the intervention; reasons for study decline/withdrawal.Intervention fidelity and acceptability, evaluated through an independent process evaluation.Patient measures including activity baseline, healthcare activation, arm function & impairment collected at baseline, week 7 and week 14 of participation to assess suitability for a RCT.Results:181 individuals screened, 37 met eligibility criteria, 24 recruited (65%); of these, 15 (63%) were recruited before Covid-19, and 9 (37%) during. 12 completed the intervention (50%). Despite Covid-19 disruptions,recruitment, retention and completion were in line with pre-study expectations and acceptable for a definitive trial. Participants felt the study requirements were acceptable and the intervention usable.Fidelity of delivery was acceptable according to predetermined fidelity markers. Outcome measures collected helped determine sample size estimates and primary outcomes for an RCT.Conclusions:The intervention was found to be usabl
Elson D, Nazarian S, Gkouzionis I, et al., 2022, Real-time Classification of Colorectal Tissue Using Diffuse Reflectance Spectroscopy to Aid Margin Assessment, European Society of Coloproctology Scientific Conference
Li E, Clarke J, Ashrafian H, et al., 2022, Impact of electronic health record interoperability on safety and quality of care in high-income countries: A systematic review, Journal of Medical Internet Research, Vol: 24, Pages: 1-15, ISSN: 1438-8871
Background: Electronic health records (EHR) and poor systems interoperability are well-known issues in the use of health information technologies worldwide in most high-income countries. Despite the abundance of literature exploring their relationship, its practical implications on patient safety and quality of care remain unclear.Objective: To examine how EHR interoperability affects patient safety, or other dimensions of care quality, in high-income healthcare settings. Methods: A systematic search was conducted using four online medical journal repositories and grey literature sources. Publications included were published in English between 2010-2022, pertaining to EHR use, interoperability, and patient safety or care quality in high-income settings. Screening was completed by three researchers in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Risk of bias assessments was performed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) and the Cochrane Risk of Bias 2 (RoB2) tools. Findings were presented as a narrative synthesis and mapped based on the Institute of Medicine’s framework for healthcare quality.Results: Twelve studies met the inclusion criteria to be included in our review. Findings were categorised into six common outcome measure categories: patient safety events, medication safety, data accuracy and errors, care effectiveness, productivity, and cost-savings. EHR interoperability was found to positively influence medication safety, reduce patient safety events, and lower costs. Improvements to time-savings and clinical workflow are mixed. However, true measures of effect are difficult to determine with certainty due to the heterogeneity in outcome measures used and notable variation in study quality.Conclusion: The benefits of EHR interoperability on the quality and safety of care remain unclear and reflect the extensive heterogeneity in the interventions, designs, and outcome
Goiana-Da-Silva F, Miraldo M, 2022, Modelling the health impact of legislation to limit the salt content of bread in Portugal: a macro simulation study, Frontiers in Public Health, Vol: 10, Pages: 1-9, ISSN: 2296-2565
Background: Excessive salt consumption - associated with a range of adverse health outcomes – is very high in Portugal, and bread is the second largest source. Current Portuguese legislation sets a maximum limit of 1.4g salt per 100g bread, but imported and traditional breads are exempted. In 2017 the Ministry of Health proposed reducing the salt threshold to 1.0g/100g by 2022, however the legislation was vetoed by the European Commission on free-trade grounds. Aims: To estimate the health impact of subjecting imported and traditional breads to the current 1.4g threshold, and to model the potential health impact of implementing the proposed 1.0g threshold. Methods: We gathered bread sales, salt consumption, and epidemiological data from robust publicly available data sources. We used the open source WHO PRIME modelling tool to estimate the number of salt-related deaths that would have been averted in 2016 (the latest year for which all data were available) from; 1) Extending the 1.4g threshold to all types of bread, and 2) Applying the 1.0g threshold to all bread sold in Portugal. We used Monte Carlo simulations to generate confidence intervals. Results: Applying the current 1.4g threshold to imported and traditional bread would have averted 107 deaths in 2016 (95%CI: 43 to 172). Lowering the current threshold from 1.4 to 1.0g and applying it to all bread products would reduce daily salt consumption by 3.6 tonnes per day, saving an estimated 286 lives a year (95%CI 123-454).Conclusions: Salt is an important risk factor in Portugal and bread is a major source. Lowering maximum permissible levels and removing exemptions would save lives. The European Commission should revisit its decision on the basis of this new evidence.
