Imperial College London

MrHutanAshrafian

Faculty of MedicineDepartment of Surgery & Cancer

Scientific Advisor
 
 
 
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Contact

 

+44 (0)20 3312 7651h.ashrafian

 
 
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Location

 

1089Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

316 results found

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

Ruban A, Prechtl C, Glaysher M, Chhina N, Al-Najim W, Miras A, smith C, Goldstone A, Patel M, Moore M, Ashrafian H, Byrne J, Teare Jet al., 2019, Effectiveness of different recruitment strategies in an RCT of a surgical device:;Experience from the Endobarrier trial, BMJ Open, Vol: 9, ISSN: 2044-6055

Recruiting participants into clinical trials is notoriously difficult and poses the greatest challenge when planning any investigative study. Poor recruitment may not only have financial ramifications owing to increased time and resources being spent but could adversely influence the clinical impact of a study if it becomes underpowered. Herein we present our own experience of recruiting into a nationally funded, multi-centre, randomised controlled trial (RCT) of the Endobarrier vs. standard medical therapy in obese patients with type 2 diabetes. Despite these both being highly prevalent conditions, there were considerable barriers to the effectiveness of different recruitment strategies across each study site. Although recruitment from primary care proved extremely successful at one study site, this largely failed at another site prompting the implementation of multimodal recruitment strategies including a successful media campaign to ensure sufficient participants were enrolled and the study was adequately powered. From this experience we propose where appropriate the early engagement and investment in media campaigns to enhance recruitment into clinical trials.

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

Cameron SJS, Alexander JL, Bolt F, Burke A, Ashrafian H, Teare J, Marchesi JR, Kinross J, Li JV, Takáts Zet al., 2019, Evaluation of Direct from Sample Metabolomics of Human Feces Using Rapid Evaporative Ionization Mass Spectrometry., Anal Chem, Vol: 91, Pages: 13448-13457

Mass spectrometry is a powerful tool in the investigation of the human fecal metabolome. However, current approaches require time-consuming sample preparation, chromatographic separations, and consequently long analytical run times. Rapid evaporative ionization mass spectrometry (REIMS) is a method of ambient ionization mass spectrometry and has been utilized in the metabolic profiling of a diverse range of biological materials, including human tissue, cell culture lines, and microorganisms. Here, we describe the use of an automated, high-throughput REIMS robotic platform for direct analysis of human feces. Through the analysis of fecal samples from five healthy male participants, REIMS analytical parameters were optimized and used to assess the chemical information obtainable using REIMS. Within the fecal samples analyzed, bile acids, including primary, secondary, and conjugate species, were identified, and phospholipids of possible bacterial origin were detected. In addition, the effect of storage conditions and consecutive freeze/thaw cycles was determined. Within the REIMS mass spectra, the lower molecular weight metabolites, such as fatty acids, were shown to be significantly affected by storage conditions for prolonged periods at temperatures above -80 °C and consecutive freeze/thaw cycles. However, the complex lipid region was shown to be unaffected by these conditions. A further cohort of 50 fecal samples, collected from patients undergoing bariatric surgery, were analyzed using the optimized REIMS parameters and the complex lipid region mass spectra used for multivariate modeling. This analysis showed a predicted separation between pre- and post-surgery specimens, suggesting that REIMS analysis can detect biological differences, such as microbiome-level differences, which have traditionally been reliant upon methods utilizing extensive sample preparations and chromatographic separations and/or DNA sequencing.

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

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

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

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.

Journal article

Navaratne L, Ashrafian H, Martinez-Isla A, 2019, Quantifying tension in tension-free hiatal hernia repair: a new intra-operative technique, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 33, Pages: 3040-3049, ISSN: 0930-2794

Journal article

Judah G, Markiewicz O, Lavelle M, Lorencatto F, Ashrafian H, Darzi Aet al., Threats to safe transitions from hospital to home: Consensus study in primary care, British Journal of General Practice, ISSN: 0960-1643

