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
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333 results found

Sun L, Joshi M, Khan SN, Ashrafian H, Darzi Aet al., 2020, Clinical impact of multi-parameter continuous non-invasive monitoring in hospital wards: a systematic review and meta-analysis, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, ISSN: 0141-0768

Journal article

Soosaipillai G, Archer S, Ashrafian H, Darzi Aet al., Breaking bad news training in the COVID-19 era and beyond, Journal of Medical Education and Curricular Development, ISSN: 2382-1205

Journal article

Sounderajah V, Ashrafian H, Aggarwal R, De Fauw J, Denniston AK, Greaves F, Karthikesalingam A, King D, Liu X, Markar SR, McInnes MDF, Panch T, Pearson-Stuttard J, Ting DSW, Golub RM, Moher D, Bossuyt PM, Darzi Aet al., 2020, Developing specific reporting guidelines for diagnostic accuracy studies assessing AI interventions: The STARD-AI Steering Group, NATURE MEDICINE, Vol: 26, Pages: 807-808, ISSN: 1078-8956

Journal article

Denning M, Ashrafian H, Leading for Innovation, BMJ Leader

Journal article

Cartucho J, Shapira D, Ashrafian H, Giannarou Set al., 2020, Multimodal mixed reality visualisation for intraoperative surgical guidance, International Journal of Computer Assisted Radiology and Surgery, Vol: 15, Pages: 819-826, ISSN: 1861-6410

PurposeIn the last decade, there has been a great effort to bring mixed reality (MR) into the operating room to assist surgeons intraoperatively. However, progress towards this goal is still at an early stage. The aim of this paper is to propose a MR visualisation platform which projects multiple imaging modalities to assist intraoperative surgical guidance.MethodologyIn this work, a MR visualisation platform has been developed for the Microsoft HoloLens. The platform contains three visualisation components, namely a 3D organ model, volumetric data, and tissue morphology captured with intraoperative imaging modalities. Furthermore, a set of novel interactive functionalities have been designed including scrolling through volumetric data and adjustment of the virtual objects’ transparency. A pilot user study has been conducted to evaluate the usability of the proposed platform in the operating room. The participants were allowed to interact with the visualisation components and test the different functionalities. Each surgeon answered a questionnaire on the usability of the platform and provided their feedback and suggestions.ResultsThe analysis of the surgeons’ scores showed that the 3D model is the most popular MR visualisation component and neurosurgery is the most relevant speciality for this platform. The majority of the surgeons found the proposed visualisation platform intuitive and would use it in their operating rooms for intraoperative surgical guidance. Our platform has several promising potential clinical applications, including vascular neurosurgery.ConclusionThe presented pilot study verified the potential of the proposed visualisation platform and its usability in the operating room. Our future work will focus on enhancing the platform by incorporating the surgeons’ suggestions and conducting extensive evaluation on a large group of surgeons.

Journal article

Goiana-Da-Silva K, Cruz-e-Silva D, Bartlett O, Vasconcelos J, Nunes AM, Ashrafian H, Miraldo M, do Céu Machado M, Araújo F, Darzi Aet al., 2020, The ethics of taxing sugar-sweetened beverages to improve public health, Frontiers in Public Health, Vol: 8, ISSN: 2296-2565

The World Health Organization highlights fiscal policies as priority interventions for the promotion of healthy eating in its Action Plan for the Prevention and Control of Non-communicable Diseases. The taxation of sugar sweetened beverages (SSBs) in particular is noted to be an effective measure, and SSBs taxes have already been implemented in several countries worldwide. However, although the evidence base suggests that this will be effective in helping to combat rising obesity rates, opponents of SSBs taxation argue that it is illiberal and paternalistic, and therefore should be avoided. Bioethical analysis may play an essential role in clarifying whether policymakers should adopt SSBs taxes as part of wider obesity strategy. In this article we argue that no single ethical theory can account for the complexities inherent in obesity prevention strategy, especially the liberal theories relied upon by opponents of SSBs taxation. We contend that a pluralist approach to the ethics of SSBs taxation must be adopted as the only suitable way of accounting for the multiple overlapping, and sometimes, conflicting factors that are relevant to determining the moral acceptability of such an intervention.

Journal article

Posthuma LM, Downey C, Visscher MJ, Ghazali DA, Joshi M, Ashrafian H, Khan S, Darzi A, Goldstone J, Preckel Bet al., 2020, Remote wireless vital signs monitoring on the ward for early detection of deteriorating patients: A case series, INTERNATIONAL JOURNAL OF NURSING STUDIES, Vol: 104, ISSN: 0020-7489

Journal article

Goiana-da-Silva F, Severo M, Cruz-E-Silva D, Gregório MJ, Allen L, Muc M, Morais Nunes A, Torres D, Miraldo M, Ashrafian H, Rito A, Wickramasinghe K, Breda J, Darzi A, Araújo F, Lopes Cet al., 2020, Projected impact of the Portuguese sugar-sweetened beverages tax on obesity incidence across different age groups: a modelling study, PLoS Medicine, Vol: 17, Pages: 1-17, ISSN: 1549-1277

