Publications
554 results found
Ravindran S, Matharoo M, Rutter MD, et al., 2023, Patient safety incidents in endoscopy: a human factors analysis of non-procedural significant harm incidents from the National Reporting and Learning System (NRLS)., Endoscopy
BACKGROUND AND AIMS Despite advances in understanding and reducing risk of endoscopic procedures, there is little consideration of the safety of the wider endoscopy service. Patient safety incidents (PSIs) still occur. We sought to identify non-procedural PSIs (nPSIs) and their causative factors from a human factors perspective and generate ideas for safety improvement. METHODS Endoscopy-specific PSI reports were extracted from the National Reporting and Learning System (NRLS). A retrospective, cross-sectional human factors analysis of data was performed. Two independent researchers coded data using a hybrid thematic analysis approach. The Human Factors Analysis and Classification System (HFACS) was used to code contributory factors. Analysis informed creation of driver diagrams and key recommendations for safety improvement in endoscopy. RESULTS From 2017 - 2019, 1181 endoscopy-specific PSIs of significant harm were reported across England and Wales. Of these, 539 (45.6%) were nPSIs. Five categories accounted for over 80% of all incidents with 'follow up and surveillance' being the largest (23.4% of all nPSIs). 487 human factors codes were identified from free-text incident reports. Decision-based errors were the most common act prior to PSI occurrence. Preconditions to incident focussed on environmental factors, particularly overwhelmed resources, patient factors, and ineffective team communication. Lack of staffing, standard operating procedures, effective systems, and clinical pathways were also contributory. Seven key recommendations for improving safety are made in response to our findings. CONCLUSIONS This was the first national-level human factors analysis of endoscopy-specific PSIs. This work will inform safety improvement strategies and should empower individual services to review their approach to safety.
Fehervari M, Fadel MG, Alghazawi LOK, et al., 2023, Medium-Term Weight Loss and Remission of Comorbidities Following Endoscopic Sleeve Gastroplasty: a Systematic Review and Meta-analysis., Obes Surg
This systematic review and meta-analysis aimed to determine the short- and medium-term weight loss outcomes and comorbidity resolution following endoscopic sleeve gastroplasty. Our search identified 35 relevant studies containing data from 7525 patients. Overall, pooled short-term (12 months) total weight loss (TWL) was 16.2% (95% CI 13.1-19.4%) in 23 studies (n = 5659). Pooled medium-term TWL was 15.4% (95% CI 13.7-17.2%) in 10 studies (n = 4040). Diabetes resolution was 55.4% (95% CI 46-64%), hypertension resolution was 62.8% (95% CI 43-82%), dyslipidaemia resolution was 56.3% (95% CI 49-63%), and obstructive sleep apnoea resolution was 51.7% (95% CI 16.2-87.3%) in four studies (n = 480). This pooled analysis demonstrates that ESG can induce durable weight loss and resolution of obesity-associated comorbidities in patients with moderate obesity.
