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

473 results found

Beaney T, Neves AL, Alboksmaty A, Ashrafian H, Flott K, Fowler A, Benger J, Aylin P, Elkin S, Darzi A, Clarke Jet al., 2022, Trends and associated factors for Covid-19 hospitalisation and fatality risk in 2.3 million adults in England, Nature Communications, ISSN: 2041-1723

The Covid-19 mortality rate varies between countries and over time but the extent to which this is explained by the underlying risk in those infected is unclear. Using data on all adults in England with a positive Covid-19 test between 1st October 2020 and 30th April 2021 linked to clinical records, we examined trends and risk factors for hospital admission and mortality. Of 2,311,282 people included in the study, 164,046 (7.1%) were admitted and 53,156 (2.3%) died within 28 days of a positive Covid-19 test. We found significant variation in the case hospitalisation and mortality risk over time, which remained after accounting for the underlying risk of those infected. Older age groups, males, those resident in areas of greater socioeconomic deprivation, and those with obesity had higher odds of admission and death. People with severe mental illness and learning disability had the highest odds of admission and death. Our findings highlight both the role of external factors in Covid-19 admission and mortality risk and the need for more proactive care in the most vulnerable groups.

Journal article

Danielli S, Ashrafian H, Darzi A, 2022, Population health: transformation will happen at the speed of trust, JOURNAL OF PUBLIC HEALTH, ISSN: 1741-3842

Journal article

Sounderajah V, McCradden MD, Li X, Rose S, Ashrafian H, Collins GS, Anderson J, Bossuyt PM, Moher D, Darzi Aet al., 2022, Ethics methods are required as part of reporting guidelines for artificial intelligence in healthcare, NATURE MACHINE INTELLIGENCE, Vol: 4, Pages: 316-317

Journal article

Bakri NAC, Kwasnicki R, Khan N, Ghandour O, Lee A, Grant Y, 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: Systematic review and meta-analysis, Publisher: SPRINGER, Pages: 92-93, ISSN: 1068-9265

Conference paper

Zhang J, Whebell S, Gallifant J, Budhdeo S, Mattie H, Lertvittayakumjorn P, Del Pilar Arias Lopez M, Tiangco BJ, Gichoya JW, Ashrafian H, Celi LA, Teo JTet al., 2022, An interactive dashboard to track themes, development maturity, and global equity in clinical artificial intelligence research., Lancet Digit Health, Vol: 4, Pages: e212-e213

Journal article

Han J, Davids J, Ashrafian H, Darzi A, Elson DS, Sodergren Met al., 2022, A systematic review of robotic surgery: From supervised paradigms to fully autonomous robotic approaches, International Journal of Medical Robotics and Computer Assisted Surgery, Vol: 18, Pages: 1-11, ISSN: 1478-5951

BackgroundFrom traditional open surgery to laparoscopic surgery and robot-assisted surgery, advances in robotics, machine learning, and imaging are pushing the surgical approach to-wards better clinical outcomes. Pre-clinical and clinical evidence suggests that automation may standardise techniques, increase efficiency, and reduce clinical complications.MethodsA PRISMA-guided search was conducted across PubMed and OVID.ResultsOf the 89 screened articles, 51 met the inclusion criteria, with 10 included in the final review. Automatic data segmentation, trajectory planning, intra-operative registration, trajectory drilling, and soft tissue robotic surgery were discussed.ConclusionAlthough automated surgical systems remain conceptual, several research groups have developed supervised autonomous robotic surgical systems with increasing consideration for ethico-legal issues for automation. Automation paves the way for precision surgery and improved safety and opens new possibilities for deploying more robust artificial intelligence models, better imaging modalities and robotics to improve clinical outcomes.

