Imperial College London

DrHutanAshrafian

Faculty of MedicineDepartment of Surgery & Cancer

Honorary Senior Research Fellow
 
 
 
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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

504 results found

Naik R, Kogkas A, Ashrafian H, Mylonas G, Darzi Aet al., 2022, The Measurement of Cognitive Workload in Surgery Using Pupil Metrics: A Systematic Review and Narrative Analysis, JOURNAL OF SURGICAL RESEARCH, Vol: 280, Pages: 258-272, ISSN: 0022-4804

Journal article

Zhang J, Budhdeo S, Ashrafian H, 2022, Failing IT infrastructure is undermining safe healthcare in the NHS., BMJ, Vol: 379

Journal article

Acharya A, Judah G, Ashrafian H, Sounderajah V, Johnstone-Waddell N, Harris M, Stevenson A, Darzi Aet al., 2022, Investigating the implementation of mobile messaging in population screening programmes: a modified Delphi study., Lancet, Vol: 400 Suppl 1

BACKGROUND: Mobile messaging is an increasingly important health-care communication tool. Screening programmes pose unique challenges because of the large, diverse populations invited, who might have not interacted with services previously. This study aimed to provide guidance on how screening programmes in England can effectively implement mobile messaging services. METHODS: Experts based in England, from public health, policy, screening provision, communications, and academia were recruited to this Delphi study. Recommendations were derived from an evidence synthesis involving a literature review, expert scoping questionnaire, public consultation, and discussion with relevant national organisations. Experts voted upon the importance and feasibility of recommendations across two consensus rounds, using a five-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 discussed at an expert meeting to determine suitability. Ethical approval was obtained (20IC6088), and participants provided informed consent. FINDINGS: 33 experts representing all 11 screening programmes were enrolled, with 100% retention across rounds. Of the initial 101 items, 23 (23%) reached consensus. These core recommendations were divided across six domains: message content, timing, delivery, evaluation, security, and research. They included the use of general practitioner endorsement and limiting message length to 320 characters. A further 17 items were considered desirable; for example, introducing greater functionality such as bidirectional and tailored messaging. INTERPRETATION: Findings will facilitate the effective use of mobile messaging across screening and will form national guidance for services. This guidance will enable programmes to overcome implementation challenges and facilitate uptake of screening invitations. As repres

Journal article

Ravindran S, Cavilla R, Ashrafian H, Haycock A, Healey C, Coleman M, Archer S, Darzi A, Thomas-Gibson Set al., 2022, Development of the 'Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills' (TEAM-ENTS) behavioural marker system., Endoscopy

Background and study aims Non-technical skills (NTS) are integral to team performance and subsequent quality and safety of care. Behavioural marker systems (BMS) are now increasingly used in healthcare to support training and assessment of team NTS. Within gastrointestinal endoscopy, this is an area of novel research. The aims of this study were to define the core relevant NTS for endoscopy teams and develop a preliminary framework for a team-based BMS known as TEAM-ENTS (Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills). Methods This study was conducted in two phases. In phase 1, a literature review of team-based BMS was performed to inform an interview study of core endoscopy team members. Cognitive task analysis was used to breakdown the NTS relevant to endoscopy teams. Framework analysis generated the structure for the preliminary TEAM-ENTS framework. In phase 2, a modified Delphi process was undertaken to refine items of the framework. Results Seven consultant endoscopists and six nurses were interviewed. The final coding framework consisted of 88 codes grouped into 5 overarching categories. In total, 58 participants were recruited to the Delphi panel. In the first round, 9 elements and 37 behavioural descriptors did not meet consensus. Following item adjustment, merging and deletion, all remaining items met consensus thresholds after the second round. The refined TEAM-ENTS BMS consists of 5 categories, 16 elements and 47 behavioural descriptors. Conclusions The refined TEAM-ENTS behavioural marker system was developed to reflect the core non-technical skills relevant to endoscopy teams. Future studies will aim to fully validate this tool.