Ashrafian H, 2023, Rheumatology hand signs in a Shepherd by Joachim Wtewael (1566-1638)., Rheumatol Int, Vol: 43, Pages: 1765-1766
Ashrafian H, 2023, Differential diagnosis of the periorbital lump on "Young Woman with Unicorn" (1505-1506) by Raphael (1483-1520)., Eur J Ophthalmol, Vol: 33, Pages: NP144-NP145
Ashrafian H, 2023, The Creation of Adam's Divinity and the School of Athens by Michelangelo and Raphael displaying clinical hand and foot signs to elucidate painting characters., Rheumatol Int
Che Bakri NA, Kwasnicki RM, Giannas E, et al., 2023, ASO Visual Abstract: The Use of Wearable Activity Monitors to Measure the Upper Limb Physical Activity After Axillary Lymph Node Dissection and Sentinel Lymph Node Biopsy., Ann Surg Oncol
Zhang J, Ashrafian H, Delaney B, et al., 2023, Impact of primary to secondary care data sharing on care quality in NHS England hospitals, npj Digital Medicine, Vol: 6, Pages: 1-10, ISSN: 2398-6352
Health information exchange (HIE) is seen as a key component of effective care but remains poorly evidenced at a health system level. In the UK National Health Service (NHS), the ability to share primary care data with secondary care clinicians is a focus of continued digital investment. In this study, we report the evolution of interoperable technology across a period of rapid digital transformation in NHS England from 2015 to 2019, and test association of primary to secondary care data-sharing capabilities with clinical care quality indicators across all acute secondary care providers (n=135 NHS Trusts). In multivariable analyses, data-sharing capabilities are associated with reduction in patients breaching an Accident & Emergency (A&E) 4-hour decision time threshold, and better patient-reported experience of acute hospital care quality. Using synthetic control analyses, we estimate mean 2.271% (STD+/-3.371) absolute reduction in A&E 4-hour decision time breach, 12 months following introduction of data-sharing capabilities. Our findings support current digital transformation programs for developing regional HIE networks but highlight the need to focus on implementation factors in addition to technological procurement.
Li E, Lounsbury O, Clarke J, et al., 2023, Perceptions of chief clinical information officers on the state of electronic health records systems interoperability in NHS England: a qualitative interview study, BMC Medical Informatics and Decision Making, Vol: 23, Pages: 1-15, ISSN: 1472-6947
BackgroundIn the era of electronic health records (EHR), the ability to share clinical data is a key facilitator of healthcare delivery. Since the introduction of EHRs, this aspect has been extensively studied from the perspective of healthcare providers. Less often explored are the day-to-day challenges surrounding the procurement, deployment, maintenance, and use of interoperable EHR systems, from the perspective of healthcare administrators, such as chief clinical information officers (CCIOs).ObjectiveOur study aims to capture the perceptions of CCIOs on the current state of EHR interoperability in the NHS, its impact on patient safety, the perceived facilitators and barriers to improving EHR interoperability, and what the future of EHR development in the NHS may entail.MethodsSemi-structured interviews were conducted between November 2020 – October 2021. Convenience sampling was employed to recruit NHS England CCIOs. Interviews were digitally recorded and transcribed verbatim. A thematic analysis was performed by two independent researchers to identify emerging themes.ResultsFifteen CCIOs participated in the study. Participants reported that limited EHR interoperability contributed to the inability to easily access and transfer data into a unified source, thus resulting in data fragmentation. The resulting lack of clarity on patients' health status negatively impacts patient safety through suboptimal care coordination, duplication of efforts, and more defensive practice. Facilitators to improving interoperability included the recognition of the need by clinicians, patient expectations, and the inherent centralised nature of the NHS. Barriers included systems usability difficulties, and institutional, data management, and financial-related challenges. Looking ahead, participants acknowledged that realising that vision across the NHS would require a renewed focus on mandating data standards, user-centred design, greater patient involvement, and encouraging i
Zhang J, Morley J, Gallifant J, et al., 2023, Mapping and evaluating whole nation data flows: transparency, privacy, and guiding infrastructural transformation, The Lancet: Digital Health, ISSN: 2589-7500
Che Bakri NA, Kwasnicki R, Giannas E, et al., 2023, The Use of Wearable Activity Monitors to Measure the Upper Limb Physical Activity after Axillary Lymph Node Dissection and Sentinel Lymph Node Biopsy, Annals of Surgical Oncology, ISSN: 1068-9265
Che Bakri NA, Kwasnicki RM, Giannas E, et al., 2023, ASO author reflections: objective outcome measure of upper limb function following axillary lymph node dissection and sentinel lymph node biopsy, Annals of Surgical Oncology, ISSN: 1068-9265
Danielli S, Ashrafian H, Darzi A, 2023, Healthy city: global systematic scoping review of city initiatives to improve health with policy recommendations, BMC Public Health, Vol: 23, Pages: 1-15, ISSN: 1471-2458