Sanford N, Lavelle M, Markiewicz O, et al., 2022, Understanding complex work using an extension of the resilience CARE model: an ethnographic study, BMC HEALTH SERVICES RESEARCH, Vol: 22
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Bielinska A-M, Soosaipillai G, Riley J, et al., 2022, Views of advance care planning in older hospitalized patients following an emergency admission: A qualitative study, PLOS ONE, Vol: 17, ISSN: 1932-6203
Eales O, Ainslie KEC, Walters CE, et al., 2022, Appropriately smoothing prevalence data to inform estimates of growth rate and reproduction number, Epidemics: the journal of infectious disease dynamics, Vol: 40, ISSN: 1755-4365
The time-varying reproduction number () can change rapidly over the course of a pandemic due to changing restrictions, behaviours, and levels of population immunity. Many methods exist that allow the estimation of from case data. However, these are not easily adapted to point prevalence data nor can they infer across periods of missing data. We developed a Bayesian P-spline model suitable for fitting to a wide range of epidemic time-series, including point-prevalence data. We demonstrate the utility of the model by fitting to periodic daily SARS-CoV-2 swab-positivity data in England from the first 7 rounds (May 2020–December 2020) of the REal-time Assessment of Community Transmission-1 (REACT-1) study. Estimates of over the period of two subsequent rounds (6–8 weeks) and single rounds (2–3 weeks) inferred using the Bayesian P-spline model were broadly consistent with estimates from a simple exponential model, with overlapping credible intervals. However, there were sometimes substantial differences in point estimates. The Bayesian P-spline model was further able to infer changes in over shorter periods tracking a temporary increase above one during late-May 2020, a gradual increase in over the summer of 2020 as restrictions were eased, and a reduction in during England’s second national lockdown followed by an increase as the Alpha variant surged. The model is robust against both under-fitting and over-fitting and is able to interpolate between periods of available data; it is a particularly versatile model when growth rate can change over small timescales, as in the current SARS-CoV-2 pandemic. This work highlights the importance of pairing robust methods with representative samples to track pandemics.
Chidambaram S, Maheswaran Y, Patel K, et al., 2022, Using Artificial Intelligence-Enhanced Sensing and Wearable Technology in Sports Medicine and Performance Optimisation, SENSORS, Vol: 22
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Fletcher E, Thompson A, Ashrafian H, et al., 2022, The measurement and modification of hypoxia in colorectal cancer: overlooked but not forgotten, Gastroenterology Report, Vol: 10, Pages: 1-13, ISSN: 2052-0034
Tumour hypoxia is the inevitable consequence of a tumour’s rapid growth and disorganised, inefficient vasculature. The compensatory mechanisms employed by tumours, and indeed the absence of oxygen itself, hinder the ability of all treatment modalities. The clinical consequence is poorer overall survival, disease-free survival, and locoregional control. Recognising this, clinicians have been attenuating the effect of hypoxia, primarily with hypoxic modification or with hypoxia activated pro-drugs, and notable success has been demonstrated. However, in the case of colorectal cancer (CRC), there is a general paucity of knowledge and evidence surrounding the measurement and modification of hypoxia, and this is possibly due to the comparative inaccessibility of such tumours. We specifically review the role of hypoxia in CRC, and focus on: the current evidence for the existence of hypoxia in CRC, the majority of which originates from indirect positron emission topography (PET) imaging with hypoxia selective radiotracers; the evidence correlating CRC hypoxia with poorer oncological outcome, which is largely based on the measurement of Hypoxia Inducible Factor (HIF) in correlation with clinical outcome; the evidence of hypoxic modification in CRC, of which no direct evidence exists, but is reflected in a number of indirect markers; the prognostic and monitoring implications of accurate CRC hypoxia quantification and its potential in the field of precision oncology; and the present and future imaging tools and technologies being developed for the measurement of CRC hypoxia, including the use of blood oxygen level dependent (BOLD) MRI imaging and diffuse reflectance spectroscopy.
