Imperial College London

Dr Melody Zhifang Ni

Faculty of MedicineDepartment of Surgery & Cancer

Senior Research Fellow
 
 
 
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Contact

 

+44 (0)20 3312 7657z.ni

 
 
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Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

94 results found

Tase A, Buckle P, Ni MZ, Hanna GBet al., 2024, Usability of home use medical technology: The patient perspective, Journal of Patient Safety and Risk Management, ISSN: 2516-0435

Introduction: Technological advancements have increased the scope and range of home-use medical devices. These have allowed development of care at home. This requires appropriate understanding of patient's needs with regards to such devices for safe use of medical technology at home and minimise usability errors. This study sought to investigate patient experiences of usability and to identify future requirements for such devices Methods: A qualitative mixed methods study was chosen. The participants were asked to complete a survey which included both multiple-choice and free-text entry questions. Participant recruitment was through purposive and snowball sampling approaches. All participants were required to have direct experience in using a medical device. Data were thematically analysed. Results: There were 360 responses by patients, parents and carers. 503 devices were used by these participants. 99.4% used their device(s) on a daily basis. The largest group of responders were from type 1 diabetic patients. Multiple usability challenges were reported with respect to training, device interoperability, development of workarounds and the device-user interfaces. Device acceptance and their costs were also raised as issues for concern. A list of usability challenges was compiled. Conclusions: Patients and other end users continue to experience multiple usability challenges in the use of medical devices at home despite guidance from regulatory bodies. Better post market studies are required to generate evidence to enable the improved design and safety of the device. This should be accompanied with an evaluation of improvements in patient satisfaction and their compliance with monitoring and treatment.

Journal article

Savva K-V, Kawka M, Vadhwana B, Penumaka R, Patton I, Khan K, Perrott C, Das S, Giot M, Mavroveli S, Hanna GB, Ni MZ, Peters CJet al., 2023, The Biomarker Toolkit - an evidence-based guideline to predict cancer biomarker success and guide development, BMC Medicine, Vol: 21, ISSN: 1741-7015

BACKGROUND: An increased number of resources are allocated on cancer biomarker discovery, but very few of these biomarkers are clinically adopted. To bridge the gap between Biomarker discovery and clinical use, we aim to generate the Biomarker Toolkit, a tool designed to identify clinically promising biomarkers and promote successful biomarker translation. METHODS: All features associated with a clinically useful biomarker were identified using mixed-methodology, including systematic literature search, semi-structured interviews, and an online two-stage Delphi-Survey. Validation of the checklist was achieved by independent systematic literature searches using keywords/subheadings related to clinically and non-clinically utilised breast and colorectal cancer biomarkers. Composite aggregated scores were generated for each selected publication based on the presence/absence of an attribute listed in the Biomarker Toolkit checklist. RESULTS: Systematic literature search identified 129 attributes associated with a clinically useful biomarker. These were grouped in four main categories including: rationale, clinical utility, analytical validity, and clinical validity. This checklist was subsequently developed using semi-structured interviews with biomarker experts (n=34); and 88.23% agreement was achieved regarding the identified attributes, via the Delphi survey (consensus level:75%, n=51). Quantitative validation was completed using clinically and non-clinically implemented breast and colorectal cancer biomarkers. Cox-regression analysis suggested that total score is a significant driver of biomarker success in both cancer types (BC: p>0.0001, 95.0% CI: 0.869-0.935, CRC: p>0.0001, 95.0% CI: 0.918-0.954). CONCLUSIONS: This novel study generated a validated checklist with literature-reported attributes linked with successful biomarker implementation. Ultimately, the application of this toolkit can be used to detect biomarkers with the highest clinical

Journal article

Di Bidino R, Piaggio D, Andellini M, Merino-Barbancho B, Lopez-Perez L, Zhu T, Raza Z, Ni M, Morrison A, Borsci S, Fico G, Pecchia L, Iadanza Eet al., 2023, Scoping Meta-Review of Methods Used to Assess Artificial Intelligence-Based Medical Devices for Heart Failure., Bioengineering (Basel), Vol: 10, ISSN: 2306-5354