BackgroundGlobal health will increasingly be determined by cities. Currently over half of the world’s population, over 4 billion people, live in cities. This systematic scoping review has been conducted to understand what cities are doing to improve health and healthcare for their populations.MethodsWe conducted a systematic search to identify literature on city-wide initiatives to improve health. The study was conducted in accordance with PRISMA and the protocol was registered with PROSPERO (CRD42020166210).ResultsThe search identified 42,137 original citations, yielding 1,614 papers across 227 cities meeting the inclusion criteria. The results show that the majority of initiatives were targeted at non-communicable diseases. City health departments are making an increasing contribution; however the role of mayors appears to be limited.ConclusionThe collective body of evidence identified in this review, built up over the last 130 years, has hitherto been poorly documented and characterised. Cities are a meta-system with population health dictated by multiple interactions and multidirectional feedback loops. Improving health in cities requires multiple actions, by multiple actors, at every level. The authors use the term ‘The Vital 5’. They are the five most important health risk factors; tobacco use; harmful alcohol use; physical-inactivity, unhealthy diet and planetary health. These ‘Vital 5’ are most concentrated in deprived areas and show the greatest increase in low and middle income countries. Every city should develop a comprehensive strategy and action plan to address these ‘Vital 5’.
Lawrance E, Thompson R, Roberts L, et al., 2023, Ambient temperature and mental health: a systematic review and meta analysis, The Lancet Planetary Health, Vol: 7, Pages: e580-e589, ISSN: 2542-5196
BackgroundIncreasing evidence indicates that ambient outdoor temperature could affect mental health, which is especially concerning in the context of climate change. We aimed to comprehensively analyse the current evidence regarding the associations between ambient temperature and mental health outcomes.MethodsWe did a systematic review and meta-analysis of the evidence regarding associations between ambient outdoor temperature and changes in mental health outcomes. We searched WebOfScience, Embase, PsychINFO, and PubMed for articles published from database origin up to April 7, 2022. Eligible articles were epidemiological, observational studies in humans of all ages, which evaluated real-world responses to ambient outdoor temperature, and had mental health as a documented outcome; studies of manipulated or controlled temperature or those with only physical health outcomes were excluded. All eligible studies were synthesised qualitatively. If three or more studies reported the same or equivalent effect statistics and if they had equivalent exposure, outcome, and metrics, the studies were pooled in a random-effects meta-analysis. The risk of bias for individual studies was assessed using the Newcastle-Ottawa Scale. The quality of evidence across studies was assessed using the Office of Health Assessment and Translation (OHAT) approach.Findings114 studies were included in the systematic review, of which 19 were suitable for meta-analysis. Three meta-analyses were conducted for suicide outcomes: a 1°C increase in mean monthly temperature was associated with an increase in incidence of 1·5% (95% CI 0·8–2·2, p<0·001; n=1 563 109, seven effects pooled from three studies); a 1°C increase in mean daily temperature was associated with an increase in incidence of 1·7% (0·3–3·0, p=0·014; n=113 523, five effects pooled from five studies); and a 1°C increase in mean monthly temperature was associa
Ravindran S, Matharoo M, Marshall S, et al., 2023, Development, validation, and results of a national endoscopy safety attitudes questionnaire (Endo-SAQ)., Endosc Int Open, Vol: 11, Pages: E679-E689, ISSN: 2364-3722
Background and study aims Safety attitudes are linked to patient outcomes. The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) identifies the need to improve our understanding of safety culture in endoscopy. We describe the development and validation of the Endo-SAQ (endoscopy safety attitudes questionnaire) and the results of a national survey of staff attitudes. Methods Questions from the original SAQ were adapted to reflect endoscopy-specific content. This was refined by an expert group, followed by a pilot study to assess acceptability. The refined Endo-SAQ (comprising 35 questions across six domains) was disseminated to endoscopy staff across the UK and Ireland. Outcomes were domain scores and the percentage of positive responses (score ≥75/100) per domain. Descriptive and comparative analyses were performed. Binary logistic regression identified staff and service factors associated with positive scores. Validity and reliability of Endo-SAQ were assessed through psychometric analysis. Results After expert review, four questions in the preliminary Endo-SAQ were adjusted. Sixty-one participants undertook the pilot study with good acceptability. A total of 453 participants completed the refined Endo-SAQ. There were positive responses in teamwork, safety climate, job satisfaction, and working conditions domains. Endoscopists had significantly more positive responses to stress recognition and working conditions than nursing staff. JAG accreditation was associated with positive scores in safety climate and job satisfaction domains. Endo-SAQ met thresholds of construct validity and reliability. Conclusions Endoscopy staff had largely positive safety attitudes scores but there were significant differences across domains and staff. There is evidence for the validity and reliability of Endo-SAQ. Endo-SAQ could complement current measures of patient safety in endoscopy and be used in evaluation and research.
