Publications by authors named "Ara Darzi"

948 Publications

Diagnostic accuracy of deep learning in medical imaging: a systematic review and meta-analysis.

NPJ Digit Med 2021 Apr 7;4(1):65. Epub 2021 Apr 7.

Institute of Global Health Innovation, Imperial College London, London, UK.

Deep learning (DL) has the potential to transform medical diagnostics. However, the diagnostic accuracy of DL is uncertain. Our aim was to evaluate the diagnostic accuracy of DL algorithms to identify pathology in medical imaging. Searches were conducted in Medline and EMBASE up to January 2020. We identified 11,921 studies, of which 503 were included in the systematic review. Eighty-two studies in ophthalmology, 82 in breast disease and 115 in respiratory disease were included for meta-analysis. Two hundred twenty-four studies in other specialities were included for qualitative review. Peer-reviewed studies that reported on the diagnostic accuracy of DL algorithms to identify pathology using medical imaging were included. Primary outcomes were measures of diagnostic accuracy, study design and reporting standards in the literature. Estimates were pooled using random-effects meta-analysis. In ophthalmology, AUC's ranged between 0.933 and 1 for diagnosing diabetic retinopathy, age-related macular degeneration and glaucoma on retinal fundus photographs and optical coherence tomography. In respiratory imaging, AUC's ranged between 0.864 and 0.937 for diagnosing lung nodules or lung cancer on chest X-ray or CT scan. For breast imaging, AUC's ranged between 0.868 and 0.909 for diagnosing breast cancer on mammogram, ultrasound, MRI and digital breast tomosynthesis. Heterogeneity was high between studies and extensive variation in methodology, terminology and outcome measures was noted. This can lead to an overestimation of the diagnostic accuracy of DL algorithms on medical imaging. There is an immediate need for the development of artificial intelligence-specific EQUATOR guidelines, particularly STARD, in order to provide guidance around key issues in this field.
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http://dx.doi.org/10.1038/s41746-021-00438-zDOI Listing
April 2021

The pilot, proof of concept REMOTE-COVID trial: remote monitoring use in suspected cases of COVID-19 (SARS-CoV 2).

BMC Public Health 2021 Apr 1;21(1):638. Epub 2021 Apr 1.

Division of Surgery & Cancer, 10th Floor Queen Elizabeth the Queen Mother Wing (QEQM) St Mary's Campus, London, W2 1NY, UK.

Background: SARS-CoV-2 has ever-increasing attributed deaths. Vital sign trends are routinely used to monitor patients with changes in these parameters preceding an adverse event. Wearable sensors can measure vital signs continuously and remotely, outside of hospital facilities, recognising early clinical deterioration. We aim to determine the feasibility & acceptability of remote monitoring systems for quarantined individuals in a hotel suspected of COVID-19.

Methods: A pilot, proof-of-concept, feasibility trial was conducted in engineered hotels near London airports (May-June 2020). Individuals arriving to London with mild suspected COVID-19 symptoms requiring quarantine, as recommended by Public Health England, or healthcare professionals with COVID-19 symptoms unable to isolate at home were eligible. The SensiumVitals™ patch, measuring temperature, heart & respiratory rates, was applied on arrival for the duration of their stay. Alerts were generated when pre-established thresholds were breeched; trained nursing staff could consequently intervene.

Results: Fourteen individuals (M = 7, F = 7) were recruited; the mean age was 34.9 (SD 11) years. Mean length of stay was 3 (SD 1.8) days. In total, 10 vital alerts were generated across 4 participants, resulting in telephone contact, reassurance, or adjustment of the sensor. No individuals required hospitalisation or virtual general practitioner review.

Discussion: This proof-of-concept trial demonstrated the feasibility of a rapidly implemented model of healthcare delivery through remote monitoring during a pandemic at a hotel, acting as an extension to a healthcare trust. Benefits included reduced viral exposure to healthcare staff, with recognition of clinical deterioration through ambulatory, continuous, remote monitoring using a discrete wearable sensor.

Conclusion: Remote monitoring systems can be applied to hotels to deliver healthcare safely in individuals suspected of COVID-19. Further work is required to evaluate this model on a larger scale.

Trial Registration: Clinical trials registration information: ClinicalTrials.gov Identifier: NCT04337489 (07/04/2020).
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http://dx.doi.org/10.1186/s12889-021-10660-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013165PMC
April 2021

Neuroenhancement of future surgeons - Opinions from students, surgeons and patients.

Brain Stimul 2021 Mar 28;14(3):616-618. Epub 2021 Mar 28.

Department of Surgery and Cancer, Imperial College London, UK.

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http://dx.doi.org/10.1016/j.brs.2021.03.012DOI Listing
March 2021

Validation of Ultrasonic Harmonic Scalpel for Real-Time Tissue Identification Using Rapid Evaporative Ionization Mass Spectrometry.

Anal Chem 2021 Apr 31;93(14):5906-5916. Epub 2021 Mar 31.

Department of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom.