Artificial intelligence and machine learning (AI/ML) are playing increasingly important roles, permeating the field of medical devices (MDs). This rapid progress has not yet been matched by the Health Technology Assessment (HTA) process, which still needs to define a common methodology for assessing AI/ML-based MDs. To collect existing evidence from the literature about the methods used to assess AI-based MDs, with a specific focus on those used for the management of heart failure (HF), the International Federation of Medical and Biological Engineering (IFMBE) conducted a scoping meta-review. This manuscript presents the results of this search, which covered the period from January 1974 to October 2022. After careful independent screening, 21 reviews, mainly conducted in North America and Europe, were retained and included. Among the findings were that deep learning is the most commonly utilised method and that electronic health records and registries are among the most prevalent sources of data for AI/ML algorithms. Out of the 21 included reviews, 19 focused on risk prediction and/or the early diagnosis of HF. Furthermore, 10 reviews provided evidence of the impact on the incidence/progression of HF, and 13 on the length of stay. From an HTA perspective, the main areas requiring improvement are the quality assessment of studies on AI/ML (included in 11 out of 21 reviews) and their data sources, as well as the definition of the criteria used to assess the selection of the most appropriate AI/ML algorithm.

Journal article

Manetti S, Lettieri E, Ni M, 2023, Development of Medical Device Key Evidence Tool ('MEDKET'): an evidence-based framework to explain success in selected European and US companies, PLoS One, Vol: 18, ISSN: 1932-6203

Innovating in Medical Device (MD) industry is challenging. This study aims to develop and validate an evidence-based framework that helps innovators of small and large enterprises (SEs and LEs) assess their readiness for successful MD development and deployment. We conducted a key-informant process (stage 1) where 25 international experts identified a list of emergent Health Technology Assessment (HTA) themes they believed were essential to company success. A sample of 22 European and US selected companies (13 SEs and 9 LEs) then reached a consensus on a list of key themes through a robust Delphi process (stage 2). Finally, we constructed (stage 3) and validated (stage 4) the checklist for SEs and LEs. The checklist for SEs and LEs included 21 and 15 items (i.e., fundamental Yes/No questions) with nine overlapping criteria for both SEs and LEs. In both groups, MD success was driven by three major item categories: (i) R&D assessment strategy; (ii) device-outcome measures; (iii) company profiling. Alongside the retrospective validation study, we collected 40 case studies on MDs (23 successes and 17 failures) across the selected enterprises. The retrospective validation provided the proportion of successful and failed case studies that met the ’MeDKET’ criteria. We discovered that early HTA plays a pivotal role in MD industry success with different implications based on enterprise size. This study is the first of its kind to provide a holistic picture of the perceived role of early-stage HTA in MD industry success.

Journal article

Banerjee J, McLister A, Gourin B, McClure Z, Mariampillai K, Boyle RJ, Hanna GB, Ni MZet al., 2023, Tributyrin ester-impregnated pH strips for confirming neonatal feeding tube placement: a diagnostic test accuracy study, Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol: 108, Pages: 433-434, ISSN: 1359-2998

Journal article

Talaya BZZ, Moorthy K, Savva K, Ni Met al., 2023, A health economic model to assess the impact of prehabilitation on hospital cost savings in gastrointestinal cancer, modelled on English National Health Service tariff., Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO), Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0732-183X

Conference paper

Tase A, Micocci M, Buckle P, Ni M, Hanna Get al., 2023, Pathway map development for medical device event reporting in operating theatres: a human factors approach to improving the existing system, BMJ Surgery, Interventions, & Health Technologies, Vol: 5, ISSN: 2631-4940

OBJECTIVES: This study aimed to develop the actual pathway to reporting and information transfer in operating theatres in relation to medical technology malfunction/failure. This with the aim of understanding the differences with the pathway published by NHS Improvement and identification of points for improvement. DESIGN: This is a qualitative study involving stakeholder interviews with doctors, nurses, manufacturers, medical device safety officer and Medicines and Healthcare products Regulatory Agency. SETTING: Data were collected on reporting pathway used in operating theatres. Clinical staff who took part worked in different trusts throughout UK while manufacturers provided devices in UK and EU/USA. PARTICIPANTS: Semistructured interviews were completed with 15 clinicians and 13 manufacturers. Surveys were completed by 38 clinicians and 5 manufacturers. Recognised methods of pathway development were used. The Lean Six Sigma principles adapted to healthcare were used to develop suggestions for improvement. MAIN OUTCOME MEASURES: To identify the differences between the set pathway to reporting and information transfer to what is occurring on a day-to-day basis as reported by staff. Identify points in the pathway where improvements could be applied. RESULTS: The developed pathway demonstrated great complexity of the current reporting system for medical devices. It identified numerous areas that give rise to problems and multiple biases in decision making. This highlighted the core issues leading to under-reporting and lack of knowledge on device performance and patient risk. Suggestions for improvement were deduced based on end user requirements and identified problems. CONCLUSIONS: This study has provided a detailed understanding of the key problem areas that exist within the current reporting system for medical devices and technology. The developed pathway sets to address the key problems to improve reporting outcomes. The identification of pathway differences be