Journal article

Wei J, Monfort Sanchez E, Avery J, Barbouti O, Hoare J, Ashrafian H, Darzi A, Thompson Aet al., 2022, Non-invasive assessment of intestinal permeability in healthy volunteers using transcutaneous fluorescence spectroscopy, Methods and Applications in Fluorescence, ISSN: 2050-6120

Journal article

Penney N, Yeung K, Garcia Perez I, Posma J, Kopytek A, Garratt B, Ashrafian H, Frost G, Marchesi J, Purkayastha S, Hoyles L, Darzi A, Holmes Eet al., 2022, Multi-omic phenotyping reveals host-microbe responses to bariatric surgery, glycaemic control and obesity, communications medicine, Vol: 2, Pages: 1-18, ISSN: 2730-664X

Background: Resolution of type 2 diabetes (T2D) is common following bariatric surgery, particularly Roux-en-Y gastric bypass. However, the underlying mechanisms have not been fully elucidated.Methods: To address this we compare the integrated serum, urine and faecal metabolic profiles of participants with obesity +/- T2D (n=80, T2D=42) with participants who underwent Roux-en-Y gastric bypass or sleeve gastrectomy (pre and 3-months post-surgery; n=27), taking diet into account. We co-model these data with shotgun metagenomic profiles of the gut microbiota to provide a comprehensive atlas of host-gut microbe responses to bariatric surgery, weight-loss and glycaemic control at the systems level.Results: Here we show that bariatric surgery reverses several disrupted pathways characteristic of T2D. The differential metabolite set representative of bariatric surgery overlaps with both diabetes (19.3% commonality) and body mass index (18.6% commonality). However, the percentage overlap between diabetes and body mass index is minimal (4.0% commonality), consistent with weight-independent mechanisms of T2D resolution. The gut microbiota is more strongly correlated to body mass index than T2D, although we identify some pathways such as amino acid metabolism that correlate with changes to the gut microbiota and which influence glycaemic control.Conclusion: We identify multi-omic signatures associated with responses to surgery, body mass index, and glycaemic control. Improved understanding of gut microbiota - host co-metabolism may lead to novel therapies for weight-loss or diabetes. However, further experiments are required to provide mechanistic insight into the role of the gut microbiota in host metabolism and establish proof of causality.

Journal article

Schaarup JFR, Aggarwal R, Dalsgaard E-M, Norman K, Dollerup OL, Ashrafian H, Witte DR, Sandbæk A, Hulman Aet al., 2022, Perception of artificial intelligence-based solutions in healthcare among people with and without diabetes: a cross-sectional survey from the Health in Central Denmark cohort, Diabetes Epidemiology and Management, Pages: 100114-100114, ISSN: 2666-9706

Journal article

Li E, Clarke J, Ashrafian H, Darzi A, Neves ALet al., 2022, Impact of electronic health record interoperability on safety and quality of care in high-income countries: A systematic review, Journal of Medical Internet Research, Vol: 24, Pages: 1-15, ISSN: 1438-8871

Background: Electronic health records (EHR) and poor systems interoperability are well-known issues in the use of health information technologies worldwide in most high-income countries. Despite the abundance of literature exploring their relationship, its practical implications on patient safety and quality of care remain unclear.Objective: To examine how EHR interoperability affects patient safety, or other dimensions of care quality, in high-income healthcare settings. Methods: A systematic search was conducted using four online medical journal repositories and grey literature sources. Publications included were published in English between 2010-2022, pertaining to EHR use, interoperability, and patient safety or care quality in high-income settings. Screening was completed by three researchers in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Risk of bias assessments was performed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) and the Cochrane Risk of Bias 2 (RoB2) tools. Findings were presented as a narrative synthesis and mapped based on the Institute of Medicine’s framework for healthcare quality.Results: Twelve studies met the inclusion criteria to be included in our review. Findings were categorised into six common outcome measure categories: patient safety events, medication safety, data accuracy and errors, care effectiveness, productivity, and cost-savings. EHR interoperability was found to positively influence medication safety, reduce patient safety events, and lower costs. Improvements to time-savings and clinical workflow are mixed. However, true measures of effect are difficult to determine with certainty due to the heterogeneity in outcome measures used and notable variation in study quality.Conclusion: The benefits of EHR interoperability on the quality and safety of care remain unclear and reflect the extensive heterogeneity in the interventions, designs, and outcome