In this study, we integrate rapid evaporative ionization mass spectrometry (REIMS) with the Harmonic scalpel, an advanced laparoscopic surgical instrument that utilizes ultrasound energy to dissect and coagulate tissues. It provides unparalleled manipulation capability to surgeons and has superseded traditional electrosurgical tools particularly in abdominal surgery, but is yet to be validated with REIMS. The REIMS platform coupled with the Harmonic device was shown to produce tissue-specific lipid profiles through the analysis of porcine tissues in both negative and positive ionization modes. Comparison with other methods of electrosurgical dissection, such as monopolar electrosurgery and CO laser, showed spectral differences in the profile dependent on the energy device used. The Harmonic device demonstrated major spectral differences in the phospholipid region of / 600-1000 compared with the monopolar electrosurgical and CO laser-generated spectra. Within the Harmonic REIMS spectra, high intensities of diglycerides and triglycerides were observed. In contrast, monopolar electrosurgical and laser spectra demonstrated high abundances of glycerophospholipids. The Harmonic scalpel was able to differentiate between the liver, muscle, colon, and small intestine, demonstrating 100% diagnostic accuracy. The validation of the Harmonic device-mass spectrometry combination will allow the platform to be used safely and robustly for real-time surgical tissue identification in a variety of clinical applications.
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http://dx.doi.org/10.1021/acs.analchem.1c00270DOI Listing
April 2021

Dataset of prefrontal transcranial direct-current stimulation to improve early surgical knot-tying skills.

Data Brief 2021 Apr 23;35:106905. Epub 2021 Feb 23.

Department of Surgery & Cancer, Imperial College London, St Mary's Hospital Campus, 10th Floor, QEQM Building, Praed Street, London W2 1NY, United Kingdom.

Transcranial direct-current stimulation (tDCS) has previously demonstrated promising effects in improving surgical performance with motor region stimulation [1], [2], [3], [4]. However, extensive prior research has revealed an important role of the prefrontal cortex in surgical skill development [5,6]. This article presents the data of a double-blind randomized sham-controlled trial investigating the effect of prefrontal tDCS on knot-tying performance [7]. Data was collected from an active ( = 20) and sham ( = 20) group across three blocks: pre-, online- (during) and post-tDCS. Group and block differences of knot-tying performance were analyzed using a Generalized linear mixed model and supported with a Friedman's test. Further sub-analyses were conducted to compare high vs. low skilled individuals and initial vs. last knots. Subjective workload was assessed after each block using a SURG-TLX questionnaire and side-effects of the tDCS block were recorded using an additional survey.
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http://dx.doi.org/10.1016/j.dib.2021.106905DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941089PMC
April 2021

Stapler closure versus manual closure in total laryngectomy for laryngeal cancer: A systematic review and meta-analysis.

Clin Otolaryngol 2021 Mar 17. Epub 2021 Mar 17.

Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head and Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.

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http://dx.doi.org/10.1111/coa.13757DOI Listing
March 2021

A national survey assessing public readiness for digital health strategies against COVID-19 within the United Kingdom.

Sci Rep 2021 03 16;11(1):5958. Epub 2021 Mar 16.

Department of Surgery and Cancer, Imperial College London, London, W2 1NY, UK.

There is concern that digital public health initiatives used in the management of COVID-19 may marginalise certain population groups. There is an overlap between the demographics of groups at risk of digital exclusion (older, lower social grade, low educational attainment and ethnic minorities) and those who are vulnerable to poorer health outcomes from SARS-CoV-2. In this national survey study (n = 2040), we assessed how the UK population; particularly these overlapping groups, reported their preparedness for digital health strategies. We report, with respect to using digital information to make health decisions, that those over 60 are less comfortable (net comfort: 57%) than those between 18 and 39 (net comfort: 78%) and lower social grades are less comfortable (net comfort: 63%) than higher social grades (net comfort: 75%). With respect to a preference for digital over non-digital sources in seeking COVID-19 health information, those over 60 (net preference: 21%) are less inclined than those between 18 and 39 (net preference: 60%) and those of low educational attainment (net preference: 30%) are less inclined than those of high educational attainment (net preference: 52%). Lastly, with respect to distinguishing reliable digital COVID-19 information, lower social grades (net confidence: 55%) are less confident than higher social grades (net confidence: 68%) and those of low educational attainment (net confidence: 51%) are less confident than those of high educational attainment (net confidence: 71%). All reported differences are statistically significant (p < 0.01) following multivariate regression modelling. This study suggests that digital public health approaches to COVID-19 have the potential to marginalise groups who are concurrently at risk of digital exclusion and poor health outcomes from SARS-CoV-2.
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http://dx.doi.org/10.1038/s41598-021-85514-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966397PMC
March 2021

Systematic review into city interventions to address obesity.

EClinicalMedicine 2021 Feb 8;32:100710. Epub 2021 Jan 8.

Imperial College, Exhibition Rd, London, United Kingdom.

Background: Obesity threatens to undo the improvements that have been made in life expectancy over the last two centuries. It disproportionately affects lower socioeconomic and ethnic minority groups and has become one of the most important global health challenges of the 21century. Whilst obesity is not confined to city populations, cities are home to more than half of the world's population with concentrated groups at high risk of obesity. Cities have also long been the forefront of social and technological change that has led to our current obesogenic environment. The aim of this study was to systematically identify city-wide interventions to address obesity, from which recommendations for policy makers, health system leaders and political leaders in cities could be made.

Methods: Systematic review, conducted according to PRISMA guidelines, examining Embase, Ovid Medline, Central, Scopus, Campbell Library, CINALH, Health Business Elite; Health Management Information Consortium (HMIC), PyschINFO and Prospero. No restrictions on article type, date range or geographic location were applied. Along with classic academic sources, books and policy white papers were sought and reviewed. Studies that described a city-wide intervention to reduce obesity were included, irrespective of study design or perceived methodological quality. Only studies in English language were included. The primary outcome indicators that were sought and extracted were: reduction in obesity, reduction in weight and/or reduction in BMI. Where a primary outcome indicator was not stated, any other secondary impact measure was identified and recorded. This manuscript represents thematic analysis of a sub-set of data from the Prospero study, registration number: CRD42020166210.