Journal article

Sherman T, Rodrigues IAS, Goyal S, Alaghband P, Bloom P, Barton K, Jayaram H, Abu-Bakra M, Ni M, Lim KS, Writing Committee for the CONCEPT Study Writing Groupet al., 2023, Comparing the Effectiveness of Phacoemulsification + Endoscopic Cyclophotocoagulation Laser versus Phacoemulsification Alone for the Treatment of Primary Open Angle Glaucoma in Patients with Cataract (CONCEPT): Study Methodology., Ophthalmol Glaucoma, Vol: 6, Pages: 474-479

OBJECTIVE: To describe the methodology of the Comparing the Effectiveness of Phacoemulsification + Endoscopic Cyclophotocoagulation Laser and Phacoemulsification Alone for the Treatment of Primary Open Angle Glaucoma in Patients with Cataract (CONCEPT) study, a randomized controlled trial. DESIGN: Double-masked, randomized controlled trial. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Participants will be recruited from 5 United Kingdom-based centers. One hundred and sixty eyes with a diagnosis of primary open-angle glaucoma and visually significant cataract will be included. Eighty eyes will be randomized to undergo cataract surgery alone and eighty to undergo cataract surgery with endoscopic cyclophotocoagulation (ECP). METHODS: The baseline diurnal washout intraocular pressure (IOP) will be measured. The participants will be randomized to undergo cataract surgery alone or cataract surgery with ECP upon completion of uncomplicated cataract surgery. At the 1- and 2-year post surgery follow-up visits, the measurements of washout diurnal IOP will be repeated. MAIN OUTCOME MEASURES: Diurnal washout IOP, use of glaucoma medications, and adverse events. CONCLUSIONS: We described the methodology of the first randomized controlled trial comparing cataract surgery alone with cataract surgery combined with ECP in the context of patients with primary open-angle glaucoma and symptomatic cataract. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Journal article

Chana P, Ni MZ, Moore J, Baker C, Kelly M, Davies A, Gossage Jet al., 2022, A Review of Minimally Invasive Oesophagogastric Cancer Surgery in a High-Volume UK Unit, AUGIS Annual Scientific Meeting, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323

Conference paper

Ni M, Mackenzie H, Talaya ZMB, Miskovic D, Wyles S, Coleman M, Hanna Get al., 2022, IS THE NATIONAL TRAINING PROGRAMME FOR LAPAROSCOPIC COLORECTAL SURGERY (LAPCO) VALUE FOR MONEY?, Publisher: ELSEVIER SCIENCE INC, Pages: S273-S273, ISSN: 1098-3015

Conference paper

Nwankwo L, Donovan J, Ni M, Loebinger M, Armstrong-James D, Shah Aet al., 2022, Evaluation of remote triazole capillary blood testing to facilitate remote therapeutic drug monitoring (TDM): A validation study, Publisher: OXFORD UNIV PRESS, Pages: 257-259, ISSN: 1369-3786

Conference paper

Hanna GB, Mackenzie H, Miskovic D, Ni M, Wyles S, Aylin P, Parvaiz A, Cecil T, Gudgeon A, Griffith J, Robinson JM, Selvasekar C, Rockall T, Acheson A, Maxwell-Armstrong C, Jenkins JT, Horgan A, Cunningham C, Lindsay I, Arulampalam T, Motson RW, Francis NK, Kennedy RH, Coleman MG, Lapco programet al., 2022, Laparoscopic colorectal surgery outcomes improved after national training program (LAPCO) for specialists in England, Annals of Surgery, Vol: 275, Pages: 1149-1155, ISSN: 0003-4932