Journal article

Zhang J, Budhdeo S, William W, Cerrato P, Shuaib H, Sood H, Ashrafian H, Halamka J, Teo Jet al., 2022, Moving towards vertically integrated artificial intelligence development, npj Digital Medicine, Vol: 5, Pages: 1-9, ISSN: 2398-6352

Substantial interest and investment in clinical artificial intelligence (AI) research has not resulted in widespread translation to deployed AI solutions. Current attention has focused on bias and explainability in AI algorithm development, external validity and model generalisability, and lack of equity and representation in existing data. While of great importance, these considerations also reflect a model-centric approach seen in publishedclinical AI research, which focuses on optimising architecture and performance of an AI model on best available datasets. However, even robustly built models using state-of-the-art algorithms may fail once tested in realistic environments due to unpredictability of real-world conditions, out-of-dataset scenarios, characteristics of deployment infrastructure, and lack ofadded value to clinical workflows relative to cost and potential clinical risks. In this perspective, we define a vertically integrated approach to AI development that incorporates early, cross-disciplinary, consideration of impact evaluation, data lifecycles, and AI production, and explore its implementation in two contrasting AI development pipelines: a scalable “AI factory” (Mayo Clinic, Rochester, United States), and an end-to-end cervicalcancer screening platform for resource poor settings (Paps AI, Mbarara, Uganda). We provide practical recommendations for implementers, and discuss future challenges and novel approaches (including a decentralised federated architecture being developed in the NHS (AI4VBH, London, UK)). Growth in global clinical AI research continues unabated, and introduction of vertically integrated teams and development practices can increase thetranslational potential of future clinical AI projects.

Journal article

Fadel MG, Fehervari M, Lairy A, Das B, Alyaqout K, Ashrafian H, Khwaja H, Efthimiou Eet al., 2022, Clinical outcomes of single-stage versus two-stage laparoscopic Roux-en-y gastric bypass in the management of obesity (BMI >= 50 kg/m(2)): a retrospective cohort study, LANGENBECKS ARCHIVES OF SURGERY, ISSN: 1435-2443

Journal article

Nabeel A, Al-Sabah SK, Ashrafian H, 2022, Digital Contact Tracing Applications against COVID-19: A Systematic Review, MEDICAL PRINCIPLES AND PRACTICE, ISSN: 1011-7571

Journal article

Fletcher E, Thompson A, Ashrafian H, Darzi Aet al., 2022, The measurement and modification of hypoxia in colorectal cancer: overlooked but not forgotten, Gastroenterology Report, Vol: 10, Pages: 1-13, ISSN: 2052-0034

Tumour hypoxia is the inevitable consequence of a tumour’s rapid growth and disorganised, inefficient vasculature. The compensatory mechanisms employed by tumours, and indeed the absence of oxygen itself, hinder the ability of all treatment modalities. The clinical consequence is poorer overall survival, disease-free survival, and locoregional control. Recognising this, clinicians have been attenuating the effect of hypoxia, primarily with hypoxic modification or with hypoxia activated pro-drugs, and notable success has been demonstrated. However, in the case of colorectal cancer (CRC), there is a general paucity of knowledge and evidence surrounding the measurement and modification of hypoxia, and this is possibly due to the comparative inaccessibility of such tumours. We specifically review the role of hypoxia in CRC, and focus on: the current evidence for the existence of hypoxia in CRC, the majority of which originates from indirect positron emission topography (PET) imaging with hypoxia selective radiotracers; the evidence correlating CRC hypoxia with poorer oncological outcome, which is largely based on the measurement of Hypoxia Inducible Factor (HIF) in correlation with clinical outcome; the evidence of hypoxic modification in CRC, of which no direct evidence exists, but is reflected in a number of indirect markers; the prognostic and monitoring implications of accurate CRC hypoxia quantification and its potential in the field of precision oncology; and the present and future imaging tools and technologies being developed for the measurement of CRC hypoxia, including the use of blood oxygen level dependent (BOLD) MRI imaging and diffuse reflectance spectroscopy.