Findings: Our search yielded 42,137 original citations of which 1614 met the inclusion criteria and 96 were coded as relating to obesity. The 96 citations, ranging in year of publication 1997 to 2019, were conducted in 36 cities, with 13 citations either not stating a city or covering multiple cities, across 5 continents. The highest proportion of publications were from North America (59 / 96) and in particular the USA (56/96) and New York City (23/96). Primary outcome indicators were only stated in one quarter of the identified studies (24/96). Overall, there was heterogeneity of study design, descriptive methodologies and publication types, with a majority being descriptive texts using qualitative instruments of assessment.

Interpretation: Multi-level and multi-component interventions, at the individual, community and city level, done in concert, are needed to address obesity. A composite of interventions that cities can utilise to address obesity is provided. These interventions will also be beneficial to the environment and make the case that personal health and planetary health are inextricably linked and should be considered as one.

Funding: None.
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http://dx.doi.org/10.1016/j.eclinm.2020.100710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910670PMC
February 2021

Design of the pilot, proof of concept REMOTE-COVID trial: remote monitoring use in suspected cases of COVID-19 (SARS-CoV-2).

Pilot Feasibility Stud 2021 Mar 5;7(1):62. Epub 2021 Mar 5.

Division of Surgery & Cancer, St Mary's Hospital, 10th Floor Queen Elizabeth the Queen Mother Wing (QEQM) St Mary's Campus, London, W2 1NY, UK.

Background: The outbreak of SARS-CoV-2 (coronavirus, COVID-19), declared a pandemic by the World Health Organization (WHO), is a global health problem with ever-increasing attributed deaths. Vital sign trends are routinely used to monitor patients with changes in these parameters often preceding an adverse event. Wearable sensors can measure vital signs continuously (e.g. heart rate, respiratory rate, temperature) remotely and can be utilised to recognise early clinical deterioration.

Methods: We describe the protocol for a pilot, proof-of-concept, observational study to be conducted in an engineered hotel near London airports, UK. The study is set to continue for the duration of the pandemic. Individuals arriving to London with mild symptoms suggestive of COVID-19 or returning from high-risk areas requiring quarantine, as recommended by the Public Health England, or healthcare professionals with symptoms suggestive of COVID-19 unable to isolate at home will be eligible for a wearable patch to be applied for the duration of their stay. Notifications will be generated should deterioration be detected through the sensor and displayed on a central monitoring hub viewed by nursing staff, allowing for trend deterioration to be noted. The primary objective is to determine the feasibility of remote monitoring systems in detecting clinical deterioration for quarantined individuals in a hotel.

Discussion: This trial should prove the feasibility of a rapidly implemented model of healthcare delivery through remote monitoring during a global pandemic at a hotel, acting as an extension to a healthcare trust. Potential benefits would include reducing infection risk of COVID-19 to healthcare staff, with earlier recognition of clinical deterioration through ambulatory, continuous, remote monitoring using a discrete wearable sensor. We hope our results can power future, robust randomised trials.

Trial Registration: ClinicalTrials.gov Identifier: NCT04337489 .
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http://dx.doi.org/10.1186/s40814-021-00804-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933391PMC
March 2021

SARS-CoV-2 lateral flow assays for possible use in national covid-19 seroprevalence surveys (React 2): diagnostic accuracy study.

BMJ 2021 03 2;372:n423. Epub 2021 Mar 2.

Department of Infectious Disease, Imperial College London, School of Medicine, St Mary's Hospital, Praed Street, London W2 1NY, UK.

Objective: To evaluate the performance of new lateral flow immunoassays (LFIAs) suitable for use in a national coronavirus disease 2019 (covid-19) seroprevalence programme (real time assessment of community transmission 2-React 2).

Design: Diagnostic accuracy study.

Setting: Laboratory analyses were performed in the United Kingdom at Imperial College, London and university facilities in London. Research clinics for finger prick sampling were run in two affiliated NHS trusts.

Participants: Sensitivity analyses were performed on sera stored from 320 previous participants in the React 2 programme with confirmed previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Specificity analyses were performed on 1000 prepandemic serum samples. 100 new participants with confirmed previous SARS-CoV-2 infection attended study clinics for finger prick testing.

Interventions: Laboratory sensitivity and specificity analyses were performed for seven LFIAs on a minimum of 200 serum samples from participants with confirmed SARS-CoV-2 infection and 500 prepandemic serum samples, respectively. Three LFIAs were found to have a laboratory sensitivity superior to the finger prick sensitivity of the LFIA currently used in React 2 seroprevalence studies (84%). These LFIAs were then further evaluated through finger prick testing on participants with confirmed previous SARS-CoV-2 infection: two LFIAs (Surescreen, Panbio) were evaluated in clinics in June-July 2020 and the third LFIA (AbC-19) in September 2020. A spike protein enzyme linked immunoassay and hybrid double antigen binding assay were used as laboratory reference standards.

Main Outcome Measures: The accuracy of LFIAs in detecting immunoglobulin G (IgG) antibodies to SARS-CoV-2 compared with two reference standards.