OBJECTIVE: To examine the impact of The National Training Programme for Laparoscopic Colorectal Surgery (Lapco) on the rate of laparoscopic surgery and clinical outcomes of cases performed by Lapco surgeons after completion of training. SUMMERY BACKGROUND DATA: Lapco provided competency-based supervised clinical training for specialist colorectal surgeons in England. METHODS: We compared the rate of laparoscopic surgery, mortality and morbidity for colorectal cancer resections by Lapco delegates and non-Lapco surgeons in 3-year periods preceding and following Lapco using difference in differences analysis. The changes in the rate of post-Lapco laparoscopic surgery with the Lapco sign-off competency assessment and in-training global assessment scores were examined using risk-adjusted cumulative sum to determine their predictive clinical validity with predefined competent scores of 3 and 5 respectively. RESULTS: 108 Lapco delegates performed 4586 elective colorectal resections pre-Lapco and 5115 post-Lapco while non-Lapco surgeons performed 72930 matched cases. Lapco delegates had a 37.8% increase in laparoscopic surgery which was greater than non-Lapco surgeons by 20.9% (95% CI, 18.5 to 23.3, p<0.001) with a relative decrease in 30-day mortality by -1.6% (95% CI, -3.4 to -0.2, p = 0.039) and 90-day mortality by -2.3% (95% CI, -4.3 to -0.4, p = 0.018). The change point of risk-adjusted cumulative sum was 3.12 for competency assessment tool and 4.74 for global assessment score whereas laparoscopic rate increased from 44% to 66% and 40% to 56% respectively. CONCLUSIONS: Lapco increased the rate of laparoscopic colorectal cancer surgery and reduced mortality and morbidity in England. In-training competency assessment tools predicted clinical performance after training.

Journal article

Tase A, Ni MZ, Buckle PW, Hanna GBet al., 2022, Current status of medical device malfunction reporting: using end user experience to identify current problems, BMJ OPEN QUALITY, Vol: 11

Journal article

Ni M, Adam ME, Akbar F, Huddy JR, Borsci S, Buckle P, Rubulotta F, Carr R, Fotheringham I, Wilson C, Tsang M, Harding S, White N, Hanna GBet al., 2021, Development and validation of ester impregnated pH strips for locating nasogastric feeding tubes in the stomach-a multicentre prospective diagnostic performance study., Diagnostic and Prognostic Research, Vol: 5, Pages: 1-10, ISSN: 2397-7523

BACKGROUND: NG (nasogastric) tubes are used worldwide as a means to provide enteral nutrition. Testing the pH of tube aspirates prior to feeding is commonly used to verify tube location before feeding or medication. A pH at or lower than 5.5 was taken as evidence for stomach intubation. However, the existing standard pH strips lack sensitivity, especially in patients receiving feeding and antacids medication. We developed and validated a first-generation ester-impregnated pH strip test to improve the accuracy towards gastric placements in adult population receiving routine NG-tube feeding. The sensitivity was improved by its augmentation with the action of human gastric lipase (HGL), an enzyme specific to the stomach. METHODS: We carried out a multi-centred, prospective, two-gate diagnostic accuracy study on patients who require routine NG-tube feeding in 10 NHS hospitals comparing the sensitivity of the novel pH strip to the standard pH test, using either chest X-rays or, in its absence, clinical observation of the absence of adverse events as the reference standard. We also tested the novel pH strips in lung aspirates from patients undergoing oesophageal cancer surgeries using visual inspection as the reference standard. We simulated health economics using a decision analytic model and carried out adoption studies to understand its route to commercialisation. The primary end point is the sensitivity of novel and standard pH tests at the recommended pH cut-off of 5.5. RESULTS: A total of 6400 ester-impregnated pH strips were prepared based on an ISO13485 quality management system. A total of 376 gastric samples were collected from adult patients in 10 NHS hospitals who were receiving routine NG-tube feeding. The sensitivities of the standard and novel pH tests were respectively 49.2% (95% CI 44.1‑54.3%) and 70.2% (95% CI 65.6‑74.8%) under pH cut-off of 5.5 and the novel test has a lung specificity of 89.5% (95% CI 79.6%, 99.4%). Our simulation showed that using the

Journal article

Di Paolo M, Hewitt L, Nwankwo E, Ni M, Vidal-Diaz A, Fisher MC, Armstrong-James D, Shah Aet al., 2021, Erratum to: A retrospective 'real-world' cohort study of azole therapeutic drug monitoring and evolution of antifungal resistance in cystic fibrosis., JAC Antimicrob Resist, Vol: 3

[This corrects the article DOI: 10.1093/jacamr/dlab026.].