Journal article

Wallace W, Chan C, Chidambaram S, Hanna L, Iqbal F, Acharya A, Normahani P, Ashrafian H, Markar S, Sounderajah V, Darzi Aet al., 2022, 471 Assessing the Accuracy and Bias of Digital Symptom Checkers with Myocardial Infarction Patients, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323

Conference paper

Wallace W, Chan C, Chidambaram S, Hanna L, Iqbal FM, Acharya A, Normahani P, Ashrafian H, Markar SR, Sounderajah V, Darzi Aet al., 2022, The diagnostic and triage accuracy of digital and online symptom checker tools: a systematic review, npj Digital Medicine, Vol: 5, ISSN: 2398-6352

Digital and online symptom checkers are an increasingly adopted class of health technologies that enable patients to input their symptoms and biodata to produce a set of likely diagnoses and associated triage advice. However, concerns regarding the accuracy and safety of these symptom checkers have been raised. This systematic review evaluates the accuracy of symptom checkers in providing diagnoses and appropriate triage advice. MEDLINE and Web of Science were searched for studies that used either real or simulated patients to evaluate online or digital symptom checkers. The primary outcomes were the diagnostic and triage accuracy of the symptom checkers. The QUADAS-2 tool was used to assess study quality. Of the 177 studies retrieved, 10 studies met the inclusion criteria. Researchers evaluated the accuracy of symptom checkers using a variety of medical conditions, including ophthalmological conditions, inflammatory arthritides and HIV. 50% of the studies recruited real patients, while the remainder used simulated cases. The diagnostic accuracy of the primary diagnosis was low across included studies (range: 19% to 37.9%) and varied between individual symptom checkers, despite consistent symptom data input. Triage accuracy (range: 48.8% to 90.1%) was typically higher than diagnostic accuracy. Overall, the diagnostic and triage accuracy of symptom checkers are variable and of low accuracy. Given the increasing push towards adopting this class of technologies across numerous health systems, this study demonstrates that reliance upon symptom checkers could pose significant patient safety hazards. Large scale primary studies, based upon real world data, are warranted to demonstrate adequate performance of these technologies in a manner that is and non-inferior to current best practice. Moreover, an urgent assessment of how these systems are regulated and implemented is required.

Journal article

Yeung K, Whiley L, Penney N, Ashrafian H, Purkayastha S, Darzi A, Holmes Eet al., 2022, SERUM LIPIDOMIC SIGNATURES OF TYPE 2 DIABETES AND EARLY SURGICAL DIABETES RESOLUTION Basic science and research in bariatric surgery, Publisher: SPRINGER, Pages: 485-485, ISSN: 0960-8923

Conference paper

Fadel M, Fehervari M, Lairy A, Das B, Alyaqout K, Ashrafian H, Khwaja H, Efthimiou Eet al., 2022, CLINICAL OUTCOMES OF SINGLE-STAGE VERSUS TWO-STAGE LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS IN THE MANAGEMENT OF SUPER OBESITY: A RETROSPECTIVE COHORT STUDY Multidisciplinary care (primary care, medical management), Publisher: SPRINGER, Pages: 108-108, ISSN: 0960-8923

Conference paper

Yeung K, Penney N, Whiley L, Ashrafian H, Purkayastha S, Holmes E, Darzi Aet al., 2022, SERUM AMINO ACID RATIOS AS PROXIES TO MECHANISMS CONTRIBUTING TO IMPROVED METABOLIC HEALTH AFTER BARIATRIC SURGERY Basic science and research in bariatric surgery, Publisher: SPRINGER, Pages: 483-483, ISSN: 0960-8923

Conference paper

Wallace W, Chan C, Chidambaram S, Hanna L, Iqbal FM, Acharya A, Normahani P, Ashrafian H, Markar S, Sounderajah V, Darzi Aet al., 2022, The diagnostic and triage accuracy of digital and online symptom checker tools: a systematic review, Publisher: MedArxiv