Results: The sensitivity and specificity of seven new LFIAs that were analysed using sera varied from 69% to 100%, and from 98.6% to 100%, respectively (compared with the two reference standards). Sensitivity on finger prick testing was 77% (95% confidence interval 61.4% to 88.2%) for Panbio, 86% (72.7% to 94.8%) for Surescreen, and 69% (53.8% to 81.3%) for AbC-19 compared with the reference standards. Sensitivity for sera from matched clinical samples performed on AbC-19 was significantly higher with serum than finger prick at 92% (80.0% to 97.7%, P=0.01). Antibody titres varied considerably among cohorts. The numbers of positive samples identified by finger prick in the lowest antibody titre quarter varied among LFIAs.

Conclusions: One new LFIA was identified with clinical performance suitable for potential inclusion in seroprevalence studies. However, none of the LFIAs tested had clearly superior performance to the LFIA currently used in React 2 seroprevalence surveys, and none showed sufficient sensitivity and specificity to be considered for routine clinical use.
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http://dx.doi.org/10.1136/bmj.n423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7921617PMC
March 2021

Applying natural language processing and machine learning techniques to patient experience feedback: a systematic review.

BMJ Health Care Inform 2021 Mar;28(1)

Patient Safety Translational Research Centre, Imperial College of Science Technology and Medicine, London, UK.

Objectives: Unstructured free-text patient feedback contains rich information, and analysing these data manually would require a lot of personnel resources which are not available in most healthcare organisations.To undertake a systematic review of the literature on the use of natural language processing (NLP) and machine learning (ML) to process and analyse free-text patient experience data.

Methods: Databases were systematically searched to identify articles published between January 2000 and December 2019 examining NLP to analyse free-text patient feedback. Due to the heterogeneous nature of the studies, a narrative synthesis was deemed most appropriate. Data related to the study purpose, corpus, methodology, performance metrics and indicators of quality were recorded.

Results: Nineteen articles were included. The majority (80%) of studies applied language analysis techniques on patient feedback from social media sites (unsolicited) followed by structured surveys (solicited). Supervised learning was frequently used (n=9), followed by unsupervised (n=6) and semisupervised (n=3). Comments extracted from social media were analysed using an unsupervised approach, and free-text comments held within structured surveys were analysed using a supervised approach. Reported performance metrics included the precision, recall and F-measure, with support vector machine and Naïve Bayes being the best performing ML classifiers.

Conclusion: NLP and ML have emerged as an important tool for processing unstructured free text. Both supervised and unsupervised approaches have their role depending on the data source. With the advancement of data analysis tools, these techniques may be useful to healthcare organisations to generate insight from the volumes of unstructured free-text data.
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http://dx.doi.org/10.1136/bmjhci-2020-100262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7929894PMC
March 2021

Understanding the survivorship burden of long COVID.

EClinicalMedicine 2021 Mar 24;33:100767. Epub 2021 Feb 24.

Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK.

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http://dx.doi.org/10.1016/j.eclinm.2021.100767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904277PMC
March 2021

Use of Pediatric Injectable Medicines Guidelines and Associated Medication Administration Errors: A Human Reliability Analysis.

Ann Pharmacother 2021 Mar 1:1060028021999647. Epub 2021 Mar 1.

Imperial College London, UK.

Background: In a recent human reliability analysis (HRA) of simulated pediatric resuscitations, ineffective retrieval of preparation and administration instructions from online injectable medicines guidelines was a key factor contributing to medication administration errors (MAEs).

Objective: The aim of the present study was to use a specific HRA to understand where intravenous medicines guidelines are vulnerable to misinterpretation, focusing on deviations from expected practice () that contributed to large-magnitude and/or clinically significant MAEs.

Methods: Video recordings from the original study were reanalyzed to identify discrepancies in the steps required to find and extract information from the NHS Injectable Medicines Guide (IMG) website. These data were combined with MAE data from the same original study.

Results: In total, 44 discrepancies during use of the IMG were observed across 180 medication administrations. Of these discrepancies, 21 (48%) were associated with an MAE, 16 of which (36% of 44 discrepancies) made a major contribution to that error. There were more discrepancies (31 in total, 70%) during the steps required to access the correct drug webpage than there were in the steps required to read this information (13 in total, 30%). Discrepancies when using injectable medicines guidelines made a major contribution to 6 (27%) of 22 clinically significant and 4 (15%) of 27 large-magnitude MAEs.

Conclusion And Relevance: Discrepancies during the use of an online injectable medicines guideline were often associated with subsequent MAEs, including those with potentially significant consequences. This highlights the need to test the usability of guidelines before clinical use.
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http://dx.doi.org/10.1177/1060028021999647DOI Listing
March 2021

Assessment of Patients' Ability to Review Electronic Health Record Information to Identify Potential Errors: Cross-sectional Web-Based Survey.

JMIR Form Res 2021 Feb 26;5(2):e19074. Epub 2021 Feb 26.

Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, United Kingdom.

Background: Sharing personal health information positively impacts quality of care across several domains, and particularly, safety and patient-centeredness. Patients may identify and flag up inconsistencies in their electronic health records (EHRs), leading to improved information quality and patient safety. However, in order to identify potential errors, patients need to be able to understand the information contained in their EHRs.

Objective: The aim of this study was to assess patients' perceptions of their ability to understand the information contained in their EHRs and to analyze the main barriers to their understanding. Additionally, the main types of patient-reported errors were characterized.

Methods: A cross-sectional web-based survey was undertaken between March 2017 and September 2017. A total of 682 registered users of the Care Information Exchange, a patient portal, with at least one access during the time of the study were invited to complete the survey containing both structured (multiple choice) and unstructured (free text) questions. The survey contained questions on patients' perceived ability to understand their EHR information and therefore, to identify errors. Free-text questions allowed respondents to expand on the reasoning for their structured responses and provide more detail about their perceptions of EHRs and identifying errors within them. Qualitative data were systematically reviewed by 2 independent researchers using the framework analysis method in order to identify emerging themes.