Journal article

Unsworth H, Wolfram V, Dillon B, Salmon M, Greaves F, Liu X, MacDonald T, Denniston AK, Sounderajah V, Ashrafian H, Darzi A, Ashurst C, Holmes C, Weller A, NICE Artificial Intelligence Evidence Standards Working Groupet al., 2022, Building an evidence standards framework for artificial intelligence-enabled digital health technologies., Lancet Digit Health, Vol: 4, Pages: e216-e217

Journal article

Elliott KS, Haber M, Daggag H, Busby GB, Sarwar R, Kennet D, Petraglia M, Petherbridge LJ, Yavari P, Heard-Bey FU, Shobi B, Ghulam T, Haj D, Al Tikriti A, Mohammad A, Antony S, Alyileili M, Alaydaroos S, Lau E, Butler M, Yavari A, Knight JC, Ashrafian H, Barakat MTet al., 2022, Fine-Scale Genetic Structure in the United Arab Emirates Reflects Endogamous and Consanguineous Culture, Population History, and Geography, MOLECULAR BIOLOGY AND EVOLUTION, Vol: 39, ISSN: 0737-4038

Journal article

Sounderajah V, Ashrafian H, Karthikesalingam A, Markar SR, Normahani P, Collins GS, Bossuyt PM, Darzi A, STARD-AI Study Groupet al., 2022, Developing Specific Reporting Standards in Artificial Intelligence Centred Research., Ann Surg, Vol: 275, Pages: e547-e548

Journal article

Ruban A, Miras A, glaysher M, Goldstone A, Teare Jet al., 2022, Duodenal-jejunal bypass liner for the management of Type 2 diabetes and obesity: a multicenter randomized controlled trial, Annals of Surgery, Vol: 275, Pages: 440-447, ISSN: 0003-4932

Objective: The aim of this study was to examine the clinical efficacy and safety of the duodenal-jejunal bypass liner (DJBL) while in situ for 12 months and for 12 months after explantation.Summary Background Data: This is the largest randomized controlled trial (RCT) of the DJBL, a medical device used for the treatment of people with type 2 diabetes mellitus (T2DM) and obesity. Endoscopic interventions have been developed as potential alternatives to those not eligible or fearful of the risks of metabolic surgery.Methods: In this multicenter open-label RCT, 170 adults with inadequately controlled T2DM and obesity were randomized to intensive medical care with or without the DJBL. Primary outcome was the percentage of participants achieving a glycated hemoglobin reduction of ≥20% at 12 months. Secondary outcomes included weight loss and cardiometabolic risk factors at 12 and 24 months.Results: There were no significant differences in the percentage of patients achieving the primary outcome between both groups at 12 months [DJBL 54.6% (n = 30) vs control 55.2% (n = 32); odds ratio (OR) 0.93, 95% confidence interval (CI): 0.44–2.0; P = 0.85]. Twenty-four percent (n = 16) patients achieved ≥15% weight loss in the DJBL group compared to 4% (n = 2) in the controls at 12 months (OR 8.3, 95% CI: 1.8–39; P = .007). The DJBL group experienced superior reductions in systolic blood pressure, serum cholesterol, and alanine transaminase at 12 months. There were more adverse events in the DJBL group.Conclusions: The addition of the DJBL to intensive medical care was associated with superior weight loss, improvements in cardiometabolic risk factors, and fatty liver disease markers, but not glycemia, only while the device was in situ. The benefits of the devices need to be balanced against the higher rate of adverse events when making clinical decisions.Trial Registration: ISRCTN30845205. isrctn.org; Efficacy and Mechanism Evaluation Programme, a Medical Research

Journal article

Danielli S, Donnelly P, Coffey T, Horn S, Ashrafian H, Darzi Aet al., 2022, Measuring more than just economic growth to improve well-being, Journal of Public Health, Vol: 44, Pages: e76-e78, ISSN: 1741-3842

It's official: The UK is in a recession. The economy has suffered its biggest slump on record with a drop in gross domestic product (GDP) of 20.4%. 1 This is going to have a significant impact on our health and well-being. It risks creating a spiralling decay as we know good health is not only a consequence, but also a condition for sustained and sustainable economic development. 2 In this way, the health of a nation creates a virtuous circle of improved health and improved economic prosperity. How we measure prosperity is therefore important and needs to be considered.