BackgroundExcessive consumption of sugar has a well-established link with obesity. Preliminary results show that a tax levied on sugar-sweetened beverages (SSBs) by the Portuguese government in 2017 led to a drop in sales and reformulation of these products. This study models the impact the market changes triggered by the tax levied on SSBs had on obesity incidence across various age groups in Portugal.Methods and findingsWe performed a national market analysis and population-wide modelling study using market data for the years 2014–2018 from the Portuguese Association of Non-Alcoholic Drinks (GlobalData and Nielsen Consumer Panel), dietary data from a national survey (IAN-AF 2015–2016), and obesity incidence data from several cohort studies. Dietary energy density from SSBs was calculated by dividing the energy content (kcal/gram) of all SSBs by the total food consumption (in grams). We used the potential impact fraction (PIF) equation to model the projected impact of the tax-triggered change in sugar consumption on obesity incidence, through both volume reduction and reformulation. Results showed a reduction of 6.6 million litres of SSBs sold per year. Product reformulation led to a decrease in the average energy density of SSBs by 3.1 kcal/100 ml. This is estimated to have prevented around 40–78 cases of obesity per year between 2016 and 2018, with the biggest projected impact observed in adolescents 10 to <18 years old. The model shows that the implementation of this tax allowed for a 4 to 8 times larger projected impact against obesity than would be achieved though reformulation alone. The main limitation of this study is that the model we used includes data from various sources, which can result in biases—despite our efforts to mitigate them—related to the methodological differences between these sources.ConclusionsThe tax triggered both a reduction in demand and product reformulation. These, together, can reduce obesity levels

Journal article

Ruban A, Liu Z, Glaysher M, Ashrafian H, Miras A, Prechtl C, Goldstone A, Aldhwayan M, Chhina N, Al-Najim W, Johnson N, Patel M, Li J, Byrne J, Teare Jet al., 2020, One year of duodenal-jejunal bypass liner therapy (Endobarrier (R)) leads to perturbations in the metabolic profile of urine, plasma and stool of obese diabetic patients., 11th Annual Scientific Meeting of the British-Obesity-and-Metabolic-Surgery-Society (BOMSS), Publisher: SPRINGER, Pages: S10-S10, ISSN: 0960-8923

Conference paper

Yeung KTD, Penney N, Ashrafian L, Darzi A, Ashrafian Het al., 2020, Does sleeve gastrectomy expose the distal esophagus to severe reflux?: A systematic review and meta-analysis, Annals of Surgery, Vol: 271, Pages: 257-265, 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

Ashrafian H, Goodman J, 2020, The promising connection between data science and evolutionary theory in oncology, Frontiers in Oncology, Vol: 9, ISSN: 2234-943X

Theoretical and empirical work over the past several decades suggests that oncogenesisand disease progression represents an evolutionary story. Despite this knowledge,current anti-resistance strategies to drugs are often managed through treating cancersas independent biological agents divorced from human activity. Yet once drug resistanceto cancer treatment is understood as a product of artificial or anthropogenic ratherthan unconscious selection, oncologists could improve outcomes for their patients byconsulting evolutionary studies of oncology prior to clinical trial and treatment plan design.In the setting of multiple cancer types, for example, a machine learning algorithm canpredict the genetic changes known to be related to drug resistance. In this way, a unitybetween technology and theory might have practical clinical implications—and may pavethe way for a new paradigm shift in medicine.

Journal article

Morgan C, Khatri C, Hanna SA, Ashrafian H, Sarraf KMet al., 2020, Use of three-dimensional printing in preoperative planning in orthopaedic trauma surgery: A systematic review and meta-analysis, WORLD JOURNAL OF ORTHOPEDICS, Vol: 11, Pages: 57-67, ISSN: 2218-5836

Journal article

McKinney SM, Sieniek M, Godbole V, Godwin J, Antropova N, Ashrafian H, Back T, Chesus M, Corrado GC, Darzi A, Etemadi M, Garcia-Vicente F, Gilbert FJ, Halling-Brown M, Hassabis D, Jansen S, Karthikesalingam A, Kelly CJ, King D, Ledsam JR, Melnick D, Mostofi H, Peng L, Reicher JJ, Romera-Paredes B, Sidebottom R, Suleyman M, Tse D, Young KC, De Fauw J, Shetty Set al., 2020, International evaluation of an AI system for breast cancer screening, Nature, Vol: 577, Pages: 89-94, ISSN: 0028-0836

Screening mammography aims to identify breast cancer at earlier stages of the disease, when treatment can be more successful1. Despite the existence of screening programmes worldwide, the interpretation of mammograms is affected by high rates of false positives and false negatives2. Here we present an artificial intelligence (AI) system that is capable of surpassing human experts in breast cancer prediction. To assess its performance in the clinical setting, we curated a large representative dataset from the UK and a large enriched dataset from the USA. We show an absolute reduction of 5.7% and 1.2% (USA and UK) in false positives and 9.4% and 2.7% in false negatives. We provide evidence of the ability of the system to generalize from the UK to the USA. In an independent study of six radiologists, the AI system outperformed all of the human readers: the area under the receiver operating characteristic curve (AUC-ROC) for the AI system was greater than the AUC-ROC for the average radiologist by an absolute margin of 11.5%. We ran a simulation in which the AI system participated in the double-reading process that is used in the UK, and found that the AI system maintained non-inferior performance and reduced the workload of the second reader by 88%. This robust assessment of the AI system paves the way for clinical trials to improve the accuracy and efficiency of breast cancer screening.