Results: A total of 210 responses were obtained. The majority of the responses (123/210, 58.6%) reported understanding of the information. The main barriers identified were information-related (medical terminology and knowledge and interpretation of test results) and technology-related (user-friendliness of the portal, information display). Inconsistencies relating to incomplete and incorrect information were reported in 12.4% (26/210) of the responses.

Conclusions: While the majority of the responses affirmed the understanding of the information contained within the EHRs, both technology and information-based barriers persist. There is a potential to improve the system design to better support opportunities for patients to identify errors. This is with the aim of improving the accuracy, quality, and timeliness of the information held in the EHRs and a mechanism to further engage patients in their health care.
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http://dx.doi.org/10.2196/19074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954650PMC
February 2021

Opening a "Can of Worms" to Explore the Public's Hopes and Fears About Health Care Data Sharing: Qualitative Study.

J Med Internet Res 2021 Feb 22;23(2):e22744. Epub 2021 Feb 22.

Patient Safety Translational Research Centre, Institute of Global Health Innovation, London, United Kingdom.

Background: Evidence suggests that health care data sharing may strengthen care coordination, improve quality and safety, and reduce costs. However, to achieve efficient and meaningful adoption of health care data-sharing initiatives, it is necessary to engage all stakeholders, from health care professionals to patients. Although previous work has assessed health care professionals' perceptions of data sharing, perspectives of the general public and particularly of seldom heard groups have yet to be fully assessed.

Objective: This study aims to explore the views of the public, particularly their hopes and concerns, around health care data sharing.

Methods: An original, immersive public engagement interactive experience was developed-The Can of Worms installation-in which participants were prompted to reflect about data sharing through listening to individual stories around health care data sharing. A multidisciplinary team with expertise in research, public involvement, and human-centered design developed this concept. The installation took place in three separate events between November 2018 and November 2019. A combination of convenience and snowball sampling was used in this study. Participants were asked to fill self-administered feedback cards and to describe their hopes and fears about the meaningful use of data in health care. The transcripts were compiled verbatim and systematically reviewed by four independent reviewers using the thematic analysis method to identify emerging themes.

Results: Our approach exemplifies the potential of using interdisciplinary expertise in research, public involvement, and human-centered design to tell stories, collect perspectives, and spark conversations around complex topics in participatory digital medicine. A total of 352 qualitative feedback cards were collected, each reflecting participants' hopes and fears for health care data sharing. Thematic analyses identified six themes under hopes: enablement of personal access and ownership, increased interoperability and collaboration, generation of evidence for better and safer care, improved timeliness and efficiency, delivery of more personalized care, and equality. The five main fears identified included inadequate security and exploitation, data inaccuracy, distrust, discrimination and inequality, and less patient-centered care.

Conclusions: This study sheds new light on the main hopes and fears of the public regarding health care data sharing. Importantly, our results highlight novel concerns from the public, particularly in terms of the impact on health disparities, both at international and local levels, and on delivering patient-centered care. Incorporating the knowledge generated and focusing on co-designing solutions to tackle these concerns is critical to engage the public as active contributors and to fully leverage the potential of health care data use.
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http://dx.doi.org/10.2196/22744DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939935PMC
February 2021

Constructive criticism or distortion of the humanitarian narrative? - Authors' reply.

Lancet Glob Health 2021 03;9(3):e255

Department of Digestive Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.

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http://dx.doi.org/10.1016/S2214-109X(20)30553-2DOI Listing
March 2021

Evaluating the effect of infographics on public recall, sentiment and willingness to use face masks during the COVID-19 pandemic: a randomised internet-based questionnaire study.

BMC Public Health 2021 02 17;21(1):367. Epub 2021 Feb 17.

Institute of Global Health Innovation, Department of Surgery & Cancer, Imperial College London , 10th Floor Queen Elizabeth Queen Mother Building, St Mary's Hospital, London, W2 1NY, UK.

Background: The use of face masks remains contentious, with international variation in practice. Their prevalence in the UK, is likely to increase due to new legislation. Clear information regarding the appropriate use of masks is needed, to ensure compliance with policies to reduce transmission of COVID-19. We aimed to assess the impact of visual representations of guidance, or infographics, upon the knowledge of appropriate face mask usage in a representative UK cohort.

Methods: Adult patients were recruited to this randomised internet-based questionnaire study during the 12-14 May 2020 from across the UK. Respondents viewed one of five public health stimuli regarding the use of face masks, or no stimulus. The groups accessed aids by the European Centre for Disease Control (EUCDC), World Health Organisation (WHO), Singaporean Ministry of Health (SMOH), text from the UK government (UK Gov), or an infographic designed by the Behavioural Insights Team (BIT). The primary outcome was to evaluate the effect of each infographic upon participants' recall of face mask technique, sentiments and willingness to wear a face covering. Secondary outcomes included the effect of symptomology and socio-demographic factors.

Results: 4099 respondents were randomised (1009 control, 628 EUCDC, 526 WHO, 639 SMOH, 661 UKGOV and 606 BIT). Stimuli from the WHO, SMOH and BIT demonstrated significantly higher average recall scores compared to the controls (7.40 v. 7.38 v. 7.34 v. 6.97, P < 0.001). BIT's stimulus led to the highest confidence about mask-wearing (87%). Only 48.2% of the cohort felt stimuli reduced anxiety about COVID-19. However, willingness to use a mask was high, (range 84 to 88%).

