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
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571 results found

Mitra A, Das B, Sarraf K, Ford Adams M, Fehervari M, Ashrafian Het al., 2024, Bone health following paediatric and adolescent bariatric surgery: a systematic review and meta-analysis, EClinicalMedicine, Vol: 69, ISSN: 2589-5370

Background:Childhood obesity is a pressing health crisis of epidemic proportions. Bariatric surgery (BS) is an effective weight loss solution however its role in the paediatric population is contentious owing to the paucity of weight specific and generalised health outcomes. This systematic review and meta-analysis aimed to assess the impact of paediatric BS on bone health.Methods:This prospectively registered systematic review (PROSPERO ID: CRD42023432035) was performed in accordance with PRISMA guidelines. We searched MEDLINE (1946–1928 September 2023), EMBASE (1947–1928 September 2023) via the Ovid platform, and the Cochrane Review Library to identify scientific publications reporting bone outcome measures in patients under the age of 18 years who underwent BS. Meta-analysis was undertaken on post-operative weight and bone parameters in paediatric patients following BS. Outcomes were reported as weighted or standardized mean difference with 95 percent confidence intervals. Subgroup analysis by intervention, quality scoring and risk of bias were assessed.Findings:Twelve studies with 681 patients across 5 countries (mean age 17 ± 0.57 years) were included. The quality of included studies was rated as high and there was substantial between-study heterogeneity for most factors included in the meta-analysis (I2 from 0% to 99.1%). Patients underwent Roux-en-Y gastric bypass (RYGB, n = 216), sleeve gastrectomy (SG, n = 257), gastric band (n = 184) or intragastric balloon placement (n = 24). BS was associated with significant weight reduction, body mass index (BMI) −12.7 kg/m2 (95% CI −14.5 to −10.9, p < 0.001), with RYGB being most effective, BMI −16.58 kg/m2 (95% CI −19.6 to −13.6, p < 0.001). Patients who underwent SG or RYGB had significantly lower lumbar bone mineral density, −0.96 g/cm2 (95% CI −0.1 to −0.03, p < 0.001), Z score, −1.132 (95% CI −1.8 to −0.45, p <

Journal article

Sargsyan N, Chen JY, Aggarwal R, Fadel MG, Fehervari M, Ashrafian Het al., 2024, The effects of bariatric surgery on cardiac function: a systematic review and meta-analysis., Int J Obes (Lond), Vol: 48, Pages: 166-176

INTRODUCTION: Obesity is associated with alterations in cardiac structure and haemodynamics leading to cardiovascular mortality and morbidity. Culminating evidence suggests improvement of cardiac structure and function following bariatric surgery. OBJECTIVE: To evaluate the effect of bariatric surgery on cardiac structure and function in patients before and after bariatric surgery. METHODS: Systematic review and meta-analysis of studies reporting pre- and postoperative cardiac structure and function parameters on cardiac imaging in patients undergoing bariatric surgery. RESULTS: Eighty studies of 3332 patients were included. Bariatric surgery is associated with a statistically significant improvement in cardiac geometry and function including a decrease of 12.2% (95% CI 0.096-0.149; p < 0.001) in left ventricular (LV) mass index, an increase of 0.155 (95% CI 0.106-0.205; p < 0.001) in E/A ratio, a decrease of 2.012 mm (95% CI 1.356-2.699; p < 0.001) in left atrial diameter, a decrease of 1.16 mm (95% CI 0.62-1.69; p < 0.001) in LV diastolic dimension, and an increase of 1.636% (95% CI 0.706-2.566; p < 0.001) in LV ejection fraction after surgery. CONCLUSION: Bariatric surgery led to reverse remodelling and improvement in cardiac geometry and function driven by metabolic and haemodynamic factors.