Journal article

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., Eur J Vasc Endovasc Surg

OBJECTIVES: Investigate the clinical impact of coeliac artery (CA) coverage during thoracic endovascular aortic repair (TEVAR). METHODS: This systematic review and meta-analysis was conducted according to the PRISMA guidelines. Electronic databases were searched from 1989 to 2020 for studies reporting visceral ischaemia, spinal cord ischaemia (SCI), 30-day/-in hospital mortality, endoleaks, re-intervention and caudal stent-graft migration following CA coverage in patients undergoing TEVAR. Meta-analysis was conducted using random effects modelling. The quality of the evidence was graded using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. RESULTS: Fifteen observational studies with 236 patients (108 male, age range, 61.3-79 years) were included. The pooled visceral ischaemia rate was 13% with significant heterogeneity between studies (95% confidence interval (CI) 4-24%; I2 =72%, p<.001). The SCI rate was 5% (95% CI, 2- 9%; I2 = 0%); the 30-day/in-hospital mortality was 4% (95% CI, 1-7%; I2 =0%); the overall endoleak rate was 21% (95% CI, 13 -29%; I2 = 35%) with a 5% (95% CI, 0-13%; I2= 38%) rate of type Ib and 2% (95% CI, 0 - 8%; I2 =43%) rate of type II endoleak from retrograde coeliac artery flow. The re-intervention rate was 13% (95% CI, 6-22%; I2 = 54%); the caudal stent-graft migration rate was 3% (95% CI, 0-9%, I2 =0%). The certainty of the body of evidence was judged to be very low for all outcomes. CONCLUSION: CA coverage during TEVAR is associated with a high rate of visceral ischaemia, spinal cord ischaemia, 30-day/in-hospital mortality, endoleaks and re-intervention. Although the literature is of poor quality and questions remain over effects estimates there is evidence that coeliac artery coverage should be avoided if at all possible, during TEVAR. REGISTRATION: PROSPERO registration number 244084.

Journal article

Sounderajah V, 2022, (Mis)Communicating The Microbiome: A Cross-Sectional Assessment of Social Media Video Content, JMIR Formative Research, ISSN: 2561-326X

Journal article

Joshi M, Archer S, Morbi A, Ashrafian H, Arora S, Khan S, Cooke G, Darzi Aet al., 2022, Perceptions on the Use of Wearable Sensors and Continuous Monitoring in Surgical Patients: Interview Study Among Surgical Staff., JMIR Form Res, Vol: 6

BACKGROUND: Continuous vital sign monitoring by using wearable sensors may result in the earlier detection of patient deterioration and sepsis. Few studies have explored the perspectives of surgical team members on the use of such sensors in surgical patients. OBJECTIVE: This study aims to understand the views of surgical team members regarding novel wearable sensors for surgical patients. METHODS: Wearable sensors that monitor vital signs (heart rate, respiratory rate, and temperature) continuously were used by acute surgical patients. The opinions of surgical staff who were treating patients with these sensors were collated through in-depth semistructured interviews to thematic saturation. Interviews were audio recorded, transcribed, and analyzed via thematic analysis. RESULTS: A total of 48 interviews were performed with senior and junior surgeons and senior and junior nurses. The main themes of interest that emerged from the interviews were (1) problems with current monitoring, (2) the anticipated impact of wearables on patient safety, (3) the impact on staff, (4) the impact on patients overall, (5) potential new changes, and (6) the future and views on technology. CONCLUSIONS: Overall, the feedback from staff who were continuously monitoring surgical patients via wearable sensors was positive, and relatively few concerns were raised. Surgical staff members identify problems with current monitoring and anticipate that sensors will both improve patient safety and be the future of monitoring.