<h4>ABSTRACT</h4> <h4>Objective</h4> To evaluate the accuracy of digital and online symptom checkers in providing diagnoses and appropriate triage advice. <h4>Design</h4> Systematic review. <h4>Data sources</h4> Medline and Web of Science were searched up to 15 February 2021. <h4>Eligibility criteria for study selection</h4> Prospective and retrospective cohort, vignette, or audit studies that utilised an online or application-based service designed to input symptoms and biodata in order to generate diagnoses, health advice and direct patients to appropriate services were included. <h4>Main outcome measures</h4> The primary outcomes were (1) the accuracy of symptom checkers for providing the correct diagnosis and (2) the accuracy of subsequent triage advice given. <h4>Data extraction and synthesis</h4> Data extraction and quality assessment (using the QUADAS-2 tool) were performed by two independent reviewers. Owing to heterogeneity of the studies, meta-analysis was not possible. A narrative synthesis of the included studies and pre-specified outcomes was completed. <h4>Results</h4> Of the 177 studies retrieved, nine cohort studies and one cross-sectional study met the inclusion criteria. Symptom checkers evaluated a variety of medical conditions including ophthalmological conditions, inflammatory arthritides and HIV. 50% of the studies recruited real patients, while the remainder used simulated cases. The diagnostic accuracy of the primary diagnosis was low (range: 19% to 36%) and varied between individual symptom checkers, despite consistent symptom data input. Triage accuracy (range: 48.8% to 90.1%) was typically higher than diagnostic accuracy. Of note, one study found that 78.6% of emergency ophthalmic cases were under-triaged. <h4>Conclusions</h4> The diagnostic and triage accuracy of symptom checkers are variable and of low accuracy. Given the increasin

Working paper

Acharya A, Ashrafian H, Cunnignham D, Ruwende J, Darzi A, Judah Get al., 2022, Evaluating the impact of a novel behavioural science informed animation upon breast cancer screening uptake: protocol for a randomised controlled trial, BMC Public Health, Vol: 22, ISSN: 1471-2458

BackgroundBreast cancer screening is estimated to save 1300 lives annually in the United Kingdom. Despite this, uptake of invitations has fallen over the past decade. Behavioural science-informed interventions addressing the determinants of attendance behaviour have shown variable effectiveness. This may be due to the narrow repertoire of techniques trialled, and the difficulties of implementation at a population-scale. The aim of this study is to evaluate the impact on breast screening uptake of a novel behavioural video intervention which can contain more complex combinations of behavioural change techniques. MethodsA 3-armed randomised controlled trial will be undertaken in London comparing the impact of (1) the usual care SMS reminder, to (2) a behavioural plain text SMS reminder and (3) a novel video sent as a link within the behavioural plain text SMS reminder. A total of 8391 participants (2797 per group) will be allocated to one of the three trial arms using a computer randomisation process, based upon individuals’ healthcare identification numbers. The novel video has been co-designed with a diverse range of women to overcome the barriers faced by underserved communities and the wider population. The behavioural SMS content has also been co-designed through the same process as the video. Messages will be sent through the current reminder system used by the London screening programmes, with reminders 7 days and 2 days prior to a timed appointment. The primary outcome is attendance at breast cancer screening within 3 months of the initial invitation. Secondary outcomes will include evaluating the impact of each message amongst socio-demographic groups and according to the appointment type e.g. first invitation or recall. DiscussionIn addition to general declining trends in attendance, there is also concern of increasing healthcare inequalities with breast cancer screening in London. The current novel intervention, designed with underserved groups and t

Journal article

Che Bakri NA, Kwasnicki R, Khan N, Ghandour O, Lee A, Grant Y, Dawidziuk A, Darzi A, Ashrafian H, Leff Det al., 2022, 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, 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.