Acharya A, Judah G, Ashrafian H, et al., 2023, Investigating the national implementation of SMS and mobile messaging In Population Screening (The SIPS Study), EBioMedicine, Vol: 93, Pages: 1-11, ISSN: 2352-3964
BackgroundThe increasing use of mobile messaging within healthcare, poses challenges for screening programmes, which involve communicating with large, diverse populations. This modified Delphi study aimed to create guidance regarding the use of mobile messaging for screening programmes, to facilitate greater, and equitable screening uptake.MethodsInitial recommendations were derived from a literature review, expert scoping questionnaire, public consultation, and discussion with relevant national organisations. Experts from the fields of public health, screening commissioning, industry and academia voted upon the importance and feasibility of these recommendations across two consensus rounds, using a 5-point Likert scale. Items reaching consensus, defined a priori at 70%, on importance and feasibility formed ‘core’ recommendations. Those reaching this threshold on importance only, were labelled ‘desirable’. All items were subsequently discussed at an expert meeting to confirm suitability. FindingsOf the initial 101 items, 23 reached consensus regarding importance and feasibility. These ‘core’ items were divided across six domains: message content, timing, delivery, evaluation, security, and research considerations. ‘Core’ items such as explicitly specifying the sender and the role of patient involvement in development of screening message research had the highest agreement. A further 17 ‘desirable’ items reached consensus regarding importance, but not feasibility, including the integration into GP services to enable telephone verification.InterpretationThese findings forming national guidance for services, will enable programmes to overcome implementation challenges and facilitate uptake of screening invitations. By providing a list of desirable items, this study provides areas for future consideration, as technological innovation in messaging continues to grow.FundingNIHR Imperial Patient Safety Translation
Higginson JA, Breik O, Thompson AH, et al., 2023, Diagnostic accuracy of intraoperative margin assessment techniques in surgery for head and neck squamous cell carcinoma: a meta-analysis, Oral Oncology, Vol: 142, Pages: 1-13, ISSN: 1368-8375
BACKGROUND: Positive margins following head and neck squamous cell carcinoma (HNSCC) surgery lead to significant morbidity and mortality. Existing Intraoperative Margin Assessment (IMA) techniques are not widely used due to limitations in sampling technique, time constraints and resource requirements. We performed a meta-analysis of the diagnostic performance of existing IMA techniques in HNSCC, providing a benchmark against which emerging techniques may be judged. METHODS: The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Studies were included if they reported diagnostic metrics of techniques used during HNSCC surgery, compared with permanent histopathology. Screening, manuscript review and data extraction was performed by multiple independent observers. Pooled sensitivity and specificity were estimated using the bivariate random effects model. RESULTS: From an initial 2344 references, 35 studies were included for meta-analysis. Sensitivity (Sens), specificity (Spec), diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUROC) were calculated for each group (n, Sens, Spec, DOR, AUROC): frozen section = 13, 0.798, 0.991, 309.8, 0.976; tumour-targeted fluorescence (TTF) = 5, 0.957, 0.827, 66.4, 0.944; optical techniques = 10, 0.919, 0.855, 58.9, 0.925; touch imprint cytology = 3, 0.925, 0.988, 51.1, 0.919; topical staining = 4, 0.918, 0.759, 16.4, 0.833. CONCLUSIONS: Frozen section and TTF had the best diagnostic performance. Frozen section is limited by sampling error. TTF shows promise but involves administration of a systemic agent. Neither is currently in widespread clinical use. Emerging techniques must demonstrate competitive diagnostic accuracy whilst allowing rapid, reliable, cost-effective results.