Journal article

Di Paolo M, Hewitt L, Nwankwo E, Ni M, Vidal-Diaz A, Fisher MC, Armstrong-James D, Shah Aet al., 2021, A retrospective 'real-world' cohort study of azole therapeutic drug monitoring and evolution of antifungal resistance in cystic fibrosis (vol 12, dlab086, 2021), JAC-ANTIMICROBIAL RESISTANCE, Vol: 3

Journal article

Nwankwo L, McLaren K, Donovan J, Ni Z, Vidal-Diaz A, Loebinger M, Morrisey A, Igra A, Shah Aet al., 2021, Utilisation of remote capillary blood testing in an outpatient clinic setting to improve shared decision making and patient and clinician experience: a validation and pilot study, BMJ Open Quality, Vol: 10, Pages: 1-11, ISSN: 2399-6641

Background In a tertiary respiratory centre, large cohorts of patients are managed in an outpatient setting and require blood tests to monitor disease activity and organ toxicity. This requires either visits to tertiary centres for phlebotomy and physician review or utilisation of primary care services.Objectives This study aims to validate remote capillary blood testing in an outpatient setting and analyse impact on clinical pathways.Methods A single-centre prospective cross-sectional validation and parallel observational study was performed. Remote finger prick capillary blood testing was validated compared with local standard venesection using comparative statistical analysis: paired t-test, correlation and Bland-Altman. Capillary was considered interchangeable with venous samples if all three criteria were met: non-significant paired t-test (ie, p>0.05), Pearson’s correlation coefficient (r)>0.8% and 95% of tests within 10% difference through Bland-Altman (limits of agreement). In parallel, current clinical pathways including phlebotomy practice were analysed over 4 weeks to review test predictability. A subsequent pilot cohort study analysed potential impact of remote capillary blood sampling on shared decision making. A final implementation phase ensued to embed the service into clinical pathways within the institution.Results 117 paired capillary and venous blood samples were prospectively analysed. Interchangeability with venous blood was seen with glycated haemoglobin (%), total protein and C reactive protein. Further tests, although not interchangeable, are likely useful to enable longitudinal remote monitoring (eg, liver function and total IgE). 65% of outpatient clinic blood tests were predictable with 16% of patients requiring further follow-up. Patient and clinician-reported improvement in shared decision making given contemporaneous blood test results was observed.Conclusions Remote capillary blood sampling can be used accurately fo

Journal article

Klevebro F, Boshier PR, Savva K, Waller A, Hage L, Ni M, Hanna GB, Low DEet al., 2021, Severe Dumping Symptoms Are Uncommon Following Transthoracic Esophagectomy But Significantly Decrease Health-Related Quality of Life in Long-Term, Disease-Free Survivors, JOURNAL OF GASTROINTESTINAL SURGERY, Vol: 25, Pages: 1941-1947, ISSN: 1091-255X

Journal article

Tase A, Buckle P, Ni MZ, Hanna GBet al., 2021, Medical device error and failure reporting: Learning from the car industry, Journal of Patient Safety and Risk Management, Vol: 26, Pages: 135-141, ISSN: 2516-0435

BackgroundImproving the design of technology relies in part, on the reporting of performance failures in existing devices. Healthcare has low levels of formal reporting of performance and failure of medical equipment. This paper examines methods of reporting in the car industry and healthcare and aims to understand differences and identify opportunities for improvement within healthcare.MethodsA literature search was carried out in Pubmed, Medline, Embase, Engineering Village, Scopus. NHS England and MHRA publications and guidelines were also reviewed. Focus was placed on the current system of reporting in both industries, known degree of patient harm, initiating factors, barriers, quality and methods of incident investigation and their validity. The findings were used to compare error reporting system in the two industries.ResultsDerivation of healthcare incident data from different sources means the full extent of patient harm is not known. For example, in 2012 there were 13,549 and 38,395 incidents reported by MHRA and NRLS (National Reporting and Learning System) respectively leading to uncertainties on the extent of the problem. The car industry emphasises the role of reporting source in ensuring data quality. Utilising some aspects of this approach might benefit healthcare reporting. These include a specific reporting system that stresses the importance of organisational learning in improving safety and recognises the limitations of root cause analysis.ConclusionsLearning from reporting systems within the car industry may help the healthcare sector improve its own reporting, aiding healthcare performance.