Journal article

Ravindran S, Matharoo M, Rutter MD, Ashrafian H, Darzi A, Healey C, Thomas-Gibson Set al., 2024, Patient safety incidents in endoscopy: a human factors analysis of nonprocedural significant harm incidents from the National Reporting and Learning System (NRLS)., Endoscopy, Vol: 56, Pages: 89-99

BACKGROUND: Despite advances in understanding and reducing the risk of endoscopic procedures, there is little consideration of the safety of the wider endoscopy service. Patient safety incidents (PSIs) still occur. We sought to identify nonprocedural PSIs (nPSIs) and their causative factors from a human factors perspective and generate ideas for safety improvement. METHODS: Endoscopy-specific PSI reports were extracted from the National Reporting and Learning System (NRLS). A retrospective, cross-sectional human factors analysis of data was performed. Two independent researchers coded data using a hybrid thematic analysis approach. The Human Factors Analysis and Classification System (HFACS) was used to code contributory factors. Analysis informed creation of driver diagrams and key recommendations for safety improvement in endoscopy. RESULTS: From 2017 to 2019, 1181 endoscopy-specific PSIs of significant harm were reported across England and Wales, with 539 (45.6%) being nPSIs. Five categories accounted for over 80% of all incidents, with "follow-up and surveillance" being the largest (23.4% of all nPSIs). From the free-text incident reports, 487 human factors codes were identified. Decision-based errors were the most common act prior to PSI occurrence. Other frequent preconditions to incidents were focused on environmental factors, particularly overwhelmed resources, patient factors, and ineffective team communication. Lack of staffing, standard operating procedures, effective systems, and clinical pathways were also contributory. Seven key recommendations for improving safety have been made in response to our findings. CONCLUSIONS: This was the first national-level human factors analysis of endoscopy-specific PSIs. This work will inform safety improvement strategies and should empower individual services to review their approach to safety.

Journal article

Sargsyan N, Das B, Robb H, Namgoong C, Ali I, Ashrafian H, Humadi S, Mitra A, Fehervari Met al., 2024, Outcomes of One-Anastomosis Gastric Bypass Conversion to Roux-en-Y Gastric Bypass for Severe Obesity: A Systematic Review and Meta-analysis., Obes Surg

One-anastomosis gastric bypass (OAGB) is an effective procedure to treat severe obesity. However, conversion to Roux-en-Y gastric bypass (RYGB) is increasing. We therefore conducted a systematic review to determine the safety and efficacy associated with OAGB-RYGB conversion. A systematic search was conducted by three independent reviewers using Medline, Embase, and the Cochrane library following PRISMA guidelines. Six studies including 134 patients were selected who were undergoing OAGB-RYGB conversion. The most common indications were reflux (47.8%), malnutrition (31.3%), and inadequate weight loss (8.2%). Study outcomes demonstrated 100% resolution of bile reflux. Overall, there was medium-term weight gain of 0.61 BMI. OAGB to RYGB conversion leads to resolution of reflux symptoms. However, it is associated with weight regain, albeit this may be acceptable to patients to treat biliary reflux.

Journal article

Mitra A, 2024, Bone health following Paediatric and Adolescent Bariatric Surgery: A Systematic Review and Meta- analysis, EClinicalMedicine, ISSN: 2589-5370

Journal article

Qiu CS, Ashrafian H, 2024, Once a doctor, always a doctor., J R Soc Med, Vol: 117, Pages: 42-44

Journal article

Kovacevic L, Naik R, Lugo-Palacios DG, Ashrafian H, Mossialos E, Darzi Aet al., 2023, The impact of collaborative organisational models and general practice size on patient safety and quality of care in the English National Health Service: A systematic review., Health Policy, Vol: 138

Collaborative primary care has become an increasingly popular strategy to manage existing pressures on general practice. In England, the recent changes taking place in the primary care sector have included the formation of collaborative organisational models and a steady increase in practice size. The aim of this review was to summarise the available evidence on the impact of collaborative models and general practice size on patient safety and quality of care in England. We searched for quantitative and qualitative studies on the topic published between January 2010 and July 2023. The quality of articles was assessed using the Newcastle-Ottawa Scale and the Critical Appraisal Skills Programme checklist. We screened 6533 abstracts, with full-text screening performed on 76 records. A total of 29 articles were included in the review. 19 met the inclusion criteria following full-text screening, with seven identified through reverse citation searching and three through expert consultation. All studies were found to be of moderate or high quality. A predominantly positive impact on service delivery measures and patient-level outcomes was identified. Meanwhile, the evidence on the effect on pay-for-performance outcomes and hospital admissions is mixed, with continuity of care and access identified as a concern. While this review is limited to evidence from England, the findings provide insights for all health systems undergoing a transition towards collaborative primary care.