Wallace W, Chan C, Chidambaram S, et al., 2022, 471 Assessing the Accuracy and Bias of Digital Symptom Checkers with Myocardial Infarction Patients, ASiT Surgical Conference, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Wallace W, Chan C, Chidambaram S, et al., 2022, The diagnostic and triage accuracy of digital and online symptom checker tools: a systematic review, npj Digital Medicine, Vol: 5, ISSN: 2398-6352
Digital and online symptom checkers are an increasingly adopted class of health technologies that enable patients to input their symptoms and biodata to produce a set of likely diagnoses and associated triage advice. However, concerns regarding the accuracy and safety of these symptom checkers have been raised. This systematic review evaluates the accuracy of symptom checkers in providing diagnoses and appropriate triage advice. MEDLINE and Web of Science were searched for studies that used either real or simulated patients to evaluate online or digital symptom checkers. The primary outcomes were the diagnostic and triage accuracy of the symptom checkers. The QUADAS-2 tool was used to assess study quality. Of the 177 studies retrieved, 10 studies met the inclusion criteria. Researchers evaluated the accuracy of symptom checkers using a variety of medical conditions, including ophthalmological conditions, inflammatory arthritides and HIV. 50% of the studies recruited real patients, while the remainder used simulated cases. The diagnostic accuracy of the primary diagnosis was low across included studies (range: 19% to 37.9%) and varied between individual symptom checkers, despite consistent symptom data input. Triage accuracy (range: 48.8% to 90.1%) was typically higher than diagnostic accuracy. Overall, the diagnostic and triage accuracy of symptom checkers are variable and of low accuracy. Given the increasing push towards adopting this class of technologies across numerous health systems, this study demonstrates that reliance upon symptom checkers could pose significant patient safety hazards. Large scale primary studies, based upon real world data, are warranted to demonstrate adequate performance of these technologies in a manner that is and non-inferior to current best practice. Moreover, an urgent assessment of how these systems are regulated and implemented is required.
Elliott P, Eales O, Bodinier B, et al., 2022, Dynamics of a national Omicron SARS-CoV-2 epidemic during January 2022 in England, Nature Communications, Vol: 13, ISSN: 2041-1723
Rapid transmission of the SARS-CoV-2 Omicron variant has led to record-breaking case incidence rates around the world. Since May 2020, the REal-time Assessment of Community Transmission-1 (REACT-1) study tracked the spread of SARS-CoV-2 infection in England through RT-PCR of self-administered throat and nose swabs from randomly-selected participants aged 5 years and over. In January 2022, we found an overall weighted prevalence of 4.41% (n=102,174), three-fold higher than in November to December 2021; we sequenced 2,374 (99.2%) Omicron infections (19 BA.2), and only 19 (0.79%) Delta, with a growth rate advantage for BA.2 compared to BA.1 or BA.1.1. Prevalence was decreasing overall (reproduction number R=0.95, 95% credible interval [CrI], 0.93, 0.97), but increasing in children aged 5 to 17 years (R=1.13, 95% CrI, 1.09, 1.18). In England during January 2022, we observed unprecedented levels of SARS-CoV-2 infection, especially among children, driven by almost complete replacement of Delta by Omicron.
Omar I, Miller K, Madhok B, et al., 2022, The first international Delphi consensus statement on Laparoscopic Gastrointestinal surgery, INTERNATIONAL JOURNAL OF SURGERY, Vol: 104, ISSN: 1743-9191
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Yeung K, Penney N, Whiley L, et al., 2022, SERUM AMINO ACID RATIOS AS PROXIES TO MECHANISMS CONTRIBUTING TO IMPROVED METABOLIC HEALTH AFTER BARIATRIC SURGERY Basic science and research in bariatric surgery, 25th IFSO World Congress, Publisher: SPRINGER, Pages: 483-483, ISSN: 0960-8923
Yeung K, Whiley L, Penney N, et al., 2022, SERUM LIPIDOMIC SIGNATURES OF TYPE 2 DIABETES AND EARLY SURGICAL DIABETES RESOLUTION Basic science and research in bariatric surgery, Publisher: SPRINGER, Pages: 485-485, ISSN: 0960-8923
Eales O, Martins LDO, Page AJ, et al., 2022, Dynamics of competing SARS-CoV-2 variants during the Omicron epidemic in England, Nature Communications, Vol: 13, ISSN: 2041-1723
The SARS-CoV-2 pandemic has been characterised by the regular emergence of genomic variants. With natural and vaccine-induced population immunity at high levels, evolutionary pressure favours variants better able to evade SARS-CoV-2 neutralising antibodies. The Omicron variant (first detected in November 2021) exhibited a high degree of immune evasion, leading to increased infection rates worldwide. However, estimates of the magnitude of this Omicron wave have often relied on routine testing data, which are prone to several biases. Using data from the REal-time Assessment of Community Transmission-1 (REACT-1) study, a series of cross-sectional surveys assessing prevalence of SARS-CoV-2 infection in England, we estimated the dynamics of England’s Omicron wave (from 9 September 2021 to 1 March 2022). We estimate an initial peak in national Omicron prevalence of 6.89% (5.34%, 10.61%) during January 2022, followed by a resurgence in SARS-CoV-2 infections as the more transmissible Omicron sub-lineage, BA.2 replaced BA.1 and BA.1.1. Assuming the emergence of further distinct variants, intermittent epidemics of similar magnitudes may become the ‘new normal’.