Conclusions: To ensure the appropriate use of masks, as mandated by UK law, guidance must provide sufficient information, yet remain understandable. Infographics can aid the recall of correct mask techniques by highlighting salient steps and reducing cognitive burden. They have also demonstrated greater trustworthiness than text-only guidance. The effect of infographics upon COVID-19-related anxiety was poor, and they should be further developed to address this sentiment. A willingness to wear face masks has, however, been demonstrated.
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http://dx.doi.org/10.1186/s12889-021-10356-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886844PMC
February 2021

Automated Vision-Based Microsurgical Skill Analysis in Neurosurgery Using Deep Learning: Development and Preclinical Validation.

World Neurosurg 2021 Feb 12. Epub 2021 Feb 12.

Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom. Electronic address:

Background/objective: Technical skill acquisition is an essential component of neurosurgical training. Educational theory suggests that optimal learning and improvement in performance depends on the provision of objective feedback. Therefore, the aim of this study was to develop a vision-based framework based on a novel representation of surgical tool motion and interactions capable of automated and objective assessment of microsurgical skill.

Methods: Videos were obtained from 1 expert, 6 intermediate, and 12 novice surgeons performing arachnoid dissection in a validated clinical model using a standard operating microscope. A mask region convolutional neural network framework was used to segment the tools present within the operative field in a recorded video frame. Tool motion analysis was achieved using novel triangulation metrics. Performance of the framework in classifying skill levels was evaluated using the area under the curve and accuracy. Objective measures of classifying the surgeons' skill level were also compared using the Mann-Whitney U test, and a value of P < 0.05 was considered statistically significant.

Results: The area under the curve was 0.977 and the accuracy was 84.21%. A number of differences were found, which included experts having a lower median dissector velocity (P = 0.0004; 190.38 ms vs. 116.38 ms), and a smaller inter-tool tip distance (median 46.78 vs. 75.92; P = 0.0002) compared with novices.

Conclusions: Automated and objective analysis of microsurgery is feasible using a mask region convolutional neural network, and a novel tool motion and interaction representation. This may support technical skills training and assessment in neurosurgery.
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http://dx.doi.org/10.1016/j.wneu.2021.01.117DOI Listing
February 2021

SARS-CoV-2 antibody prevalence in England following the first peak of the pandemic.

Nat Commun 2021 02 10;12(1):905. Epub 2021 Feb 10.

School of Public Health, Imperial College London, London, UK.

England has experienced a large outbreak of SARS-CoV-2, disproportionately affecting people from disadvantaged and ethnic minority communities. It is unclear how much of this excess is due to differences in exposure associated with structural inequalities. Here, we report from the REal-time Assessment of Community Transmission-2 (REACT-2) national study of over 100,000 people. After adjusting for test characteristics and re-weighting to the population, overall antibody prevalence is 6.0% (95% CI: 5.8-6.1). An estimated 3.4 million people had developed antibodies to SARS-CoV-2 by mid-July 2020. Prevalence is two- to three-fold higher among health and care workers compared with non-essential workers, and in people of Black or South Asian than white ethnicity, while age- and sex-specific infection fatality ratios are similar across ethnicities. Our results indicate that higher hospitalisation and mortality from COVID-19 in minority ethnic groups may reflect higher rates of infection rather than differential experience of disease or care.
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http://dx.doi.org/10.1038/s41467-021-21237-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876103PMC
February 2021

Increasing recruitment into covid-19 trials.

BMJ 2021 01 29;372:n235. Epub 2021 Jan 29.

Faculty of Intensive Care Medicine, London, UK.

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http://dx.doi.org/10.1136/bmj.n235DOI Listing
January 2021

Deployable, Variable Stiffness, Cable Driven Robot for Minimally Invasive Surgery.

Front Robot AI 2019 10;6:141. Epub 2020 Jan 10.

Human-Centered Automation, Robotics and Monitoring in Surgery (HARMS) Lab, Department of Surgery and Cancer, The Hamlyn Center, Imperial College London, London, United Kingdom.

Minimally Invasive Surgery (MIS) imposes a trade-off between non-invasive access and surgical capability. Treatment of early gastric cancers over 20 mm in diameter can be achieved by performing Endoscopic Submucosal Dissection (ESD) with a flexible endoscope; however, this procedure is technically challenging, suffers from extended operation times and requires extensive training. To facilitate the ESD procedure, we have created a deployable cable driven robot that increases the surgical capabilities of the flexible endoscope while attempting to minimize the impact on the access that they offer. Using a low-profile inflatable support structure in the shape of a hollow hexagonal prism, our robot can fold around the flexible endoscope and, when the target site has been reached, achieve a 73.16% increase in volume and increase its radial stiffness. A sheath around the variable stiffness structure delivers a series of force transmission cables that connect to two independent tubular end-effectors through which standard flexible endoscopic instruments can pass and be anchored. Using a simple control scheme based on the length of each cable, the pose of the two instruments can be controlled by haptic controllers in each hand of the user. The forces exerted by a single instrument were measured, and a maximum magnitude of 8.29 N observed along a single axis. The working channels and tip control of the flexible endoscope remain in use in conjunction with our robot and were used during a procedure imitating the demands of ESD was successfully carried out by a novice user. Not only does this robot facilitate difficult surgical techniques, but it can be easily customized and rapidly produced at low cost due to a programmatic design approach.
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http://dx.doi.org/10.3389/frobt.2019.00141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805644PMC
January 2020

Are disruptive innovations recognised in the healthcare literature? A systematic review.