Ashrafian H, 2023, Differential diagnosis of tophaceous gout and multiple facial papules in Federico da Montefeltro by Piero della Francesca (c. 1415 -1492)., Rheumatol Int, Vol: 43, Pages: 1195-1196
Ashrafian H, 2023, Earliest depiction of unilateral gynecomastia in history 300-250 B.C., Breast Cancer Res Treat, Vol: 199, Pages: 585-586
Ashrafian H, 2023, Goiter in the paintings by Rogier van der Weyden (1399-1464)., J Endocrinol Invest
Ong ZZ, Sadek Y, Liu X, et al., 2023, Diagnostic performance of deep learning in infectious keratitis: a systematic review and meta-analysis protocol., BMJ Open, Vol: 13
INTRODUCTION: Infectious keratitis (IK) represents the fifth-leading cause of blindness worldwide. A delay in diagnosis is often a major factor in progression to irreversible visual impairment and/or blindness from IK. The diagnostic challenge is further compounded by low microbiological culture yield, long turnaround time, poorly differentiated clinical features and polymicrobial infections. In recent years, deep learning (DL), a subfield of artificial intelligence, has rapidly emerged as a promising tool in assisting automated medical diagnosis, clinical triage and decision-making, and improving workflow efficiency in healthcare services. Recent studies have demonstrated the potential of using DL in assisting the diagnosis of IK, though the accuracy remains to be elucidated. This systematic review and meta-analysis aims to critically examine and compare the performance of various DL models with clinical experts and/or microbiological results (the current 'gold standard') in diagnosing IK, with an aim to inform practice on the clinical applicability and deployment of DL-assisted diagnostic models. METHODS AND ANALYSIS: This review will consider studies that included application of any DL models to diagnose patients with suspected IK, encompassing bacterial, fungal, protozoal and/or viral origins. We will search various electronic databases, including EMBASE and MEDLINE, and trial registries. There will be no restriction to the language and publication date. Two independent reviewers will assess the titles, abstracts and full-text articles. Extracted data will include details of each primary studies, including title, year of publication, authors, types of DL models used, populations, sample size, decision threshold and diagnostic performance. We will perform meta-analyses for the included primary studies when there are sufficient similarities in outcome reporting. ETHICS AND DISSEMINATION: No ethical approval is required for this systematic review. We plan to dissem
Ashrafian H, 2023, Goiter, thyroid facial involvement and eye disease in the paintings of Jan Gossaert (c. 1478-1532)., J Endocrinol Invest
Clarke J, Beaney T, Alboksmaty A, et al., 2023, Factors associated with enrolment into a national COVID-19 pulse oximetry remote monitoring programme in England: a retrospective observational study, The Lancet: Digital Health, Vol: 5, Pages: e194-e205, ISSN: 2589-7500