BackgroundTransitions between healthcare settings are vulnerable points for patients.Aim To identify key threats to safe patient transitions from hospital to primary care settings.Design Three-round web-based Delphi consensus process.Setting Clinical and non-clinical staff in 39 primary care practices. MethodRound 1: free-text idea-generating round. Rounds 2 and 3: consensus-obtaining rating rounds. Practices were encouraged to complete the questionnaires at team meetings. Aggregate ratings of perceived level of importance for each threat were calculated (1-3 not important, 4-6 somewhat important, 7-9 very important). Percentage of votes cast for each patient or medication group were recorded (consensus defined as 75%). Results 39 practices completed Round 1, 36/39 (92%) completed Round 2 and 30/36 (83%) completed Round 3. Round 1 identified nine threats encompassing problems involving communication, service organisation, medication provision and which patients were most at risk. “Poor quality of handover instructions from secondary to primary care teams” achieved the highest rating (M=8.43) and a 100% consensus that it was a “very important” threat. The elderly (97%) and patients with complex medical problems taking more than five medications (80%) were voted the most vulnerable. Anticoagulants (77%) were considered to pose the greatest risk to patients. Conclusions This study identified specific threats to safe patient transitions from hospital to primary care, providing policymakers and healthcare providers with targets for quality improvement strategies. Further work needs to identify factors underpinning these threats so that interventions can be tailored to the relevant behavioural and environmental contexts in which these threats arise.

Journal article

Aufegger L, Bicknell C, Soane E, Ashrafian H, Darzi Aet al., 2019, Understanding health management and safety decisions using signal processing and machine learning, BMC Medical Research Methodology, Vol: 19, ISSN: 1471-2288

BackgroundSmall group research in healthcare is important because it deals with interaction and decision-making processes that can help to identify and improve safer patient treatment and care. However, the number of studies is limited due to time- and resource-intensive data processing. The aim of this study was to examine the feasibility of using signal processing and machine learning techniques to understand teamwork and behaviour related to healthcare management and patient safety, and to contribute to literature and research of teamwork in healthcare.MethodsClinical and non-clinical healthcare professionals organised into 28 teams took part in a video- and audio-recorded role-play exercise that represented a fictional healthcare system, and included the opportunity to discuss and improve healthcare management and patient safety. Group interactions were analysed using the recurrence quantification analysis (RQA; Knight et al., 2016), a signal processing method that examines stability, determinism, and complexity of group interactions. Data were benchmarked against self-reported quality of team participation and social support. Transcripts of group conversations were explored using the topic modelling approach (Blei et al., 2003), a machine learning method that helps to identify emerging themes within large corpora of qualitative data.ResultsGroups exhibited stable group interactions that were positively correlated with perceived social support, and negatively correlated with predictive behaviour. Data processing of the qualitative data revealed conversations focused on: (1) the management of patient incidents; (2) the responsibilities among team members; (3) the importance of a good internal team environment; and (4) the hospital culture.ConclusionsThis study has shed new light on small group research using signal processing and machine learning methods. Future studies are encouraged to use these methods in the healthcare context, and to conduct further research

Journal article

Sajid M, O'Sullivan S, Nevejans N, Allen C, Blyth A, Leonard S, Pagallo U, Holzinger K, Holzinger A, Ashrafian Het al., 2019, Legal, regulatory and ethical frameworks or standards for AI and autonomous robotic surgery, Publisher: WILEY, Pages: 212-213, ISSN: 1470-0328

Conference paper

Patel VM, Panzarasa P, Ashrafian H, Evans TS, Kirresh A, Sevdalis N, Darzi A, Athanasiou Tet al., 2019, Collaborative patterns, authorship practices and scientific success in biomedical research: a network analysis., Journal of the Royal Society of Medicine, Vol: 112, Pages: 245-257, ISSN: 1758-1095

OBJECTIVE: To investigate the relationship between biomedical researchers' collaborative and authorship practices and scientific success. DESIGN: Longitudinal quantitative analysis of individual researchers' careers over a nine-year period. SETTING: A leading biomedical research institution in the United Kingdom. PARTICIPANTS: Five hundred and twenty-five biomedical researchers who were in employment on 31 December 2009. MAIN OUTCOME MEASURES: We constructed the co-authorship network in which nodes are the researchers, and links are established between any two researchers if they co-authored one or more articles. For each researcher, we recorded the position held in the co-authorship network and in the bylines of all articles published in each three-year interval and calculated the number of citations these articles accrued until January 2013. We estimated maximum likelihood negative binomial panel regression models. RESULTS: Our analysis suggests that collaboration sustained success, yet excessive co-authorship did not. Last positions in non-alphabetised bylines were beneficial for higher academic ranks but not for junior ones. A professor could witness a 20.57% increase in the expected citation count if last-listed non-alphabetically in one additional publication; yet, a lecturer suffered from a 13.04% reduction. First positions in alphabetised bylines were positively associated with performance for junior academics only. A lecturer could experience a 8.78% increase in the expected citation count if first-listed alphabetically in one additional publication. While junior researchers amplified success when brokering among otherwise disconnected collaborators, senior researchers prospered from socially cohesive networks, rich in third-party relationships. CONCLUSIONS: These results help biomedical scientists shape successful careers and research institutions develop effective assessment and recruitment policies that will ultimately sustain the quality of biomedical r