Eales O, Wang H, Bodinier B, et al., 2022, SARS-CoV-2 lineage dynamics in England from September to November 2021: high diversity of Delta sub-lineages and increased transmissibility of AY.4.2, BMC Infectious Diseases, Vol: 22, ISSN: 1471-2334
Background: Since the emergence of SARS-CoV-2, evolutionary pressure has driven large increases in the transmissibility of the virus. However, with increasing levels of immunity through vaccination and natural infection the evolutionary pressure will switch towards immune escape. Genomic surveillance in regions of high immunity is crucial in detecting emerging variants that can more successfully navigate the immune landscape. Methods: We present phylogenetic relationships and lineage dynamics within England (a country with high levels of immunity), as inferred from a random community sample of individuals who provided a self-administered throat and nose swab for rt-PCR testing as part of the REal-time Assessment of Community Transmission-1 (REACT-1) study. During round 14 (9 September - 27 September 2021) and 15 (19 October - 5 November 2021) lineages were determined for 1322 positive individuals, with 27.1% of those which reported their symptom status reporting no symptoms in the previous month.Results: We identified 44 unique lineages, all of which were Delta or Delta sub-lineages, and found a reduction in their mutation rate over the study period. The proportion of the Delta sub-lineage AY.4.2 was increasing, with a reproduction number 15% (95% CI, 8%-23%) greater than the most prevalent lineage, AY.4. Further, AY.4.2 was less associated with the most predictive COVID-19 symptoms (p = 0.029) and had a reduced mutation rate (p = 0.050). Both AY.4.2 and AY.4 were found to be geographically clustered in September but this was no longer the case by late October/early November, with only the lineage AY.6 exhibiting clustering towards the South of England.Conclusions: As SARS-CoV-2 moves towards endemicity and new variants emerge, genomic data obtained from random community samples can augment routine surveillance data without the potential biases introduced due to higher sampling rates of symptomatic individuals.
Wallace W, Chan C, Chidambaram S, et al., 2022, The diagnostic and triage accuracy of digital and online symptom checker tools: a systematic review, Publisher: MedArxiv
<h4>ABSTRACT</h4> <h4>Objective</h4> To evaluate the accuracy of digital and online symptom checkers in providing diagnoses and appropriate triage advice. <h4>Design</h4> Systematic review. <h4>Data sources</h4> Medline and Web of Science were searched up to 15 February 2021. <h4>Eligibility criteria for study selection</h4> Prospective and retrospective cohort, vignette, or audit studies that utilised an online or application-based service designed to input symptoms and biodata in order to generate diagnoses, health advice and direct patients to appropriate services were included. <h4>Main outcome measures</h4> The primary outcomes were (1) the accuracy of symptom checkers for providing the correct diagnosis and (2) the accuracy of subsequent triage advice given. <h4>Data extraction and synthesis</h4> Data extraction and quality assessment (using the QUADAS-2 tool) were performed by two independent reviewers. Owing to heterogeneity of the studies, meta-analysis was not possible. A narrative synthesis of the included studies and pre-specified outcomes was completed. <h4>Results</h4> Of the 177 studies retrieved, nine cohort studies and one cross-sectional study met the inclusion criteria. Symptom checkers evaluated a variety of medical conditions including ophthalmological conditions, inflammatory arthritides and HIV. 50% of the studies recruited real patients, while the remainder used simulated cases. The diagnostic accuracy of the primary diagnosis was low (range: 19% to 36%) and varied between individual symptom checkers, despite consistent symptom data input. Triage accuracy (range: 48.8% to 90.1%) was typically higher than diagnostic accuracy. Of note, one study found that 78.6% of emergency ophthalmic cases were under-triaged. <h4>Conclusions</h4> The diagnostic and triage accuracy of symptom checkers are variable and of low accuracy. Given the increasin
Iqbal F, Joshi M, Khan S, et al., 2022, Key Stakeholder Barriers and Facilitators to Implementing Remote Monitoring Technologies: Protocol for a Mixed Methods Analysis, JMIR Research Protocols, Vol: 11, ISSN: 1929-0748