Journal article

Sounderajah V, 2022, Quality assessment standards in artificial intelligence diagnostic accuracy systematic reviews: a meta-research study, npj Digital Medicine, Vol: 5, Pages: 1-13, ISSN: 2398-6352

Artificial intelligence (AI) centred diagnostic systems are increasingly recognized as robust solutions in healthcare delivery pathways. In turn, there has been a concurrent rise in secondary research studies regarding these technologies in order to influence key clinical and policymaking decisions. It is therefore essential that these studies accurately appraise methodological quality and risk of bias within shortlisted trials and reports. In order to assess whether this critical step is performed, we undertook a meta-research study evaluating adherence to the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool within AI diagnostic accuracy systematic reviews. A literature search was conducted on all studies published from 2000 to December 2020. Of 50 included reviews, 36 performed quality assessment, of which 27 utilised the QUADAS-2 tool. Bias was reported across all four domains of QUADAS-2. 243 of 423 studies (57.5%) across all systematic reviews utilising QUADAS-2 reported a high or unclear risk of bias in the patient selection domain, 110 (26%) reported a high or unclear risk of bias in the index test domain, 121 (28.6%) in the reference standard domain and 157 (37.1%) in the flow and timing domain. This study demonstrates incomplete uptake of quality assessment tools in reviews of AI-based diagnostic accuracy studies and highlights inconsistent reporting across all domains of quality assessment. Poor standards of reporting act as barriers to clinical implementation. The creation of an AI specific extension for quality assessment tools of diagnostic accuracy AI studies may facilitate the safe translation of AI tools into clinical practice.

Journal article

Wei J, Nazarian S, Teare J, Darzi A, Ashrafian H, Thompson Aet al., 2022, A case for improved assessment of gut permeability: a meta-analysis quantifying the lactulose:mannitol ratio in coeliac and Crohn’s disease, BMC Gastroenterology, Vol: 22, ISSN: 1471-230X

Background:A widely used method in assessing small bowel permeability is the lactulose:mannitol test, where the lactulose:mannitol ratio (LMR) is measured. However, there is discrepancy in how the test is conducted and in the values of LMR obtained across studies. This meta-analysis aims to determine LMR in healthy subjects, coeliac and Crohn’s disease.Methods:A literature search was performed using PRISMA guidance to identify studies assessing LMR in coeliac or Crohn’s disease. 19 studies included in the meta-analysis measured gut permeability in coeliac disease, 17 studies in Crohn’s disease. Outcomes of interest were LMR values and comparisons of standard mean difference (SMD) and weighted mean difference (WMD) in healthy controls, inactive Crohn’s, active Crohn’s, treated coeliac and untreated coeliac. Pooled estimates of differences in LMR were calculated using the random effects model.Results:Pooled LMR in healthy controls was 0.014 (95% CI: 0.006–0.022) while pooled LMRs in untreated and treated coeliac were 0.133 (95% CI: 0.089–0.178) and 0.037 (95% CI: 0.019–0.055). In active and inactive Crohn’s disease, pooled LMRs were 0.093 (95% CI: 0.031–0.156) and 0.028 (95% CI: 0.015–0.041). Significant differences were observed in LMR between: (1) healthy controls and treated coeliacs (SMD = 0.409 95% CI 0.034 to 0.783, p = 0.032), (2) healthy controls and untreated coeliacs (SMD = 1.362 95% CI: 0.740 to 1.984, p < 0.001), (3) treated coeliacs and untreated coeliacs (SMD = 0.722 95% CI: 0.286 to 1.157, p = 0.001), (4) healthy controls and inactive Crohn’s (SMD = 1.265 95% CI: 0.845 to 1.686, p < 0.001), (5) healthy controls and active Crohn’s (SMD = 2.868 95% CI: 2.112 to 3.623, p < 0.001), and (6) active Crohn’s and inactive Crohn&rsquo

Journal article

Yeung KTD, Penney N, Whiley L, Ashrafian H, Lewis M, Purkayastha S, Darzi A, Holmes Eet al., 2022, The impact of bariatric surgery on serum tryptophan-kynurenine pathway metabolites, Scientific Reports, Vol: 12, ISSN: 2045-2322