Journal article

O'Sullivan S, Leonard S, Holzinger A, Allen C, Battaglia F, Nevejans N, van Leeuwen FWB, Sajid MI, Friebe M, Ashrafian H, Heinsen H, Wichmann D, Hartnett Met al., 2019, Anatomy 101 for AI-driven robotics: Explanatory, ethical and legal frameworks for development of cadaveric skills training standards in autonomous robotic surgery/autopsy., Int J Med Robot

BACKGROUND: The application of human-centred artificial intelligence (AI) and transparent machine learning (ML), to integrated Gross anatomy models, complemented with medical imaging data of cadavers and novel audio tissue characterization methods, makes available a route to autonomous robot-delivered surgeries and pathological characterisation. It can provide the capability of objective autopsy with reliable operations that improve both accuracy (robot) and tissue interpretation (AI), thus preventing the wrong diagnosis from being made. METHODS: We reviewed technological advances and state-of-the-art developments documented by undertaking a literature search on autonomous robotics for surgery and autopsy, tracing agents, explainable AI, ML black box solutions, algorithmic transparent/opaque processes, as well as AI legal and ethical issues such as data biases (e.g. gender/racial/social bias) and relevant traditional, religious or sociocultural aspects. For the use of autonomous robotics in either surgery or autopsy, our approach is to discuss the 'challenges and knowledge gaps' followed by our proposed 'hypotheses and recommendations'. CONCLUSION: The integration of explainable AI and ML, and novel tissue characterization sensorics to tele-operated robotic procedures with medical imaged cadavers, provides robotic guidance and refines tissue classifications at a molecular level. This can lead to the development of software that is not restricted to just automating 'autopsies' but, rather, could hold potential for 'surgeries' at large. The current R&D on autonomous surgical robotics is typically presented by comparing the skills of 'humans' versus 'robots'. In contrast, our assertion is that autonomous robotics and explainable AI can support healthcare values complementing and augmenting human capacities - NOT replacing them. Autonomous robots, trained to perform surgery or autopsy, based on their trained algorithms, can deliver practical positive solutions in me

Journal article

Gooderham N, Alkandari A, Ashrafian H, Sathyapalan T, Darzi A, Holmes E, Athanasiou T, Atkin Set al., 2019, Bariatric surgery modulates urinary levels of microRNAs involved in the regulation of renal function, Frontiers in Endocrinology, Vol: 10, ISSN: 1664-2392

Background: Obesity and diabetes cause chronic kidney disease with a common pathophysiology that is characterized by the accumulation of collagen in the extracellular matrix. Recent evidence has implicated the epithelial-to-mesenchymal transition (EMT) as a key step in this pathology with regulation by microRNAs. Weight loss leads to improvements in renal function; therefore, this study hypothesized that bariatric-surgery aided weight loss would lead to changes in urinary microRNAs involved in the regulation of renal function.Materials and methods: Twenty-four bariatric patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy donated urine pre-operatively and at 2–6 months and 1–2 years post-operatively. Urine samples were also obtained from 10 healthy weight and 7 morbidly obese non-surgical controls. Expression levels of kidney microRNAs were assessed in urine and the function of microRNAs was assessed through the in vitro transfection of HK-2 cells, a kidney proximal tubule cell line.Results: Levels of miR 192, miR 200a, and miR 200b were upregulated in urine following bariatric surgery. This increase was consistent across surgical type and diabetes status and was maintained and enhanced with time. Bariatric surgery alters urinary miR 192 expression from levels seen in morbidly obese patients to levels seen in healthy weight control patients. In mechanistic studies, the transfection of miR 192 in HK-2 cells increased miR 200a expression and decreased ZEB2, a key transcriptional promoter of kidney fibrosis.Conclusions: Bariatric surgery increased miR 192 and miR 200 urinary levels, key anti-fibrotic microRNAs that could contribute to a renal-protective mechanism and may be of value as urinary biomarkers following surgery. These findings suggest that urinary microRNAs may represent potential novel biomarkers for obesity-associated renal function.