Journal article

Huddy JR, Ni MZ, Barlow J, Hanna GBet al., 2021, Qualitative analysis of stakeholder interviews to identify the barriers and facilitators to the adoption of point-of-care diagnostic tests in the UK., BMJ Open, Vol: 11, Pages: 1-9, ISSN: 2044-6055

OBJECTIVES: This study investigated the barriers and facilitators to the adoption of point-of-care tests (POCTs). DESIGN: Qualitative study incorporating a constant comparative analysis of stakeholder responses to a series of interviews undertaken to design the Point-of-Care Key Evidence Tool. SETTING: The study was conducted in relation to POCTs used in all aspects of healthcare. PARTICIPANTS: Forty-three stakeholders were interviewed including clinicians (incorporating laboratory staff and members of trust POCT committees), commissioners, industry, regulators and patients. RESULTS: Thematic analysis highlighted 32 barriers in six themes and 28 facilitators in eight themes to the adoption of POCTs. Six themes were common to both barriers and facilitators (clinical, cultural, evidence, design and quality assurance, financial and organisational) and two themes contained facilitators alone (patient factors and other (non-financial) resource use). CONCLUSIONS: Findings from this study demonstrate the complex motivations of stakeholders in the adoption of POCT. Most themes were common to both barriers and facilitators suggesting that good device design, stakeholder engagement and appropriate evidence provision can increase the likelihood of a POCT device adoption. However, it is important to realise that while the majority of identified barriers may be perceived or mitigated some may be absolute and if identified early in device development further investment should be carefully considered.

Journal article

Nwankwo L, McLaren K, Donovan J, Ni MZ, Vidal-Diaz A, Loebinger M, Shah Aet al., 2020, Utilisation of Remote Capillary Blood Testing in an Outpatient Clinic Setting to improve shared decision making and patient and clinician experience: a validation and pilot study, Publisher: Cold Spring Harbor Laboratory

<jats:p>Background In a tertiary respiratory centre, large cohorts of patients are managed in an outpatient setting and require blood tests to monitor disease activity and organ toxicity. This requires either visits to tertiary centres for phlebotomy and physician review or utilisation of primary care services.Objectives This study aims to validate remote capillary blood testing in an outpatient setting and analyse impact on clinical pathways.MethodsA single-centre prospective cross-sectional validation and parallel observational study was performed. Remote finger prick capillary blood testing was validated compared to local standard venesection using comparative statistical analysis: paired t-test, correlation and Bland-Altman. Capillary was considered interchangeable with venous samples if all 3 criteria were met: non-significant paired t-test (i.e. p&gt;0.05), Pearson's correlation coefficient (r) &gt;0.8 and 95% of tests within 10% difference through Bland-Altman (Limits of agreement). In parallel, current clinical pathways including phlebotomy practice was analysed over 4 weeks to review test predictability. A subsequent pilot cohort study analysed potential impact of remote capillary blood sampling on shared decision making and outpatient clinical pathways. Results117 paired capillary and venous blood samples were prospectively analysed. Interchangeability with venous blood was seen with HbA1c (%), total protein and CRP. Further tests, although not interchangeable, are likely useful to enable longitudinal remote monitoring (e.g. liver function, total IgE, and vitamin D). 65% of outpatient clinic blood tests were predictable with 16% of patients requiring further contact due to actions required. Pilot implementation of remote capillary sampling showed patient and clinician-reported improvement in shared decision-making given contemporaneous blood test results.ConclusionsRemote capillary blood sampling can be used accurately for specific tests t

Working paper

Vijayasingam A, Frost E, Wilkins J, Gillen L, Premachandra P, Mclaren K, Gilmartin D, Picinali L, Vidal-Diez A, Borsci S, Ni MZ, Tang WY, Morris-Rosendahl D, Harcourt J, Elston C, Simmonds NJ, Shah Aet al., 2020, Tablet and web-based audiometry to screen for hearing loss in adults with cystic fibrosis, Thorax, Vol: 75, Pages: 632-639, ISSN: 0040-6376

INTRODUCTION: Individuals with chronic lung disease (eg, cystic fibrosis (CF)) often receive antimicrobial therapy including aminoglycosides resulting in ototoxicity. Extended high-frequency audiometry has increased sensitivity for ototoxicity detection, but diagnostic audiometry in a sound-booth is costly, time-consuming and requires a trained audiologist. This cross-sectional study analysed tablet-based audiometry (Shoebox MD) performed by non-audiologists in an outpatient setting, alongside home web-based audiometry (3D Tune-In) to screen for hearing loss in adults with CF. METHODS: Hearing was analysed in 126 CF adults using validated questionnaires, a web self-hearing test (0.5 to 4 kHz), tablet (0.25 to 12 kHz) and sound-booth audiometry (0.25 to 12 kHz). A threshold of ≥25 dB hearing loss at ≥1 audiometric frequency was considered abnormal. Demographics and mitochondrial DNA sequencing were used to analyse risk factors, and accuracy and usability of hearing tests determined. RESULTS: Prevalence of hearing loss within any frequency band tested was 48%. Multivariate analysis showed age (OR 1.127; (95% CI: 1.07 to 1.18; p value<0.0001) per year older) and total intravenous antibiotic days over 10 years (OR 1.006; (95% CI: 1.002 to 1.010; p value=0.004) per further intravenous day) were significantly associated with increased risk of hearing loss. Tablet audiometry had good usability, was 93% sensitive, 88% specific with 94% negative predictive value to screen for hearing loss compared with web self-test audiometry and questionnaires which had poor sensitivity (17% and 13%, respectively). Intraclass correlation (ICC) of tablet versus sound-booth audiometry showed high correlation (ICC >0.9) at all frequencies ≥4 kHz. CONCLUSIONS: Adults with CF have a high prevalence of drug-related hearing loss and tablet-based audiometry can be a practical, accurate screening tool within integrated ototoxicity monitoring programmes for early detection.