BMJ Innov 2021 Jan 4;7(1):208-216. Epub 2020 Sep 4.

Department of Surgery and Cancer, Imperial College London, London, UK.

The study aims to conduct a systematic review to characterise the spread and use of the concept of 'disruptive innovation' within the healthcare sector. We aim to categorise references to the concept over time, across geographical regions and across prespecified healthcare domains. From this, we further aim to critique and challenge the sector-specific use of the concept. PubMed, Medline, Embase, Global Health, PsycINFO, Maternity and Infant Care, and Health Management Information Consortium were searched from inception to August 2019 for references pertaining to disruptive innovations within the healthcare industry. The heterogeneity of the articles precluded a meta-analysis, and neither quality scoring of articles nor risk of bias analyses were required. 245 articles that detailed perceived disruptive innovations within the health sector were identified. The disruptive innovations were categorised into seven domains: basic science (19.2%), device (12.2%), diagnostics (4.9%), digital health (21.6%), education (5.3%), processes (17.6%) and technique (19.2%). The term has been used with increasing frequency annually and is predominantly cited in North American (78.4%) and European (15.2%) articles. The five most cited disruptive innovations in healthcare are 'omics' technologies, mobile health applications, telemedicine, health informatics and retail clinics. The concept 'disruptive innovation' has diffused into the healthcare industry. However, its use remains inconsistent and the recognition of disruption is obscured by other types of innovation. The current definition does not accommodate for prospective scouting of disruptive innovations, a likely hindrance to policy makers. Redefining disruptive innovation within the healthcare sector is therefore crucial for prospectively identifying cost-effective innovations.
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http://dx.doi.org/10.1136/bmjinnov-2020-000424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802637PMC
January 2021

The risk-value trade-off: price and brand information impact consumers' intentions to purchase OTC drugs.

J Pharm Policy Pract 2021 Jan 25;14(1):11. Epub 2021 Jan 25.

NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, W2 1PE, UK.

Background: European countries face fiscal pressure regarding the long-term sustainability of their healthcare system due to increasing levels of public health expenditures and mounting demographic pressures. The promotion of generic drugs is considered to be an efficient means to tackle these challenges; however, market diffusion remains slow. The aim of this study was to investigate the impact of price and brand cues on purchase intentions by means of Direct-to-Consumer (DTC) advertising, and to build on the market cue evaluation model by Dodd et al. METHODS: Participants rated purchase intentions on six DTC adverts varying in price and brand information, followed by self-reports on purchase intentions, attitudes towards generics, brand loyalty, price consciousness, as well as perceptions of quality, risk and value. Open-ended questions explored attitudes toward generic drugs.

Results: Brand information and purchase intentions were mediated by perceived risk and perceived quality, while price information influenced purchase intention through perceptions of quality, risk and value. Consumers' purchase behaviour was furthermore  influenced by unawareness and misconceptions, past experiences, and advertising as a decision-making tool.

Conclusions: Advertisements, including price and brand information, are an important tool to improve consumers' awareness of the availability of different OTC drugs. Practical and theoretical implications are discussed.
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http://dx.doi.org/10.1186/s40545-020-00293-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831199PMC
January 2021

Wearable Activity Monitors in Home Based Exercise Therapy for Patients with Intermittent Claudication: A Systematic Review.

Eur J Vasc Endovasc Surg 2021 Apr 12;61(4):676-687. Epub 2021 Jan 12.

Department of Surgery and Cancer, Imperial College London, London, UK; Institute of Global Health Innovation, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK.

Objective: Intermittent claudication (IC) can severely limit functional capacity and quality of life. Supervised exercise therapy is the recommended first line management; however, this is often limited by accessibility, compliance and cost. As such, there has been an increased interest in the use of wearable activity monitors (WAMs) in home based telemonitoring exercise programmes for claudicants. This review aims to evaluate the efficacy of WAM as a feedback and monitoring tool in home based exercise programmes for patients with IC.

Data Sources: A search strategy was devised. The databases MEDLINE, EMBASE, and Web of Science were searched through to April 2020.

Review Methods: Randomised trials and prospective trials were included. Eligible trials had to incorporate WAMs as a feedback tool to target walking/exercise behaviour. The primary outcome was the change in walking ability. Study quality was assessed with risk of bias tool.

Results: A total of 1148 records were retrieved. Of these, eight randomised controlled trials and one prospective cohort study, all of which compared a WAM intervention against standard care and/or supervised exercise, met the inclusion criteria. Owing to heterogeneity between studies, no meta-analysis was conducted. WAM interventions improved measures of walking ability (heterogeneous outcomes such as maximum walking distance, claudication distance and six minute walk distance), increased daily walking activity (steps/day), cardiovascular metrics (maximum oxygen consumption), and quality of life.

Conclusion: There is some evidence that home based WAM interventions are beneficial for improving walking ability and quality of life in patients with IC. However, existing studies are limited by inadequate sample size, duration, and appropriate power. Achieving consensus on outcome reporting and study methods, as well as maximising device adherence, is needed.
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http://dx.doi.org/10.1016/j.ejvs.2020.11.044DOI Listing
April 2021

The evolution of lower gastrointestinal endoscopy: where are we now?

Ther Adv Gastrointest Endosc 2020 Jan-Dec;13:2631774520979591. Epub 2020 Dec 20.