Background: The implementation of novel digital solutions within the National Health Service has historically been challenging. Since the start of the COVID-19 pandemic, there has been a greater push for digitization and for operating remote monitoring solutions. However, the implementation and widespread adoption of this type of innovation have been poorly studied.Objective: We aim to investigate key stakeholder barriers and facilitators to implementing remote monitoring solutions to identify factors that could affect successful adoption.Methods: A mixed methods approach will be implemented. Semistructured interviews will be conducted with high-level stakeholders from industry and academia and health care providers who have played an instrumental role in, and have prior experience with, implementing digital solutions, alongside the use of an adapted version of the Technology Acceptance Model questionnaire.Results: Enrollment is currently underway, having started in February 2022. It is anticipated to end in July 2022, with data analysis scheduled to commence in August 2022.Conclusions: The results of our study may highlight key barriers and facilitators to implementing digital remote monitoring solutions, thereby allowing for improved widespread adoption within the National Health Service in the future.Trial Registration: ClinicalTrials.gov NCT05321004; https://clinicaltrials.gov/ct2/show/NCT05321004
Lam K, Abramoff M, Balibrea J, et al., 2022, A Delphi consensus statement for digital surgery, npj Digital Medicine, Vol: 5, Pages: 1-9, ISSN: 2398-6352
The use of digital technology is increasing rapidly across surgical specialities, yet there is noconsensus for the term ‘digital surgery’. This is critical as digital health technologies present technical, governance, and legal challenges which are unique to the surgeon and surgical patient. We aim to define the term digital surgery and the ethical issues surrounding its clinical application, and to identify barriers and research goals for future practice. 38 international experts, across the fields of surgery, AI, industry, law, ethics and policy, participated in a four-round Delphi exercise. Issues were generated by an expert panel and public panel through a scoping questionnaire around key themes identified from the literature and voted upon in two subsequent questionnaire rounds. Consensus was defined if >70% of the panel deemed the statement important and <30% unimportant. A final online meeting was held to discuss consensus statements. The definition of digital surgery as the use of technology for the enhancement of preoperative planning, surgical performance, therapeutic support, or training, to improve outcomes and reduce harm achieved 100% consensus agreement. We highlight key ethical issues concerning data, privacy, confidentiality and public trust, consent, law; litigation and liability, and commercial partnerships within digital surgery and identify barriers and research goals for future practice. Developers and users of digital surgery must not only have an awareness of the ethical issues surrounding digital applications in healthcare, but also the ethical considerations unique to digital surgery. Future research into these issues must involve all digital surgery stakeholders including patients.
Acharya A, Ashrafian H, Cunnignham D, et al., 2022, Evaluating the impact of a novel behavioural science informed animation upon breast cancer screening uptake: protocol for a randomised controlled trial, BMC Public Health, Vol: 22, ISSN: 1471-2458
BackgroundBreast cancer screening is estimated to save 1300 lives annually in the United Kingdom. Despite this, uptake of invitations has fallen over the past decade. Behavioural science-informed interventions addressing the determinants of attendance behaviour have shown variable effectiveness. This may be due to the narrow repertoire of techniques trialled, and the difficulties of implementation at a population-scale. The aim of this study is to evaluate the impact on breast screening uptake of a novel behavioural video intervention which can contain more complex combinations of behavioural change techniques. MethodsA 3-armed randomised controlled trial will be undertaken in London comparing the impact of (1) the usual care SMS reminder, to (2) a behavioural plain text SMS reminder and (3) a novel video sent as a link within the behavioural plain text SMS reminder. A total of 8391 participants (2797 per group) will be allocated to one of the three trial arms using a computer randomisation process, based upon individuals’ healthcare identification numbers. The novel video has been co-designed with a diverse range of women to overcome the barriers faced by underserved communities and the wider population. The behavioural SMS content has also been co-designed through the same process as the video. Messages will be sent through the current reminder system used by the London screening programmes, with reminders 7 days and 2 days prior to a timed appointment. The primary outcome is attendance at breast cancer screening within 3 months of the initial invitation. Secondary outcomes will include evaluating the impact of each message amongst socio-demographic groups and according to the appointment type e.g. first invitation or recall. DiscussionIn addition to general declining trends in attendance, there is also concern of increasing healthcare inequalities with breast cancer screening in London. The current novel intervention, designed with underserved groups and t
