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

516 results found

Ashrafian H, 2023, Goiters in the Renaissance era: Multiple cases of thyroid autoimmunity and iodine deficiency., Best Pract Res Clin Endocrinol Metab, Vol: 37

The Renaissance is recognised as an inflection point in history that led to the dissemination of innovation, science, philosophy, and the arts to spearhead a leap for global civilisation. Many of the greatest outputs from the Renaissance were presented in artwork which was able to champion elements of naturalism and realism, and therefore moved away from preconceived ideas. This included the portrayal of anatomy and pathology with an exactitude previously unseen in art. I note novel identification of goiters in multiple paintings of the foremost Renaissance genius artists and their originating artistic schools, those of Verrocchio, Lippi and Ferrara. These can be categorised through the proposed (i) 'da Vinci Sign' after Leonardo da Vinci, where the goitre is artistically presented as a loss or shallowing of the suprasternal notch recess or (ii) the 'Botticelli Sign' after Sandro Botticelli, where there is demonstrable cranio-cervical neck flexion that forward projects the visceral compartment of the neck that includes the thyroid to accentuate a recognisable thyroid enlargement. These are notable in the works of genius artists that include Verrocchio, Lorenzo di Credi, Filippo Lippi, Cosimo Tura and Francesco Cossa. Together, the work of these artistic geniuses add to the corpus of notable endocrine pathology in the Renaissance deriving from endemic iodine deficiency and autoimmunity. They demonstrate this profound extent of pathology within their artistic masterpieces and extend our admiration of the wider experience of Renaissance artists into the current era and beyond.

Journal article

Marecos J, Shattock E, Bartlett O, Goiana-da-Silva F, Maheswaran H, Ashrafian H, Darzi Aet al., 2023, Health misinformation and freedom of expression: considerations for policymakers, HEALTH ECONOMICS POLICY AND LAW, ISSN: 1744-1331

Journal article

Das B, Ledesma F, Ashrafian H, Reddy M, Khan OA, Fehervari Met al., 2023, Gastrojejunostomy Closure Technique and Risk of Leak: an Evaluation in Ex Vivo Porcine Models, OBESITY SURGERY, ISSN: 0960-8923

Journal article

Ashrafian H, 2023, Goiter and thyroid eye sign in the Madonna and Child with Angels by Francesco del Cossa (c. 1430-1477), JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION, ISSN: 0391-4097

Journal article

Ashrafian H, Harling L, 2023, Earliest depiction of lymphedema in history 1700 to 1500 BC, JOURNAL OF VASCULAR SURGERY-VENOUS AND LYMPHATIC DISORDERS, Vol: 11, Pages: 229-230, ISSN: 2213-333X

Journal article

Schaarup JFR, Aggarwal R, Dalsgaard E-M, Norman K, Dollerup OL, Ashrafian H, Witte DR, Sandbæk A, Hulman Aet al., 2023, 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, Vol: 9, Pages: 100114-100114, ISSN: 2666-9706

Journal article

Bolous NS, Graetz DE, Ashrafian H, Barlow J, Bhakta N, Sounderajah V, Dowdeswell Bet al., 2022, Harnessing a clinician-led governance model to overcome healthcare tribalism and drive innovation: a case study of Northumbria NHS Foundation Trust, JOURNAL OF HEALTH ORGANIZATION AND MANAGEMENT, Vol: 37, Pages: 1-16, ISSN: 1477-7266

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) behavioral marker system, ENDOSCOPY, ISSN: 0013-726X

Journal article

Fehervari M, Banh S, Varma P, Das B, Al-Yaqout K, Al-Sabah S, Khwaja H, Efthimiou E, Ashrafian Het al., 2022, Weight loss specific to indication, remission of diabetes, and short-term complications after sleeve gastrectomy conversion to Roux-en-Y gastric bypass: a systematic review and meta-analysis., Surg Obes Relat Dis

Laparoscopic sleeve gastrectomy (SG) is the most frequently performed bariatric procedure worldwide. Long-term complications such as insufficient weight loss (IWL) and gastroesophageal reflux disease (GERD) may necessitate SG conversion to Roux-en-Y gastric bypass (RYGB). The aim of this review was to determine the indication-specific weight loss and diabetes remission after SG conversion to RYGB (STOBY). Our objective was to extract all available published data on indication for conversion, weight loss, remission of diabetes, and short-term complications after STOBY. A systematic literature search was conducted to identify studies reporting outcomes following STOBY. A random effects model was used for meta-analysis. The search identified 44 relevant studies. Overall short-term (12-mo) excess weight loss (EWL) was 54.6% (95% confidence interval [CI], 46%-63%) in 23 studies (n = 712) and total weight loss (TWL) was 19.9% (95% CI, 14%-25%) in 21 studies (n = 740). For IWL, short-term (12-mo) pooled weight loss outcomes were 53.9% EWL (95% CI, 48%-59%) in 14 studies (n = 295) and 22.7% TWL (95% CI, 17%-28%) in 12 studies (n = 219), and medium-term (2-5 yr) outcomes were 45.8% EWL (95% CI, 38%-53%) in 7 studies (n = 154) and 20.6% TWL (95% CI, 15%-26%) in 9 studies (n = 206). Overall diabetes remission was 53% (95% CI, 33%-72%), and the perioperative complication rate was 8.2% (95% CI, 7.6%-8.7%). Revisional SG conversion to RYGB for IWL can achieve good weight loss outcomes and diabetes remission.

Journal article

Zhang J, Budhdeo S, Ashrafian H, 2022, Failing IT infrastructure is undermining safe healthcare in the NHS, BMJ-BRITISH MEDICAL JOURNAL, Vol: 379, ISSN: 0959-535X

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, Pages: 15-15, ISSN: 0140-6736

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

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

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

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

Nabeel A, Al-Sabah SK, Ashrafian H, 2022, Digital Contact Tracing Applications against COVID-19: A Systematic Review, MEDICAL PRINCIPLES AND PRACTICE, Vol: 31, Pages: 424-432, 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, ASiT Surgical Conference, 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, 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, 25th IFSO World Congress, Publisher: SPRINGER, Pages: 483-483, ISSN: 0960-8923

Conference paper

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

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, Cunnigham 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, ISSN: 1471-2458

Journal article

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