Imperial College, London, UK.

Lower gastrointestinal endoscopy has evolved over time, fulfilling a widening diagnostic and therapeutic remit. As our understanding of colorectal cancer and its prevention has improved, endoscopy has progressed with improved diagnostic technologies and advancing endoscopic therapies. Despite this, the fundamental design of the endoscope has remained similar since its inception. This review presents the important role lower gastrointestinal endoscopy serves in the prevention of colorectal cancer and the desirable characteristics of the endoscope that would enhance this. A brief history of the endoscope is presented. Current and future robotic endoscopic platforms, which may fulfil these desirable characteristics, are discussed. The incorporation of new technologies from allied scientific disciplines will help the endoscope fulfil its maximum potential in preventing the increasing global burden of colorectal cancer. There are a number of endoscopic platforms under development, which show significant promise.
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http://dx.doi.org/10.1177/2631774520979591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754801PMC
December 2020

Clinical outcomes of digital sensor alerting systems in remote monitoring: a systematic review and meta-analysis.

NPJ Digit Med 2021 Jan 8;4(1). Epub 2021 Jan 8.

Division of Surgery, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK.

Advances in digital technologies have allowed remote monitoring and digital alerting systems to gain popularity. Despite this, limited evidence exists to substantiate claims that digital alerting can improve clinical outcomes. The aim of this study was to appraise the evidence on the clinical outcomes of digital alerting systems in remote monitoring through a systematic review and meta-analysis. A systematic literature search, with no language restrictions, was performed to identify studies evaluating healthcare outcomes of digital sensor alerting systems used in remote monitoring across all (medical and surgical) cohorts. The primary outcome was hospitalisation; secondary outcomes included hospital length of stay (LOS), mortality, emergency department and outpatient visits. Standard, pooled hazard ratio and proportion of means meta-analyses were performed. A total of 33 studies met the eligibility criteria; of which, 23 allowed for a meta-analysis. A 9.6% mean decrease in hospitalisation favouring digital alerting systems from a pooled random effects analysis was noted. However, pooled weighted mean differences and hazard ratios did not reproduce this finding. Digital alerting reduced hospital LOS by a mean difference of 1.043 days. A 3% mean decrease in all-cause mortality from digital alerting systems was noted. There was no benefit of digital alerting with respect to emergency department or outpatient visits. Digital alerts can considerably reduce hospitalisation and length of stay for certain cohorts in remote monitoring. Further research is required to confirm these findings and trial different alerting protocols to understand optimal alerting to guide future widespread implementation.
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http://dx.doi.org/10.1038/s41746-020-00378-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794456PMC
January 2021

Perspectives Measuring more than just economic growth to improve well-being.

J Public Health (Oxf) 2020 Dec 24. Epub 2020 Dec 24.

Institute of Global Health Innovation, Imperial College, London SW7 2NA, United Kingdom.

It's official: The UK is in a recession. The economy has suffered its biggest slump on record with a drop in gross domestic product (GDP) of 20.4%. 1 This is going to have a significant impact on our health and well-being. It risks creating a spiralling decay as we know good health is not only a consequence, but also a condition for sustained and sustainable economic development. 2 In this way, the health of a nation creates a virtuous circle of improved health and improved economic prosperity. How we measure prosperity is therefore important and needs to be considered.
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http://dx.doi.org/10.1093/pubmed/fdaa203DOI Listing
December 2020

The role of the state in financing and regulating primary care in Europe: a taxonomy.

Health Policy 2021 Feb 16;125(2):168-176. Epub 2020 Nov 16.

Department of Surgery and Cancer, Imperial College London, Address: St Mary's Hospital, Praed St, Paddington, London W2 1NY, United Kingdom.

Traditional health systems typologies were based on health system financing type, such as the well-known OECD typology. However, the number of dimensions captured in classifications increased to reflect health systems complexity. This study aims to develop a taxonomy of primary care (PC) systems based on the actors involved (state, societal and private) and mechanisms used in governance, financing and regulation, which conceptually represents the degree of decentralisation of functions. We use nonlinear canonical correlations analysis and agglomerative hierarchical clustering on data obtained from the European Observatory on Health Systems and Policy and informants from 24 WHO European Region countries. We obtain four clusters: 1) Bosnia Herzegovina, Czech Republic, Germany, Slovakia and Switzerland: corporatist and/or fragmented PC system, with state involvement in PC supply regulation, without gatekeeping; 2) Greece, Ireland, Israel, Malta, Sweden, and Ukraine: public and (re)centralised PC financing and regulation with private involvement, without gatekeeping; 3) Finland, Norway, Spain and United Kingdom: public financing and devolved regulation and organisation of PC, with gatekeeping; and 4) Bulgaria, Croatia, France, North Macedonia, Poland, Romania, Serbia, Slovenia and Turkey: public and deconcentrated with professional involvement in supply regulation, and gatekeeping. This taxonomy can serve as a framework for performance comparisons and a means to analyse the effect that different actors and levels of devolution or fragmentation of PC delivery may have in health outcomes.
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http://dx.doi.org/10.1016/j.healthpol.2020.11.008DOI Listing
February 2021

Ensuring that the NHS realises fair financial value from its data.

Lancet Digit Health 2020 01 23;2(1):e10-e12. Epub 2019 Dec 23.

Institute of Global Health Innovation, Imperial College London, St Mary's Hospital, London W2 1NY, UK.

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http://dx.doi.org/10.1016/S2589-7500(19)30225-0DOI Listing
January 2020