Objectives: This study aims to explore the immediate effects of bariatric surgery on serum tryptophan – kynurenine pathway metabolites in individuals with type 2 diabetes and BMI >30. With the goal of providing insight into the link between tryptophan pathway metabolites, type 2 diabetes, and chronic obesity-induced inflammation. Methods: This longitudinal study included 20 participants. Half were diagnosed with type 2 diabetes. 11 and 9 underwent RYGB and SG respectively. Blood samples were obtained at pre-operative and three months post-operative timepoints. Tryptophan and downstream metabolites of the kynurenine pathway were quantified with an ultrahigh-performance liquid chromatography tandem mass spectrometry with electrospray ionisation method. Results: At 3 months post-operation, RYGB led to significant reductions in tryptophan, kynurenic acid and xanthurenic acid levels when compared to baseline. Significant reductions of the same metabolites after surgery were also observed in individuals with T2D irrespective of surgical procedure. These metabolites were significantly correlated with serum HbA1c levels and BMI. Conclusions: Bariatric surgery, in particular RYGB reduces serum levels of tryptophan and its downstream kynurenine metabolites. These metabolites are associated with T2D and thought to be potentially mechanistic in the systemic processes of obesity induced inflammation leading to insulin resistance. Its reduction after surgery is associated with an improvement in glycaemic control (HbA1c).

Journal article

Penney N, Yeung D, Garcia-Perez I, POSMA J, Kopytek A, Garratt B, Ashrafian H, Frost G, Marchesi J, Purkayastha S, Hoyles L, Darzi A, Holmes Eet al., 2021, Longitudinal Multi-omic Phenotyping Reveals Host-microbe Responses to Bariatric Surgery, Glycaemic Control and Obesity

<jats:title>Abstract</jats:title> <jats:p>Resolution of type-2 diabetes (T2D) is common following bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB). However, the underlying mechanisms have not been fully elucidated. To address this we compared the integrated serum, urine and faecal metabolic profiles of obese participants with and without T2D (n=81, T2D=42) with participants who underwent RYGB or sleeve gastrectomy (pre and 3-months post-surgery; n=27), taking diet into account. We co-modelled 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. Bariatric surgery reversed a number of disrupted pathways characteristic of T2D. The differential metabolite set representative of bariatric surgery overlapped with both diabetes (19.3% commonality) and BMI (18.6% commonality). However, the percentage overlap between diabetes and BMI was minimal (4.0% commonality), consistent with weight-independent mechanisms of T2D resolution. The gut microbiota was more strongly correlated to BMI than T2D, although we identified some pathways such as amino acid metabolism that correlated with changes to the gut microbiota and which influence glycaemic control. Improved understanding of GM-host co-metabolism may lead to novel therapies for weight-loss or diabetes.</jats:p>

Journal article

Acharya A, Judah G, Ashrafian H, Sounderajah V, Johnstone-Waddell N, Stevenson A, Darzi Aet al., 2021, Investigating the implementation of SMS and mobile messaging In Population Screening (The SIPS Study): Protocol for a Delphi Study, JMIR Research Protocols, Vol: 10, Pages: 1-8, ISSN: 1929-0748

BackgroundThe use of mobile messaging including Short Message Service (SMS) and Web-based messaging in healthcare has grown significantly. Using messaging to facilitate patient communication has been advocated in several circumstances including population screening. These programmes, however, pose unique challenges to mobile communication, as messaging is often sent from a central hub to a diverse population with differing needs. Despite this, there is a paucity of robust frameworks to guide implementation. ObjectiveThis protocol describes the methods that will be used to develop a guide for the principles of use of mobile messaging for population screening programmes in England.Methods This modified Delphi study will be conducted in two parts: evidence synthesis and consensus generation. The former will incorporate a literature review of publications from 1st January 2000 to the present. This will elicit key themes to inform an online scoping questionnaire posed to a group of experts from academia, clinical medicine, industry and public health. Thematic analysis of free-text responses by two independent authors will elicit items to be used in the consensus generation. Patient and Public Involvement groups will be convened to ensure that a comprehensive item list is generated, which represents the public’s perspective. Each item will then be anonymously voted upon by experts as to its importance and feasibility of implementation in screening, during three rounds of a Delphi process. Consensus will be defined a priori at 70%, with items considered important and feasible eligible for inclusion into the final recommendation. A list of desirable items (important, but not currently feasible) will be developed to guide future work. ResultsThe Institutional Review Board at Imperial College London has granted ethical approval (20IC6088). Results are expected to involve a list of recommendations to screening services with findings made available to screening services