Journal article

Zhang J, gallifant J, pierce R, fordham A, teo J, celi L, Ashrafian H, Zhang Jet al., 2023, Quantifying digital health inequality across a national healthcare system, BMJ Health & Care Informatics, Vol: 30, ISSN: 2632-1009

Objectives Digital health inequality, observed as differential utilisation of digital tools between population groups, has not previously been quantified in the National Health Service (NHS). Deployment of universal digital health interventions, including a national smartphone app and online primary care services, allows measurement of digital inequality across a nation. We aimed to measure population factors associated with digital utilisation across 6356 primary care providers serving the population of England.Methods We used multivariable regression to test association of population and provider characteristics (including patient demographics, socioeconomic deprivation, disease burden, prescribing burden, geography and healthcare provider resource) with activation of two independent digital services during 2021/2022.Results We find a significant adjusted association between increased population deprivation and reduced digital utilisation across both interventions. Multivariable regression coefficients for most deprived quintiles correspond to 4.27 million patients across England where deprivation is associated with non-activation of the NHS App.Conclusion Results are concerning for technologically driven widening of healthcare inequalities. Targeted incentive to digital is necessary to prevent digital disparity from becoming health outcomes disparity.

Journal article

Che Bakri NA, Kwasnicki RM, Giannas E, Tenang L, Khan N, Moenig C, Imam Z, Dhillon K, Ashrafian H, Darzi A, Leff DRet al., 2023, ASO author reflections: objective outcome measure of upper limb function following axillary lymph node dissection and sentinel lymph node biopsy, Annals of Surgical Oncology, Vol: 30, Pages: 7133-7134, ISSN: 1068-9265

Journal article

Ashrafian H, 2023, Engineering a social contract: Rawlsian distributive justice through algorithmic game theory and artificial intelligence, AI and Ethics, Vol: 3, Pages: 1447-1454, ISSN: 2730-5953

<jats:title>Abstract</jats:title><jats:p>The potential for artificial intelligence algorithms and game theory concepts to offer prescriptive and decision-making capability for humankind is increasingly recognized. This derives from the increasing availability of granular, multivariable, well-curated data offering analytical insights for necessarily complex human behaviors and activities. Of the multitude of situations that this decision-making aptitude presents, the application to governmental policy offers a commanding case. This would allow decisions to be made for the benefit of societies and citizens based on rigorous objective information devoid of the traditional approach of choosing policies and societal values based on the opinion of a handful of selected representatives who may be exposed to a lack of comprehensive data analysis capacity and subject to personal biases. There would need to be a critical requirement of wider socially responsible data practices here, beyond those of technical considerations and the incorporation of wider societal fairness approaches. Amongst the schools of political thought particularly acquiescent to the application by this approach would be the egalitarian approach of John Rawls. Here an Original Position’s pre-determination tool of Veil of Ignorance and ensuing Difference Principal presents a method of distributive justice that can be clearly mathematically defined in economics theory through Wald’s Maximin principle. This offers an opportunity to apply algorithmic game theory and artificial intelligence computational approaches to implement Rawlsian distributive justice that are presented and discussed. The outputs from the algorithmic acquaintance of Rawlsian egalitarianism with applicable state data, protected with appropriate privacy, security, legal, ethical and social governance could in turn lead to automated direct governmental choices and an objective Social Contract for citizens

Journal article

Fehervari M, Fadel MG, Alghazawi LOK, Das B, Rodríguez-Luna MR, Perretta S, Wan A, Ashrafian Het al., 2023, Medium-Term Weight Loss and Remission of Comorbidities Following Endoscopic Sleeve Gastroplasty: a Systematic Review and Meta-analysis., Obes Surg, Vol: 33, Pages: 3527-3538

This systematic review and meta-analysis aimed to determine the short- and medium-term weight loss outcomes and comorbidity resolution following endoscopic sleeve gastroplasty. Our search identified 35 relevant studies containing data from 7525 patients. Overall, pooled short-term (12 months) total weight loss (TWL) was 16.2% (95% CI 13.1-19.4%) in 23 studies (n = 5659). Pooled medium-term TWL was 15.4% (95% CI 13.7-17.2%) in 10 studies (n = 4040). Diabetes resolution was 55.4% (95% CI 46-64%), hypertension resolution was 62.8% (95% CI 43-82%), dyslipidaemia resolution was 56.3% (95% CI 49-63%), and obstructive sleep apnoea resolution was 51.7% (95% CI 16.2-87.3%) in four studies (n = 480). This pooled analysis demonstrates that ESG can induce durable weight loss and resolution of obesity-associated comorbidities in patients with moderate obesity.