Journal article

Aufegger L, Shariq O, Bicknell C, Ashrafian H, Darzi Aet al., 2019, Can shared leadership enhance clinical team management? A systematic review, Leadership in Health Services, Vol: 32, Pages: 309-335, ISSN: 1751-1879

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

Journal article

Ruban A, Stoenchev K, Ashrafian H, Teare Jet al., 2019, Current treatments for obesity, Clinical Medicine, Vol: 19, Pages: 205-212, ISSN: 1470-2118

Obesity is a major health and economic crisis facing the modern world. It is associated with excess mortality and morbidity and is directly linked to common conditions such as type 2 diabetes mellitus, coronary heart disease and sleep apnoea. The management of obesity and its associated complications has evolved in recent years, with a shift towards more definitive strategies such as bariatric surgery. This review encompasses the dietary, pharmacological and surgical strategies currently available for the management of obesity.

Journal article

Yeung KTD, Penney N, Ashrafian L, Darzi A, Ashrafian Het al., 2019, Does sleeve gastrectomy expose the distal esophagus to severe reflux?: A systematic review and meta-analysis, Annals of Surgery, ISSN: 0003-4932

MINI: The reported prevalence of new-onset or worsening gastroesophageal reflux disease after sleeve gastrectomy is controversial. Subsequent esophagitis and Barrett's esophagus can be serious unintended sequalae. The aim of this study was to systematically appraise all existing published data to assess the effect of sleeve gastrectomy on gastroesophageal reflux, esophagitis, and Barrett's esophagus. OBJECTIVE: The aim of this study was to appraise the prevalence of gastroesophageal reflux disease (GERD), esophagitis, and Barrett's esophagus (BE) after sleeve gastrectomy (SG) through a systematic review and meta-analysis. BACKGROUND: The precise prevalence of new-onset or worsening GERD after SG is controversial. Subsequent esophagitis and BE can be a serious unintended sequalae. Their postoperative prevalence remains unclear. METHODS: A systematic literature search was performed to identify studies evaluating postoperative outcomes in primary SG for morbid obesity. The primary outcome was prevalence of GERD, esophagitis, and BE after SG. Meta-analysis was performed to calculate combined prevalence. RESULTS: A total of 46 studies totaling 10,718 patients were included. Meta-analysis found that the increase of postoperative GERD after sleeve (POGAS) was 19% and de novo reflux was 23%. The long-term prevalence of esophagitis was 28% and BE was 8%. Four percent of all patients required conversion to RYGB for severe reflux. CONCLUSIONS: The postoperative prevalence of GERD, esophagitis, and BE following SG is significant. Symptoms do not always correlate with the presence of pathology. As the surgical uptake of SG continues to increase, there is a need to ensure that surgical decision-making and the consent process for this procedure consider these long-term complications while also ensuring their postoperative surveillance through endoscopic and physiological approaches. The long-term outcomes of this commonly performed bariatric procedure should be considered alongsid

Journal article

O'Sullivan S, Nevejans N, Allen C, Blyth A, Leonard S, Pagallo U, Holzinger K, Holzinger A, Sajid MI, Ashrafian Het al., 2019, Legal, regulatory, and ethical frameworks for development of standards in artificial intelligence (AI) and autonomous robotic surgery, INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Vol: 15, ISSN: 1478-5951

Journal article

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, Journal of the American Medical Informatics Association, Vol: 26, Pages: 339-355, ISSN: 1067-5027

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

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

INTRODUCTION: Monitoring a patient's vital signs forms a basic component of care, enabling the identification of deteriorating patients and increasing the likelihood of improving patient outcomes. Several paper-based track and trigger warning scores have been developed to allow clinical evaluation of a patient and guidance on escalation protocols and frequency of monitoring. However, evidence suggests that patient deterioration on hospital wards is still missed, and that patients are still falling through the safety net. Wearable sensor technology is currently undergoing huge growth, and the development of new light-weight wireless wearable sensors has enabled multiple vital signs monitoring of ward patients continuously and in real time. Areas covered: In this paper, we aim to closely examine the benefits of wearable monitoring applications that measure multiple vital signs; in the context of improving healthcare and delivery. A review of the literature was performed. Expert commentary: Findings suggest that several sensor designs are available with the potential to improve patient safety for both hospital patients and those at home. Larger clinical trials are required to ensure both diagnostic accuracy and usability.

Journal article

Glover B, Patel N, Teare J, Ashrafian Het al., 2019, Diagnostic accuracy of i-scan image enhancement for real-time endoscopic diagnosis of small colorectal polyps: a meta-analysis, Therapeutic Advances in Gastroenterology, Vol: 11, ISSN: 1756-2848

Objective:i-Scan is a digital image enhancement technology, reported to improve diagnostic performance during endoscopy. Previous studies have investigated the accuracy of i-scan for distinguishing between neoplastic and non-neoplastic colonic polyps and suggested diagnostic accuracy close to that required for use in routine clinical practice. The aim of this study was to perform a meta-analysis of the available literature investigating diagnostic accuracy for i-scan optical diagnosis when made in real time for colorectal polyps <10 mm in size.