Journal article

Joshi M, Ashrafian H, Arora S, Sharabiani M, Kenny M, Sadia K, Cooke G, Ara Det al., 2022, A pilot study to investigate real time digital alerting from wearable sensors in surgical patients, Pilot and Feasibility Studies, Vol: 8, ISSN: 2055-5784

Background Continuous vital sign monitoring may identify changes sooner than current standard monitoring. Objective To investigate if the use of real time digital alerts sent to healthcare staff can improve the time taken to identify unwell patients and those with sepsis. DesignA prospective cohort study design. Setting West Middlesex University Hospital, UK. Participants 50 acutely unwell surgical patients admitted to hospital. Intervention Patients wore a lightweight wearable sensor measuring heart rate (HR), respiratory rate (RR) and temperature every 2 minutes whilst standard intermittent ward monitoring of vital signs was performed by nurses. Digital alerts were sent to healthcare staff from the sensor to a smartphone device. All alerts were reviewed for recruited patients to identify the exact time on the sensor in which deterioration occurred. The time to acknowledgement was then reviewed for each action and an average time to acknowledgement calculated.Results There were 50 patients recruited in the pilot study, of which there were vital sign alerts in 18 patients (36%). The total number of vital sign alerts generated in these 18 patients was 51. Of these 51 alerts there 7 alerts for high HR (13.7%), 33 for RR (64.7%) and 11 for temperature (21.6%). Out of the 27 acknowledged alerts there were 2 alerts for HR, 17 for RR and 8 for temperature. The average time to staff acknowledgement of the notification for all alerts was 154 minutes (2.6 hours). There were some patients which had shown signs of deterioration in the cohort. The frequency of routine observation monitoring was increased in 2 cases, 3 patients were referred to a senior clinician and 2 patients were initiated on the sepsis pathway. Conclusion This study demonstrates the evaluation of digital alerts to nurses in real-time. Although not all alerts were acknowledged, deterioration on the ward observations was detected and actions were taken accordingly. Patients were started on the sepsis pathw

Journal article

Iqbal FM, Joshi M, Khan S, Wright M, Ashrafian H, Darzi A, Iqbal FM, Joshi M, Khan S, Wright M, Ashrafian H, Darzi Aet al., 2022, Key Stakeholder Barriers and Facilitators to Implementing Remote Monitoring Technologies: Protocol for a Mixed Methods Analysis, JMIR RESEARCH PROTOCOLS, Vol: 11, ISSN: 1929-0748

Journal article

Ravindran S, Thomas-Gibson S, Bano M, Robinson E, Jenkins A, Marshall S, Ashrafian H, Darzi A, Coleman M, Healey Cet al., 2022, The national census of UK endoscopy services 2021., Future Healthc J, Vol: 9, Pages: 16-17, ISSN: 2514-6645

Journal article

Iqbal F, Joshi M, Fox R, Tonia K, Sharma A, Wright M, Khan S, Ashrafian H, Darzi Aet al., 2022, Outcomes of vital sign monitoring of an acute surgical cohort with wearable sensors and digital alerting systems: a pragmatically designed cohort study and propensity-matched analysis, Frontiers in Bioengineering and Biotechnology, Vol: 10, ISSN: 2296-4185

Background: The implementation and efficacy of wearable sensors and alerting systems in acute secondary care have been poorly described. Objectives: to pragmatically test one such system and its influence on clinical outcomes in an acute surgical cohort.Methods: In this pragmatically designed, pre-post implementation trial, participants admitted to the acute surgical unit at our institution were recruited. In the pre-implementation phase (September 2017 to May 2019), the SensiumVitals™ monitoring system, which continuously measures temperature, heart, and respiratory rates, was used for monitoring alongside usual care (intermittent monitoring in accordance with the National Early Warning Score 2 [NEWS 2] protocol) without alerts being generated. In the post-implementation phase (May 2019 to March 2020), alerts were generated when pre-established thresholds for vital parameters were breached, requiring acknowledgement from healthcare staff on provided mobile devices. Hospital length of stay, intensive care use, and 28-day mortality were measured. Balanced cohorts were created with 1:1 ‘optimal’ propensity score logistic regression models.Results: The 1:1 matching method matched the post-implementation group (n = 141) with the same number of subjects from the pre-implementation group (n = 141). The median age of the entire cohort was 52 (range: 18-95) years and the median duration of wearing the sensor was 1.3 (interquartile range: 0.7-2.0) days. The median alert acknowledgement time was 111 (range: 1-2146) minutes. There were no significant differences in critical care admission (planned or unplanned), hospital length of stay, or mortality.Conclusion: This study offered insight into the implementation of digital health technologies within our institution. Further work is required for optimisation of digital workflows, particularly given their more favourable acceptability in the post pandemic era.Clinical trials registration information: Cli