Journal article

Markar SR, Ni M, Gisbertz SS, van der Werf L, Straatman J, van der Peet D, Cuesta MA, Hanna GB, van Berge Henegouwen MIet al., 2020, Implementation of Minimally Invasive Esophagectomy From a Randomized Controlled Trial Setting to National Practice, JOURNAL OF CLINICAL ONCOLOGY, Vol: 38, Pages: 2130-+, ISSN: 0732-183X

Journal article

Markar SR, Ni M, Mackenzie H, Penna M, Faiz O, Hanna GBet al., 2020, The effect of time between procedures upon the proficiency gain period for minimally invasive esophagectomy, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 34, Pages: 2703-2708, ISSN: 0930-2794

Journal article

Harris A, Butterworth J, Boshier PR, MacKenzie H, Tokunaga M, Sunagawa H, Mavroveli S, Ni M, Mikhail S, Yeh C-C, Blencowe NS, Avery KNL, Hardwick R, Hoelscher A, Pera M, Zaninotto G, Law S, Low DE, van Lanschot JJB, Berrisford R, Barham CP, Blazeby JM, Hanna GBet al., 2020, Development of a Reliable Surgical Quality Assurance System for 2-stage Esophagectomy in Randomized Controlled Trials., Ann Surg

OBJECTIVE: The aim was to develop a reliable surgical quality assurance system for 2-stage esophagectomy. This development was conducted during the pilot phase of the multicenter ROMIO trial, collaborating with international experts. SUMMARY OF BACKGROUND DATA: There is evidence that the quality of surgical performance in randomized controlled trials influences clinical outcomes, quality of lymphadenectomy and loco-regional recurrence. METHODS: Standardization of 2-stage esophagectomy was based on structured observations, semi-structured interviews, hierarchical task analysis, and a Delphi consensus process. This standardization provided the structure for the operation manual and video and photographic assessment tools. Reliability was examined using generalizability theory. RESULTS: Hierarchical task analysis for 2-stage esophagectomy comprised fifty-four steps. Consensus (75%) agreement was reached on thirty-nine steps, whereas fifteen steps had a majority decision. An operation manual and record were created. A thirty five-item video assessment tool was developed that assessed the process (safety and efficiency) and quality of the end product (anatomy exposed and lymphadenectomy performed) of the operation. The quality of the end product section was used as a twenty seven-item photographic assessment tool. Thirty-one videos and fifty-three photographic series were submitted from the ROMIO pilot phase for assessment. The overall G-coefficient for the video assessment tool was 0.744, and for the photographic assessment tool was 0.700. CONCLUSIONS: A reliable surgical quality assurance system for 2-stage esophagectomy has been developed for surgical oncology randomized controlled trials. ETHICAL APPROVAL: 11/NW/0895 and confirmed locally as appropriate, 12/SW/0161, 16/SW/0098. TRIAL REGISTRATION NUMBER: ISRCTN59036820, ISRCTN10386621.