BACKGROUND: Hypoxaemia is an important predictor of severity in individuals with COVID-19 and can present without symptoms. The COVID Oximetry @home (CO@h) programme was implemented across England in November, 2020, providing pulse oximeters to higher-risk people with COVID-19 to enable early detection of deterioration and the need for escalation of care. We aimed to describe the clinical and demographic characteristics of individuals enrolled onto the programme and to assess whether there were any inequalities in enrolment. METHODS: This retrospective observational study was based on data from a cohort of people resident in England recorded as having a positive COVID-19 test between Oct 1, 2020, and May 3, 2021. The proportion of participants enrolled onto the CO@h programmes in the 7 days before and 28 days after a positive COVID-19 test was calculated for each clinical commissioning group (CCG) in England. Two-level hierarchical multivariable logistic regression with random intercepts for each CCG was run to identify factors predictive of being enrolled onto the CO@h programme. FINDINGS: CO@h programme sites were reported by NHS England as becoming operational between Nov 21 and Dec 31, 2020. 1 227 405 people resident in 72 CCGs had a positive COVID-19 test between the date of programme implementation and May 3, 2021, of whom 19 932 (1·6%) were enrolled onto the CO@h programme. Of those enrolled, 14 441 (72·5%) were aged 50 years or older or were identified as clinically extremely vulnerable (ie, having a high-risk medical condition). Higher odds of enrolment onto the CO@h programme were found in older individuals (adjusted odds ratio 2·21 [95% CI 2·19-2·23], p<0·001, for those aged 50-64 years; 3·48 [3·33-3·63], p<0·001, for those aged 65-79 years; and 2·50 [2·34-2·68], p<0·001, for those aged ≥80 years), in individuals of non-White ethnicity (1·3
Che Bakri NA, Kwasnicki R, Khan N, et al., 2023, Impact of axillary lymph node dissection and sentinel lymph node biopsy on upper limb morbidity in breast cancer patients: a systematic review and meta-analysis, Annals of Surgery, Vol: 277, Pages: 572-580, ISSN: 0003-4932
Objective: To evaluate the impact of ALND and SLNB on upper limb (UL) morbidity in breastcancer patients.Summary Background: Axillary de-escalation is motivated by a desire to reduce harm ofALND. Understanding the impact of axillary surgery and disparities in operative procedureson post-operative arm morbidity would better direct resources to the point of need and cementthe need for de-escalation strategies.Methods: Embase, Medline, CINAHL and PsychINFO were searched from 1990 until March2020. Included studies were randomized-controlled and observational studies focusing on ULmorbidities, in breast surgery patients. The study followed the Preferred Reporting Items forSystematic Reviews and Meta-Analyses (PRISMA) guidelines. The prevalence of upper limbmorbidity comparing SLNB and ALND at less than 12 months, 12-24 months and beyond 24months were analyzed.Results: Sixty-seven studies were included. All studies reported a higher rate of lymphedemaand pain after ALND compared to SLNB. The difference in lymphedema and pain prevalencebetween SLNB and ALND was 13.7% (95% CI 10.5-16.8, p<0.005) and 24.2% (95% CI 12.1-36.3, p<0.005) respectively. Pooled estimates for prevalence of reduced strength and rangeof motion after SLNB and ALND were 15.2% vs 30.9% and 17.1% vs 29.8% respectively.Type of axillary surgery, greater BMI, and radiotherapy were some of the predictors for ULmorbidities.Conclusions: Prevalence of lymphedema after ALND was higher than previously estimated.ALND patients experienced greater rates of lymphedema, pain, reduced strength, and ROMcompared to SLNB. The findings support the continued drive to de-escalate axillary surgery.