Journal article

Wallace W, Chan C, Chidambaram S, Hanna L, Iqbal FM, Acharya A, Normahani P, Ashrafian H, Markar SR, Sounderajah V, Darzi Aet al., 2021, The diagnostic and triage accuracy of digital and online symptom checker tools: a systematic review

<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>To evaluate the accuracy of digital and online symptom checkers in providing diagnoses and appropriate triage advice.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Systematic review.</jats:p></jats:sec><jats:sec><jats:title>Data sources</jats:title><jats:p>Medline and Web of Science were searched up to 15 February 2021.</jats:p></jats:sec><jats:sec><jats:title>Eligibility criteria for study selection</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>The primary outcomes were (1) the accuracy of symptom checkers for providing the correct diagnosis and (2) the accuracy of subsequent triage advice given.</jats:p></jats:sec><jats:sec><jats:title>Data extraction and synthesis</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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, whil

Journal article

Dewa LH, Lawrance E, Roberts L, Brooks-Hall E, Ashrafian H, Fontana G, Aylin Pet al., 2021, Quality Social Connection as an Active Ingredient in Digital Interventions for Young People With Depression and Anxiety: Systematic Scoping Review and Meta-analysis, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 23, ISSN: 1438-8871

Journal article

Aggarwal R, Visram S, Martin G, Sounderajah V, Gautama S, Jarrold K, Klaber R, Maxwell S, Neal J, Pegg J, Redhead J, King D, Ashrafian H, Darzi Aet al., 2021, Defining the enablers and barriers to the implementation of large-scale healthcare related mobile technology: a qualitative case study in a tertiary hospital setting, JMIR mHealth and uHealth, Vol: 10, Pages: 1-11, ISSN: 2291-5222

Background:The successful implementation of clinical smartphone applications in hospital settings requires close collaboration with industry partners. A large-scale hospital-wide implementation of a clinical mobile application for healthcare professionals developed in partnership with Google Health and academic partners was deployed on a Bring Your Own Device (BYOD) basis using mobile device management (MDM) at our UK academic hospital. As this was the first large-scale implementation of this type of innovation in the UK health system, important insights and lessons learned from the deployment may be useful to other organisations considering implementing similar technology in partnership with commercial companies.Objective:The aims of this study were to define the key enablers and barriers, and to propose a ‘roadmap’ for the implementation of a hospital-wide clinical mobile application developed in collaboration with an industry partner as a data processor and an academic partner for independent evaluation.Methods:Semi-structured interviews were conducted with high-level stakeholders from industry, academia and healthcare providers who had instrumental roles in the implementation of the application at our hospital. The interviews explored participant’s views on the enablers and barriers to the implementation process. Interviews were analysed using a broadly deductive approach to thematic analysis.Results:In total, 14 participants were interviewed. Key enablers identified were the establishment of a steering committee with high-level clinical involvement, well-defined roles and responsibilities between partners, effective communication strategies with end-users, safe information governance precautions and increased patient engagement and transparency. Barriers identified were the lack of dedicated resources for mobile change at our hospital, risk aversion, unclear strategy and regulation, and the implications of BYOD and MDM policies. The key lesson

Journal article

Acharya A, Sounderajah V, Ashrafian H, Darzi A, Judah Get al., 2021, A systematic review of interventions to improve breast cancer screening health behaviours, Preventive Medicine, Vol: 153, ISSN: 0091-7435