Journal article

Zhang J, Morley J, Gallifant J, Oddy C, Teo J, Ashrafian H, Delaney B, Darzi Aet al., 2023, Mapping and evaluating whole nation data flows: transparency, privacy, and guiding infrastructural transformation, The Lancet: Digital Health, Vol: 5, Pages: e737-e748, ISSN: 2589-7500

The importance of big health data is recognised worldwide. Most UK National Health Service (NHS) care interactions are recorded in electronic health records, resulting in an unmatched potential for population-level datasets. However, policy reviews have highlighted challenges from a complex data-sharing landscape relating to transparency, privacy, and analysis capabilities. In response, we used public information sources to map all electronic patient data flows across England, from providers to more than 460 subsequent academic, commercial, and public data consumers. Although NHS data support a global research ecosystem, we found that multistage data flow chains limit transparency and risk public trust, most data interactions do not fulfil recommended best practices for safe data access, and existing infrastructure produces aggregation of duplicate data assets, thus limiting diversity of data and added value to end users. We provide recommendations to support data infrastructure transformation and have produced a website (https://DataInsights.uk) to promote transparency and showcase NHS data assets.

Journal article

van Nijnatten TJA, Payne NR, Hickman SE, Ashrafian H, Gilbert FJet al., 2023, Overview of trials on artificial intelligence algorithms in breast cancer screening - A roadmap for international evaluation and implementation, EUROPEAN JOURNAL OF RADIOLOGY, Vol: 167, ISSN: 0720-048X

Journal article

Fehervari M, Fadel MG, Alghazawi LOK, Das B, Rodriguez-Luna MR, Perretta S, Wan A, Ashrafian Het al., 2023, Medium-Term Weight Loss and Remission of Comorbidities Following Endoscopic Sleeve Gastroplasty: a Systematic Review and Meta-analysis, OBESITY SURGERY, ISSN: 0960-8923

Journal article

Ashrafian H, 2023, Rheumatology hand signs in a Shepherd by Joachim Wtewael (1566-1638), RHEUMATOLOGY INTERNATIONAL, Vol: 43, Pages: 1765-1766, ISSN: 0172-8172

Journal article

Ashrafian H, 2023, Differential diagnosis of the periorbital lump on "Young Woman with Unicorn" (1505-1506) by Raphael (1483-1520), EUROPEAN JOURNAL OF OPHTHALMOLOGY, Vol: 33, Pages: NP144-NP145, ISSN: 1120-6721

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, Vol: 46, Pages: 1945-1946, ISSN: 0391-4097

Journal article

Che Bakri NA, Kwasnicki RMM, Giannas E, Tenang L, Khan N, Moenig C, Imam Z, Dhillon K, Ashrafian H, Darzi A, Leff DRRet al., 2023, ASO Visual Abstract: The Use of Wearable Activity Monitors to Measure the Upper Limb Physical Activity After Axillary Lymph Node Dissection and Sentinel Lymph Node Biopsy, ANNALS OF SURGICAL ONCOLOGY, ISSN: 1068-9265

Journal article

Zhang J, Ashrafian H, Delaney B, Darzi Aet al., 2023, Impact of primary to secondary care data sharing on care quality in NHS England hospitals, npj Digital Medicine, Vol: 6, Pages: 1-10, ISSN: 2398-6352

Health information exchange (HIE) is seen as a key component of effective care but remains poorly evidenced at a health system level. In the UK National Health Service (NHS), the ability to share primary care data with secondary care clinicians is a focus of continued digital investment. In this study, we report the evolution of interoperable technology across a period of rapid digital transformation in NHS England from 2015 to 2019, and test association of primary to secondary care data-sharing capabilities with clinical care quality indicators across all acute secondary care providers (n=135 NHS Trusts). In multivariable analyses, data-sharing capabilities are associated with reduction in patients breaching an Accident & Emergency (A&E) 4-hour decision time threshold, and better patient-reported experience of acute hospital care quality. Using synthetic control analyses, we estimate mean 2.271% (STD+/-3.371) absolute reduction in A&E 4-hour decision time breach, 12 months following introduction of data-sharing capabilities. Our findings support current digital transformation programs for developing regional HIE networks but highlight the need to focus on implementation factors in addition to technological procurement.