Ashrafian H, 2023, Presentations of bubonic plague in the Renaissance by Carlo Crivelli (c. 1430-1495)., Clin Microbiol Infect, Vol: 29
Fehervari M, Banh S, Varma P, et al., 2023, Weight loss specific to indication, remission of diabetes, and short-term complications after sleeve gastrectomy conversion to Roux-en-Y gastric bypass: a systematic review and meta-analysis., Surg Obes Relat Dis, Vol: 19, Pages: 384-395
Laparoscopic sleeve gastrectomy (SG) is the most frequently performed bariatric procedure worldwide. Long-term complications such as insufficient weight loss (IWL) and gastroesophageal reflux disease (GERD) may necessitate SG conversion to Roux-en-Y gastric bypass (RYGB). The aim of this review was to determine the indication-specific weight loss and diabetes remission after SG conversion to RYGB (STOBY). Our objective was to extract all available published data on indication for conversion, weight loss, remission of diabetes, and short-term complications after STOBY. A systematic literature search was conducted to identify studies reporting outcomes following STOBY. A random effects model was used for meta-analysis. The search identified 44 relevant studies. Overall short-term (12-mo) excess weight loss (EWL) was 54.6% (95% confidence interval [CI], 46%-63%) in 23 studies (n = 712) and total weight loss (TWL) was 19.9% (95% CI, 14%-25%) in 21 studies (n = 740). For IWL, short-term (12-mo) pooled weight loss outcomes were 53.9% EWL (95% CI, 48%-59%) in 14 studies (n = 295) and 22.7% TWL (95% CI, 17%-28%) in 12 studies (n = 219), and medium-term (2-5 yr) outcomes were 45.8% EWL (95% CI, 38%-53%) in 7 studies (n = 154) and 20.6% TWL (95% CI, 15%-26%) in 9 studies (n = 206). Overall diabetes remission was 53% (95% CI, 33%-72%), and the perioperative complication rate was 8.2% (95% CI, 7.6%-8.7%). Revisional SG conversion to RYGB for IWL can achieve good weight loss outcomes and diabetes remission.
Ashrafian H, 2023, Goiters in the Renaissance era: Multiple cases of thyroid autoimmunity and iodine deficiency., Best Pract Res Clin Endocrinol Metab, Vol: 37
The Renaissance is recognised as an inflection point in history that led to the dissemination of innovation, science, philosophy, and the arts to spearhead a leap for global civilisation. Many of the greatest outputs from the Renaissance were presented in artwork which was able to champion elements of naturalism and realism, and therefore moved away from preconceived ideas. This included the portrayal of anatomy and pathology with an exactitude previously unseen in art. I note novel identification of goiters in multiple paintings of the foremost Renaissance genius artists and their originating artistic schools, those of Verrocchio, Lippi and Ferrara. These can be categorised through the proposed (i) 'da Vinci Sign' after Leonardo da Vinci, where the goitre is artistically presented as a loss or shallowing of the suprasternal notch recess or (ii) the 'Botticelli Sign' after Sandro Botticelli, where there is demonstrable cranio-cervical neck flexion that forward projects the visceral compartment of the neck that includes the thyroid to accentuate a recognisable thyroid enlargement. These are notable in the works of genius artists that include Verrocchio, Lorenzo di Credi, Filippo Lippi, Cosimo Tura and Francesco Cossa. Together, the work of these artistic geniuses add to the corpus of notable endocrine pathology in the Renaissance deriving from endemic iodine deficiency and autoimmunity. They demonstrate this profound extent of pathology within their artistic masterpieces and extend our admiration of the wider experience of Renaissance artists into the current era and beyond.
Marecos J, Shattock E, Bartlett O, et al., 2023, Health misinformation and freedom of expression: considerations for policymakers, HEALTH ECONOMICS POLICY AND LAW, ISSN: 1744-1331
Das B, Ledesma F, Ashrafian H, et al., 2023, Gastrojejunostomy Closure Technique and Risk of Leak: an Evaluation in Ex Vivo Porcine Models, OBESITY SURGERY, ISSN: 0960-8923
Ashrafian H, 2023, Goiter and thyroid eye sign in the Madonna and Child with Angels by Francesco del Cossa (c. 1430-1477), JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION, ISSN: 0391-4097
Ashrafian H, 2023, Differential diagnosis of a thyroid mass, Gottron's papules, Calcinosis Cutis and Ptosis on the Saint Mary Magdalen and two depictions of a Madonna and Baby by Bartolomeo Vivarini (1432-1499), JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION, ISSN: 0391-4097
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