Journal article

Berner-Rodoreda A, Rehfuess EA, Klipstein-Grobusch K, Cobelens F, Raviglione M, Flahaut A, Casamitjana N, Fröschl G, Skordis-Worral J, Abubakar I, Ashrafian H, Agardh A, Visser L, Schultsz C, Plasència A, Jahn A, Norton R, van Leeuwen R, Hagander L, Bärnighausen Tet al., 2019, Where is the 'global' in the European Union's Health Research and Innovation Agenda?, BMJ Glob Health, Vol: 4, ISSN: 2059-7908

Global Health has not featured as prominently in the European Union (EU) research agenda in recent years as it did in the first decade of the new millennium, and participation of low-income and middle-income countries (LMICs) in EU health research has declined substantially. The Horizon Europe Research and Innovation Framework adopted by the European Parliament in April 2019 for the period 2021-2027 will serve as an important funding instrument for health research, yet the proposed health research budget to be finalised towards the end of 2019 was reduced from 10% in the current framework, Horizon 2020, to 8% in Horizon Europe. Our analysis takes the evolvement of Horizon Europe from the initial framework of June 2018 to the framework agreed on in April 2019 into account. It shows that despite some improvements in terms of Global Health and reference to the Sustainable Development Goals, European industrial competitiveness continues to play a paramount role, with Global Health research needs and relevant health research for LMICs being only partially addressed. We argue that the globally interconnected nature of health and the transdisciplinary nature of health research need to be fully taken into account and acted on in the new European Research and Innovation Framework. A facilitated global research collaboration through Horizon Europe could ensure that Global Health innovations and solutions benefit all parts of the world including EU countries.

Journal article

Ashrafian H, Darzi A, 2018, Transforming health policy through machine learning., PLoS Medicine, Vol: 15, ISSN: 1549-1277

In their Perspective, Ara Darzi and Hutan Ashrafian give us a tour of the future policymaker's machine learning toolkit.

Journal article

Ashrafian H, 2018, The INkWELL index of global innovation, Annals of Global Health, Vol: 84, Pages: 590-591, ISSN: 2214-9996

Journal article

Ashrafian H, Monnich M, Braby TS, Smellie J, Bonanomi G, Efthimiou Eet al., 2018, Intragastric balloon outcomes in super-obesity: a 16-year city center hospital series, SURGERY FOR OBESITY AND RELATED DISEASES, Vol: 14, Pages: 1691-1699, ISSN: 1550-7289

Journal article

Joshi M, Ashrafian H, Darzi A, 2018, Is it time for hospitals with smart wards?, Journal of the Royal Society of Medicine, Vol: 111, Pages: 345-346, ISSN: 1758-1095

Journal article

Toma T, Harling L, Athanasiou T, Darzi A, Ashrafian Het al., 2018, Does body contouring after bariatric weight loss enhance quality of life? A systematic review of QOL studies, Obesity Surgery, Vol: 28, Pages: 3333-3341, ISSN: 0960-8923

Massive weight loss following bariatric surgery can result in excess tissue, manifesting as large areas of redundant skin that can be managed by body contouring surgery. This study aims to quantify the effects of body contouring surgery on indicators of quality of life in post-bariatric patients. A systematic review and meta-analysis of the literature revealed on indices of quality of life in post-bariatric patients, before and after body contouring surgery. Body contouring surgery resulted in statistically significant improvements in physical functioning, psychological wellbeing and social functioning, as well as a reduction in BMI. Body contouring surgery offers a strategy to improve quality of life in patients suffering from the functional and psychosocial consequences of excess skin after bariatric surgery.

Journal article

Ruban A, Ashrafian H, Teare JP, 2018, The EndoBarrier: Duodenal-Jejunal Bypass Liner for Diabetes and Weight Loss, GASTROENTEROLOGY RESEARCH AND PRACTICE, Vol: 2018, ISSN: 1687-6121

The rapid rise of obesity and type 2 diabetes poses a global threat to healthcare and is a major cause of mortality and morbidity. Bariatric surgery has revolutionised the treatment of both these conditions but is invasive and associated with an increased risk of complications. The EndoBarrier is a device placed endoscopically in the duodenum, which is designed to mimic the effects of gastric bypass surgery with the aim of inducing weight loss and improving glycaemic control. This review outlines the current clinical evidence of the device, its efficacy, potential mechanisms of action, and utility in clinical practice.

Journal article

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