Journal article

Markiewicz O, Lavelle M, Lorencatto F, Judah G, Ashrafian H, Darzi Aet al., 2020, Threats to safe transitions from hospital to home: a consensus study in North West London primary care, British Journal of General Practice, Vol: 70, Pages: e9-e19, ISSN: 0960-1643

Background Transitions between healthcare settings are vulnerable points for patients.Aim To identify key threats to safe patient transitions from hospital to primary care settings.Design and setting Three-round web-based Delphi consensus process among clinical and non-clinical staff from 39 primary care practices in North West London, England.Method Round 1 was a free-text idea-generating round. Rounds 2 and 3 were 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 was defined as ≥75%.Results A total of 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 patients who were most at risk. ‘Poor quality of handover instructions from secondary to primary care teams’ achieved the highest rating (mean rating at round 3 = 8.43) and a 100% consensus that it was a ‘very important’ threat. Older individuals (97%) and patients with complex medical problems taking >5 medications (80%) were voted the most vulnerable. Anticoagulants (77%) were considered to pose the greatest risk to patients.Conclusion 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 would need 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

Thibaut B, Dewa L, Ramtale S, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer Set al., 2019, Patient safety in inpatient mental health settings: a systematic review, BMJ Open, Vol: 9, Pages: 1-19, 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

Joshi M, Ashrafian H, Arora S, Khan S, Cooke G, Darzi Aet al., 2019, Digital Alerting and Outcomes in Patients With Sepsis: Systematic Review and Meta-Analysis, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 21, ISSN: 1438-8871

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, Vol: 25

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

Journal article

Patel R, Ashcroft J, Patel A, Ashrafian H, Woods A, Singh H, Darzi A, Leff Det al., 2019, The impact of transcranial direct current stimulation on upper-limb motor performance in healthy adults: A systematic review and meta-analysis, Frontiers in Neuroscience, Vol: 13, ISSN: 1662-453X

Background: Transcranial direct current stimulation (tDCS) has previously been reported to improve facets of upper limb motor performance such as accuracy and strength. However, the magnitude of motor performance improvement has not been reviewed by contemporaneous systematic review or meta-analysis of sham vs. active tDCS.Objective: To systematically review and meta-analyse the existing evidence regarding the benefits of tDCS on upper limb motor performance in healthy adults.Methods: A systematic search was conducted to obtain relevant articles from three databases (MEDLINE, EMBASE, and PsycINFO) yielding 3,200 abstracts. Following independent assessment by two reviewers, a total of 86 articles were included for review, of which 37 were deemed suitable for meta-analysis.Results: Meta-analyses were performed for four outcome measures, namely: reaction time (RT), execution time (ET), time to task failure (TTF), and force. Further qualitative review was performed for accuracy and error. Statistically significant improvements in RT (effect size −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) were demonstrated compared to sham. In exercise tasks, increased force (effect size 0.10; 95% CI 0.08 to 0.13, p < 0.001) and a trend towards improved TTF was also observed.Conclusions: This meta-analysis provides evidence attesting to the impact of tDCS on upper limb motor performance in healthy adults. Improved performance is demonstrable in reaction time, task completion time, elbow flexion tasks and accuracy. Considerable heterogeneity exists amongst the literature, further confirming the need for a standardised approach to reporting tDCS studies.

Journal article

El-Khani U, Ashrafian H, Rasheed S, Veen H, Darwish A, Nott D, Darzi Aet al., 2019, The patient safety practices of emergency medical teams in disaster zones: a systematic analysis, BMJ Global Health, Vol: 4, Pages: 1-10, 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

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

Cameron SJS, Alexander JL, Bolt F, Burke A, Ashrafian H, Teare J, Marchesi JR, Kinross J, Li JV, Takats Zet al., 2019, Evaluation of direct from sample metabolomics of human feces using rapid evaporative ionization mass spectrometry, Analytical Chemistry, Vol: 91, Pages: 13448-13457, ISSN: 0003-2700

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

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

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

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

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

Ravindran S, Ashrafian H, Broughton R, Dron M, Shaw T, Darzi A, Thomas-Gibson Set al., 2019, LEARNING FROM ADVERSE EVENTS: A STUDY OF JAG ENDOSCOPY UNITS, Annual Meeting of the British-Society-of-Gastroenterology (BSG), Publisher: BMJ PUBLISHING GROUP, Pages: A51-A52, ISSN: 0017-5749

Conference paper

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