Journal article

Iqbal F, Joshi M, Khan S, Wright M, Ashrafian H, Darzi Aet al., 2022, Barriers and facilitators of key stakeholders to implement remote monitoring technologies: a protocol for a mixed-methods analysis, JMIR Research Protocols, ISSN: 1929-0748

Background: Implementation of novel digital solutions within the National Health Service (NHS) has historically been challenging. Since the COVID-19 pandemic, there has been a greater push for digitisation and for operating remote monitoring solutions. However, the implementation and widespread adoption of this type of innovation has been poorly studied.Objective: to investigate key stakeholder barriers and facilitators of implementing remote monitoring solutions, identifying factors that could affect successful adoption.Methods: A mixed methods approach will be implemented: semi-structured interviews will be conducted with high level stakeholders from industry, academia, and healthcare providers who have played an instrumental role with prior experience of implementing digital solutions alongside the use of an adapted version of the Technology Acceptance Model (TAM) questionnaire.Results: Enrolment is currently underway, having started in February 2022; it is anticipated to end in July 2022 with data analysis to commence in August 2022.Conclusions: the results of this study may highlight key barriers and facilitators in implementing digital remote monitoring solutions, allowing for improved future widespread adoption with the NHS.Clinical trials registration information: ClinicalTrials.gov Identifier: NCT05321004

Journal article

Ravindran S, Marshall S, Healey C, Ashrafian H, Darzi A, Coleman M, Thomas-Gibson Set al., 2022, THE NATIONAL CENSUS OF UK ENDOSCOPY SERVICES 2021, Annual Meeting of the British Society of Gastroenterology (BSG), Publisher: BMJ PUBLISHING GROUP, Pages: A136-A136, ISSN: 0017-5749

Conference paper

Ravindran S, Matharoo M, Healey C, Marshall S, Bassett P, Coleman M, Ashrafian H, Darzi A, Thomas-Gibson Set al., 2022, THE ENDOSCOPY SAFETY ATTITUDES QUESTIONNAIRE (ENDO-SAQ): VALIDATION AND RESULTS, Annual Meeting of the British Society of Gastroenterology (BSG), Publisher: BMJ PUBLISHING GROUP, Pages: A136-A137, ISSN: 0017-5749

Conference paper

Ravindran S, Healey C, Coleman M, Ashrafian H, Haycock A, Archer S, Darzi A, Thomas-Gibson Set al., 2022, VALIDATION OF THE TEAM-ENTS (TEAMWORK IN ENDOSCOPY ASSESSMENT MODULE FOR ENDOSCOPIC NON-TECHNICAL SKILLS) FRAMEWORK, Publisher: BMJ PUBLISHING GROUP, Pages: A135-A136, ISSN: 0017-5749

Conference paper

Ravindran S, Matharoo M, Healey C, Coleman M, Ashrafian H, Darzi A, Thomas-Gibson Set al., 2022, ENDOSCOPY SAFETY INCIDENTS REPORTED IN A NATIONAL DATA SET - A HUMAN FACTORS ANALYSIS, Publisher: BMJ PUBLISHING GROUP, Pages: A134-A135, ISSN: 0017-5749

Conference paper

Hanna L, Lam K, Agbeko AE, Amoako JK, Ashrafian H, Sounderajah V, Abdullah A, Gibbs Ret al., 2022, Coverage of the Coeliac Artery During Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-Analysis, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 63, Pages: 828-837, ISSN: 1078-5884

Journal article

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