Journal article

Ni M, Borsci S, Walne S, Mclister AP, Buckle P, Barlow JG, Hanna GBet al., 2020, The Lean and Agile Multi-dimensional Process (LAMP) - a new framework for rapid and iterative evidence generation to support health-care technology design and development, Expert Review of Medical Devices, Vol: 17, Pages: 277-288, ISSN: 1743-4440

Introduction: Health technology assessments (HTA) are tools for policymaking and resource allocation. Early HTAs are increasingly used in design and development of new technologies. Conducting early HTAs is challenging, due to a lack of evidence and significant uncertainties in the technology and the market. A multi-disciplinary approach is considered essential. However, an operational framework that can enable the integration of multi-dimensional evidence into commercialization remains lacking.Areas covered: We developed the Lean and Agile Multi-dimensional Process (LAMP), an early HTA framework, for embedding commercial decision-making in structured evidence generation activities, divided into phases. Diverse evidence in unmet needs, user acceptance, cost-effectiveness, and market competitiveness are being generated in increasing depth. This supports the emergence of design and value propositions that align technology capabilities and clinical and user needs.Expert opinion: We have been applying LAMP to working with medical device and diagnostic industry in the UK. The framework can be adapted to suit different technologies, decision needs, time scales, and resources. LAMP offers a practical solution to the multi-disciplinary approach. Methodologists drive the process by performing evidence generation and synthesis as and by enabling interactions between manufacturers, designers, clinicians, and other key stakeholders.

Journal article

Subbe CP, Bannard-Smith J, Bunch J, Champunot R, DeVita MA, Durham L, Edelson DP, Gonzalez I, Hancock C, Haniffa R, Hartin J, Haskell H, Hogan H, Jones DA, Kalkman CJ, Lighthall GK, Malycha J, Ni MZ, Phillips AV, Rubulotta F, So RK, Welch Jet al., 2019, Quality metrics for the evaluation of Rapid Response Systems: Proceedings from the third international consensus conference on Rapid Response Systems (vol 141, pg 1, 2019), RESUSCITATION, Vol: 145, Pages: 93-94, ISSN: 0300-9572

Journal article

Subbe CP, Bannard-Smith J, Bunch J, Champunot R, DeVita MA, Durham L, Edelson DP, Gonzalez I, Hancock C, Haniffa R, Hartin J, Haskell H, Hogan H, Jones DA, Kalkman CJ, Lighthall GK, Malycha J, Ni MZ, Phillips AV, Rubulotta F, So RK, Welch Jet al., 2019, Quality metrics for the evaluation of Rapid Response Systems: Proceedings from the third international consensus conference on Rapid Response Systems, RESUSCITATION, Vol: 141, Pages: 1-12, ISSN: 0300-9572

Journal article

Vijayasingam A, Frost E, Wilkins J, Picinali L, Premachandra P, Gillen L, Morris-Rosendahl D, Ni M, Elston C, Simmonds NJ, Shah Aet al., 2019, S140 Interim results from a prospective study of tablet and web-based audiometry to detect ototoxicity in adults with cystic fibrosis (vol 73, pg A87, 2018), THORAX, Vol: 74, Pages: 723-723, ISSN: 0040-6376

Journal article

Huddy JR, Ni M, Misra S, Mavroveli S, Barlow J, Hanna GBet al., 2019, Development of the Point-of-Care Key Evidence Tool (POCKET): a checklist for multi-dimensional evidence generation in point-of-care tests, Clinical Chemistry and Laboratory Medicine, Vol: 57, Pages: 845-855, ISSN: 1434-6621

BackgroundThis study aimed to develop the Point-of-Care Key Evidence Tool (POCKET); a multi-dimensional checklist to guide the evaluation of point-of-care tests (POCTs) incorporating validity, utility, usability, cost-effectiveness and patient experience. The motivation for this was to improve the efficiency of evidence generation in POCTs and reduce the lead-time for the adoption of novel POCTs.MethodsA mixed qualitative and quantitative approach was applied. Following a literature search, a three round Delphi process was undertaken incorporating a semi-structured interview study and two questionnaire rounds. Participants included clinicians, laboratory personnel, commissioners, regulators (including members of National Institute for Health and Care Excellence [NICE] committees), patients, industry representatives and methodologists. Qualitative data were analysed based on grounded theory. The final tool was revised at an expert stakeholder workshop.ResultsForty-three participants were interviewed within the semi-structured interview study, 32 participated in the questionnaire rounds and nine stakeholders attended the expert workshop. The final version of the POCKET checklist contains 65 different evidence requirements grouped into seven themes. Face validity, content validity and usability has been demonstrated. There exists a shortfall in the evidence that industry and research methodologists believe should be generated regarding POCTs and what is actually required by policy and decision makers to promote implementation into current healthcare pathways.ConclusionsThis study has led to the development of POCKET, a checklist for evidence generation and synthesis in POCTs. This aims to guide industry and researchers to the evidence that is required by decision makers to facilitate POCT adoption so that the benefits they can bring to patients can be effectively realised.

Journal article

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