Whilst breast cancer screening has been implemented in many countries, uptake is often suboptimal. Consequently, several interventions targeting non-attendance behaviour have been developed. This systematic review aims to appraise the successes of interventions, identifying and comparing the specific techniques they use to modify health behaviours. A literature search (PROSPERO CRD42020212090) between January 2005 and December 2020 using PubMed, Medline, PsycInfo, EMBASE and Google Scholar was conducted. Studies which investigated patient-facing interventions to increase attendance at breast cancer screening appointments were included. Details regarding the intervention delivery, theoretical background, and contents were extracted, as was quantitative data on the impact on attendance rates, compared to control measures. Interventions were also coded using the Behavioural Change Techniques (BCT) Taxonomy. In total fifty-four studies, detailing eighty interventions, met the inclusion criteria. Only 50% of interventions reported a significant impact on screening attendance. Thirty-two different BCTs were used, with 'prompts/cues' the most commonly incorporated (77.5%), however techniques from the group 'covert learning' had the greatest pooled effect size 0.12 (95% CI 0.05-0.19, P < 0·01, I2 = 91.5%). 'Problem solving' was used in the highest proportion of interventions that significantly increased screening attendance (69.0%). 70% of the interventions were developed using behavioural theories. These results show interventions aimed at increasing screening uptake are often unsuccessful. Commonly used approaches which focus upon explaining the consequences of not attending mammograms were often ineffective. Problem solving, however, has shown promise. These techniques should be investigated further, as should emerging technologies which can enable interventions to be feasibly translated at a population-level.

Journal article

Yeung KTD, Penney N, Harling L, Darzi A, Ashrafian Het al., 2021, Response to comment on "'Does sleeve gastrectomy expose the distal esophagus to severe reflux?' So what? Keep the big picture in perspective", Annals of Surgery, Vol: 274, Pages: e793-e794, ISSN: 0003-4932

Journal article

Ravindran S, Matharoo M, Shaw T, Robinson E, Choy M, Berry P, O'Donohue J, Healey CJ, Coleman M, Thomas-Gibson Set al., 2021, 'Case of the month': a novel way to learn from endoscopy-related patient safety incidents, FRONTLINE GASTROENTEROLOGY, Vol: 12, Pages: 636-643, ISSN: 2041-4137

Journal article

Ravindran S, Bassett P, Shaw T, Dron M, Broughton R, Griffiths H, Keen D, Wood E, Healey CJ, Green J, Ashrafian H, Darzi A, Coleman M, Thomas-Gibson Set al., 2021, Improving safety and reducing error in endoscopy (ISREE): a survey of UK services, FRONTLINE GASTROENTEROLOGY, Vol: 12, Pages: 593-600, ISSN: 2041-4137

Journal article

Ashrafian H, 2021, Venus and Mars: chest wall deformity and thoracic disease, LANCET RESPIRATORY MEDICINE, Vol: 9, Pages: 1363-1364, ISSN: 2213-2600

Journal article

Jiwa N, Kumar S, Gandhewar R, Chauhan H, Nagarajan V, Wright C, Hadjiminas D, Takats Z, Ashrafian H, Leff DRet al., 2021, Diagnostic Accuracy of Nipple Discharge Fluid Cytology: A Meta-Analysis and Systematic Review of the Literature, Publisher: SPRINGER, Pages: 1774-1786, ISSN: 1068-9265

Conference paper

Zhang J, Whebell S, Gallifant J, Budhdeo S, Mattie H, Lertvittayakumjorn P, Arias Lopez MP, Tiangco BJ, Gichoya JW, Ashrafian H, Celi LA, Teo JTet al., 2021, An interactive dashboard to track themes, development maturity, and global equity in clinical artificial intelligence research

<jats:title>Abstract</jats:title><jats:p>The global clinical artificial intelligence (AI) research landscape is constantly evolving, with heterogeneity across specialties, disease areas, geographical representation, and development maturity. Continual assessment of this landscape is important for monitoring progress. Taking advantage of developments in natural language processing (NLP), we produce an end-to-end NLP pipeline to automate classification and characterization of all original clinical AI research on MEDLINE, outputting real-time results to a public, interactive dashboard (<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://aiforhealth.app/">https://aiforhealth.app/</jats:ext-link>).</jats:p>

Journal article

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