Journal article

Li E, Lounsbury O, Clarke J, Ashrafian H, Darzi A, Neves ALet al., 2023, Perceptions of chief clinical information officers on the state of electronic health records systems interoperability in NHS England: a qualitative interview study, BMC Medical Informatics and Decision Making, Vol: 23, Pages: 1-15, ISSN: 1472-6947

BackgroundIn the era of electronic health records (EHR), the ability to share clinical data is a key facilitator of healthcare delivery. Since the introduction of EHRs, this aspect has been extensively studied from the perspective of healthcare providers. Less often explored are the day-to-day challenges surrounding the procurement, deployment, maintenance, and use of interoperable EHR systems, from the perspective of healthcare administrators, such as chief clinical information officers (CCIOs).ObjectiveOur study aims to capture the perceptions of CCIOs on the current state of EHR interoperability in the NHS, its impact on patient safety, the perceived facilitators and barriers to improving EHR interoperability, and what the future of EHR development in the NHS may entail.MethodsSemi-structured interviews were conducted between November 2020 – October 2021. Convenience sampling was employed to recruit NHS England CCIOs. Interviews were digitally recorded and transcribed verbatim. A thematic analysis was performed by two independent researchers to identify emerging themes.ResultsFifteen CCIOs participated in the study. Participants reported that limited EHR interoperability contributed to the inability to easily access and transfer data into a unified source, thus resulting in data fragmentation. The resulting lack of clarity on patients' health status negatively impacts patient safety through suboptimal care coordination, duplication of efforts, and more defensive practice. Facilitators to improving interoperability included the recognition of the need by clinicians, patient expectations, and the inherent centralised nature of the NHS. Barriers included systems usability difficulties, and institutional, data management, and financial-related challenges. Looking ahead, participants acknowledged that realising that vision across the NHS would require a renewed focus on mandating data standards, user-centred design, greater patient involvement, and encouraging i

Journal article

Fadel MG, Fehervari M, Das B, Soleimani-Nouri P, Ashrafian Het al., 2023, Vagal nerve therapy in the management of obesity: a systematic review and metaanalysis, EUROPEAN SURGICAL RESEARCH, ISSN: 0014-312X

Journal article

Che Bakri NA, Kwasnicki R, Giannas E, Tenang L, Khan N, Moenig C, Imam Z, Dhillon K, Ashrafian H, Darzi A, Leff Det al., 2023, The Use of Wearable Activity Monitors to Measure the Upper Limb Physical Activity after Axillary Lymph Node Dissection and Sentinel Lymph Node Biopsy, Annals of Surgical Oncology, ISSN: 1068-9265

Journal article

Danielli S, Ashrafian H, Darzi A, 2023, Healthy city: global systematic scoping review of city initiatives to improve health with policy recommendations, BMC Public Health, Vol: 23, Pages: 1-15, ISSN: 1471-2458

BackgroundGlobal health will increasingly be determined by cities. Currently over half of the world’s population, over 4 billion people, live in cities. This systematic scoping review has been conducted to understand what cities are doing to improve health and healthcare for their populations.MethodsWe conducted a systematic search to identify literature on city-wide initiatives to improve health. The study was conducted in accordance with PRISMA and the protocol was registered with PROSPERO (CRD42020166210).ResultsThe search identified 42,137 original citations, yielding 1,614 papers across 227 cities meeting the inclusion criteria. The results show that the majority of initiatives were targeted at non-communicable diseases. City health departments are making an increasing contribution; however the role of mayors appears to be limited.ConclusionThe collective body of evidence identified in this review, built up over the last 130 years, has hitherto been poorly documented and characterised. Cities are a meta-system with population health dictated by multiple interactions and multidirectional feedback loops. Improving health in cities requires multiple actions, by multiple actors, at every level. The authors use the term ‘The Vital 5’. They are the five most important health risk factors; tobacco use; harmful alcohol use; physical-inactivity, unhealthy diet and planetary health. These ‘Vital 5’ are most concentrated in deprived areas and show the greatest increase in low and middle income countries. Every city should develop a comprehensive strategy and action plan to address these ‘Vital 5’.