Acharya A, Ashrafian H, Cunnigham D, et al., 2022, Evaluating the impact of a novel behavioural science informed animation upon breast cancer screening uptake: protocol for a randomised controlled trial, BMC Public Health, ISSN: 1471-2458
Fernandez Crespo R, Leis M, Alford J, et al., 2022, COVID-19 Global Behaviours and Attitudes: A review of the survey results of over 450,000 people in 9 countries
Lear R, Freise L, Kybert M, et al., 2022, Patients’ willingness and ability to identify and respond to errors in their personal health records: a mixed methods analysis of cross-sectional survey data, Journal of Medical Internet Research, Vol: 24, ISSN: 1438-8871
Background:Errors in electronic health records are known to contribute to patient safety incidents, yet systems for checking the accuracy of patient records are almost non-existent. Personal health records, enabling patient access to, and interaction, with the clinical record, offer a valuable opportunity for patients to actively participate in error surveillance.Objective:The aim of this study was to evaluate patients’ willingness and ability to identify and respond to errors in their personal health records.Methods:A cross-sectional survey study was conducted using an online questionnaire. Patient sociodemographic data were collected, including age, gender, ethnicity, educational level, health status, geographical location, motivation to self-manage, and digital health literacy (measured by the eHEALS tool). Patients with experience of using the Care Information Exchange (CIE) portal, who specified both age and gender, were included in these analyses. Patients’ responses to four relevant survey items (closed-ended questions, some with space for free-text comments) were examined to understand their willingness and ability to identify and respond to errors in their personal health records. Multinomial logistic regression was used to identify patient characteristics that predict i) ability to understand information in CIE, and ii) willingness to respond to errors in their records. The Framework Method was used to derive themes from patients’ free-text responses.Results:Of 445 patients, 40.7% (n=181) “definitely” understood CIE information and around half (49.4%, n=220) understood CIE information “to some extent”. Patients with high digital health literacy (eHEALS score ≥30) were more confident in their ability to understand their records compared to patients with low digital health literacy (odds ratio (OR) 7.85, 95% confidence interval (CI) 3.04-20.29, P<.001). Information-related barriers (medical terminology; lack of
Soukup T, Lamb BW, Morbi A, et al., 2022, Cancer multidisciplinary team meetings: impact of logistical challenges on communication and decision-making, BJS OPEN, Vol: 6, ISSN: 2474-9842
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Joshi M, Ashrafian H, Arora S, et al., 2022, A pilot study to investigate real time digital alerting from wearable sensors in surgical patients, Pilot and Feasibility Studies, Vol: 8, ISSN: 2055-5784
Background Continuous vital sign monitoring may identify changes sooner than current standard monitoring. Objective To investigate if the use of real time digital alerts sent to healthcare staff can improve the time taken to identify unwell patients and those with sepsis. DesignA prospective cohort study design. Setting West Middlesex University Hospital, UK. Participants 50 acutely unwell surgical patients admitted to hospital. Intervention Patients wore a lightweight wearable sensor measuring heart rate (HR), respiratory rate (RR) and temperature every 2 minutes whilst standard intermittent ward monitoring of vital signs was performed by nurses. Digital alerts were sent to healthcare staff from the sensor to a smartphone device. All alerts were reviewed for recruited patients to identify the exact time on the sensor in which deterioration occurred. The time to acknowledgement was then reviewed for each action and an average time to acknowledgement calculated.Results There were 50 patients recruited in the pilot study, of which there were vital sign alerts in 18 patients (36%). The total number of vital sign alerts generated in these 18 patients was 51. Of these 51 alerts there 7 alerts for high HR (13.7%), 33 for RR (64.7%) and 11 for temperature (21.6%). Out of the 27 acknowledged alerts there were 2 alerts for HR, 17 for RR and 8 for temperature. The average time to staff acknowledgement of the notification for all alerts was 154 minutes (2.6 hours). There were some patients which had shown signs of deterioration in the cohort. The frequency of routine observation monitoring was increased in 2 cases, 3 patients were referred to a senior clinician and 2 patients were initiated on the sepsis pathway. Conclusion This study demonstrates the evaluation of digital alerts to nurses in real-time. Although not all alerts were acknowledged, deterioration on the ward observations was detected and actions were taken accordingly. Patients were started on the sepsis pathw
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