Journal article

Lawrance E, Thompson R, Roberts L, Grailey K, Ashrafian H, Maheswaran H, Toledano M, Darzi Aet al., 2023, Ambient temperature and mental health: a systematic review and meta analysis, The Lancet Planetary Health, Vol: 7, Pages: e580-e589, ISSN: 2542-5196

BackgroundIncreasing evidence indicates that ambient outdoor temperature could affect mental health, which is especially concerning in the context of climate change. We aimed to comprehensively analyse the current evidence regarding the associations between ambient temperature and mental health outcomes.MethodsWe did a systematic review and meta-analysis of the evidence regarding associations between ambient outdoor temperature and changes in mental health outcomes. We searched WebOfScience, Embase, PsychINFO, and PubMed for articles published from database origin up to April 7, 2022. Eligible articles were epidemiological, observational studies in humans of all ages, which evaluated real-world responses to ambient outdoor temperature, and had mental health as a documented outcome; studies of manipulated or controlled temperature or those with only physical health outcomes were excluded. All eligible studies were synthesised qualitatively. If three or more studies reported the same or equivalent effect statistics and if they had equivalent exposure, outcome, and metrics, the studies were pooled in a random-effects meta-analysis. The risk of bias for individual studies was assessed using the Newcastle-Ottawa Scale. The quality of evidence across studies was assessed using the Office of Health Assessment and Translation (OHAT) approach.Findings114 studies were included in the systematic review, of which 19 were suitable for meta-analysis. Three meta-analyses were conducted for suicide outcomes: a 1°C increase in mean monthly temperature was associated with an increase in incidence of 1·5% (95% CI 0·8–2·2, p<0·001; n=1 563 109, seven effects pooled from three studies); a 1°C increase in mean daily temperature was associated with an increase in incidence of 1·7% (0·3–3·0, p=0·014; n=113 523, five effects pooled from five studies); and a 1°C increase in mean monthly temperature was associa

Journal article

Higginson JA, Breik O, Thompson AH, Ashrafian H, Hardman JC, Takats Z, Paleri V, Dhanda Jet al., 2023, Diagnostic accuracy of intraoperative margin assessment techniques in surgery for head and neck squamous cell carcinoma: a meta-analysis, Oral Oncology, Vol: 142, Pages: 1-13, ISSN: 1368-8375

BACKGROUND: Positive margins following head and neck squamous cell carcinoma (HNSCC) surgery lead to significant morbidity and mortality. Existing Intraoperative Margin Assessment (IMA) techniques are not widely used due to limitations in sampling technique, time constraints and resource requirements. We performed a meta-analysis of the diagnostic performance of existing IMA techniques in HNSCC, providing a benchmark against which emerging techniques may be judged. METHODS: The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Studies were included if they reported diagnostic metrics of techniques used during HNSCC surgery, compared with permanent histopathology. Screening, manuscript review and data extraction was performed by multiple independent observers. Pooled sensitivity and specificity were estimated using the bivariate random effects model. RESULTS: From an initial 2344 references, 35 studies were included for meta-analysis. Sensitivity (Sens), specificity (Spec), diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUROC) were calculated for each group (n, Sens, Spec, DOR, AUROC): frozen section = 13, 0.798, 0.991, 309.8, 0.976; tumour-targeted fluorescence (TTF) = 5, 0.957, 0.827, 66.4, 0.944; optical techniques = 10, 0.919, 0.855, 58.9, 0.925; touch imprint cytology = 3, 0.925, 0.988, 51.1, 0.919; topical staining = 4, 0.918, 0.759, 16.4, 0.833. CONCLUSIONS: Frozen section and TTF had the best diagnostic performance. Frozen section is limited by sampling error. TTF shows promise but involves administration of a systemic agent. Neither is currently in widespread clinical use. Emerging techniques must demonstrate competitive diagnostic accuracy whilst allowing rapid, reliable, cost-effective results.

Journal article

Alghazawi L, Fadel MG, Chen JY, Sargsyan N, Das B, Robb H, Ashrafian H, Fehervari Met al., 2023, Educational Values of Laparoscopic Sleeve Gastrectomy Videos; A Quality Review of Both Academic and Commercial Platforms, Publisher: SPRINGER, Pages: S57-S57, ISSN: 0960-8923

Conference paper

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