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Sharma D, Mairal A, Prabhu J, Cotton M. Challenges faced by frugal surgical innovations. Trop Doct 2024; 54:223-226. [PMID: 38752260 DOI: 10.1177/00494755241253098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Affiliation(s)
- Dhananjaya Sharma
- Professor and Head, Department of Surgery, NSCB Government Medical College, Jabalpur, IN-MP, India
| | - Anurag Mairal
- Director, Global Outreach Programs, Center for Biodesign, Stanford University Byers Center for Biodesign, Stanford, CA, USA
| | - Jaideep Prabhu
- Jawaharlal Nehru Professor of Indian Business and Enterprise, Cambridge Judge Business School, University of Cambridge, Cambridge, UK
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Gupta KK, De M, Athanasiou T, Georgalas C, Garas G. Quality of life outcomes comparing primary Transoral Robotic Surgery (TORS) with primary radiotherapy for early-stage oropharyngeal squamous cell carcinoma: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108434. [PMID: 38795678 DOI: 10.1016/j.ejso.2024.108434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Transoral Robotic Surgery (TORS) and radiotherapy are considered oncologically equivalent primary treatment options for early-stage HPV-positive oropharyngeal squamous cell carcinoma (OPSCC). Quality of Life (QoL) and Patient Reported Outcome Measures (PROMs) are therefore imperative in supporting clinical decision-making and optimising patient-centred care. The aim of this article is to evaluate how these primary treatment modalities compare in terms of QoL. MATERIALS AND METHODS Systematic review and meta-analysis of studies comparing primary TORS and primary radiotherapy for OPSCC using validated QoL tools. Swallowing and global QoL were the primary endpoints with secondary endpoints including all other QoL domains. An inverse variance random-effects model was employed to calculate the weighted estimate of the treatment effects across trials. RESULTS A total of six studies collectively reporting on 555 patients were included (n = 236 TORS and n = 319 radiotherapy). Meta-analysis showed no significant difference for swallowing (mean difference = -0.24, p = 0.89) and global QoL (mean difference = 4.55, p = 0.14). For the remaining QoL domains (neck/shoulder impairment, neurotoxicity, voice, xerostomia, speech, and distress), the scarcity of data did not permit meta-analysis. However, the existing data showed no significant difference for any except for xerostomia where TORS appears favourable in the sole study reporting on this. CONCLUSIONS TORS and radiotherapy appear to be comparable primary treatment options for early stage OPSCC when it comes to QoL. However, a substantial proportion of patients in the TORS group received adjuvant (chemo)radiotherapy rendering it difficult to establish the 'true' QoL outcomes following surgery alone. There are also minimal studies reporting QoL outcomes beyond swallowing and global QoL. Further research is therefore needed, including more randomised trials adequately powered to detect differences in QoL outcomes.
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Affiliation(s)
- Keshav Kumar Gupta
- Head & Neck Unit. Department of Otorhinolaryngology and Head & Neck Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
| | - Mriganka De
- Head & Neck Unit. Department of Otorhinolaryngology and Head & Neck Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Thanos Athanasiou
- Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, United Kingdom
| | - Christos Georgalas
- Endoscopic Skull Base Centre Athens, Hygeia Hospital, Athens, Greece; Medical School, University of Nicosia, Nicosia, Cyprus
| | - George Garas
- Head & Neck Unit. Department of Otorhinolaryngology and Head & Neck Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, United Kingdom
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Marcus HJ, Ramirez PT, Khan DZ, Layard Horsfall H, Hanrahan JG, Williams SC, Beard DJ, Bhat R, Catchpole K, Cook A, Hutchison K, Martin J, Melvin T, Stoyanov D, Rovers M, Raison N, Dasgupta P, Noonan D, Stocken D, Sturt G, Vanhoestenberghe A, Vasey B, McCulloch P. The IDEAL framework for surgical robotics: development, comparative evaluation and long-term monitoring. Nat Med 2024; 30:61-75. [PMID: 38242979 DOI: 10.1038/s41591-023-02732-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/20/2023] [Indexed: 01/21/2024]
Abstract
The next generation of surgical robotics is poised to disrupt healthcare systems worldwide, requiring new frameworks for evaluation. However, evaluation during a surgical robot's development is challenging due to their complex evolving nature, potential for wider system disruption and integration with complementary technologies like artificial intelligence. Comparative clinical studies require attention to intervention context, learning curves and standardized outcomes. Long-term monitoring needs to transition toward collaborative, transparent and inclusive consortiums for real-world data collection. Here, the Idea, Development, Exploration, Assessment and Long-term monitoring (IDEAL) Robotics Colloquium proposes recommendations for evaluation during development, comparative study and clinical monitoring of surgical robots-providing practical recommendations for developers, clinicians, patients and healthcare systems. Multiple perspectives are considered, including economics, surgical training, human factors, ethics, patient perspectives and sustainability. Further work is needed on standardized metrics, health economic assessment models and global applicability of recommendations.
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Affiliation(s)
- Hani J Marcus
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK.
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK.
| | - Pedro T Ramirez
- Department of Obstetrics and Gynaecology, Houston Methodist Hospital Neal Cancer Center, Houston, TX, USA
| | - Danyal Z Khan
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Hugo Layard Horsfall
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - John G Hanrahan
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Simon C Williams
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - David J Beard
- RCS Surgical Interventional Trials Unit (SITU) & Robotic and Digital Surgery Initiative (RADAR), Nuffield Dept Orthopaedics, Rheumatology and Musculo-skeletal Sciences, University of Oxford, Oxford, UK
| | - Rani Bhat
- Department of Gynaecological Oncology, Apollo Hospital, Bengaluru, India
| | - Ken Catchpole
- Department of Anaesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew Cook
- NIHR Coordinating Centre and Clinical Trials Unit, University of Southampton, Southampton, UK
| | | | - Janet Martin
- Department of Anesthesia & Perioperative Medicine, University of Western Ontario, Ontario, Canada
| | - Tom Melvin
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Republic of Ireland
| | - Danail Stoyanov
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Maroeska Rovers
- Department of Medical Imaging, Radboudumc, Nijmegen, the Netherlands
| | - Nicholas Raison
- Department of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Prokar Dasgupta
- King's Health Partners Academic Surgery, King's College London, London, UK
| | | | - Deborah Stocken
- RCSEng Surgical Trials Centre, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Anne Vanhoestenberghe
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Baptiste Vasey
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Peter McCulloch
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
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Wang C, Kong D, Song H, Liu J, Qi M, Li L. Characterization of Global Research Trends and Prospects on Moyamoya Disease: Bibliometric Analysis. World Neurosurg 2023; 173:e329-e340. [PMID: 36796629 DOI: 10.1016/j.wneu.2023.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Moyamoya disease (MMD) is a rare cerebrovascular disease in neurology. This study investigates the literature related to MMD from its discovery to the present and identifies research levels, achievements, and trends. METHODS All publications on MMD from its discovery to present were downloaded from the Web of Science Core Collection on September 15, 2022 and bibliometric analyses were visualized by HistCite Pro, VOSviewer, Scimago Graphica, CiteSpace, and R language. RESULTS There were 3414 articles in 680 journals by 10,522 authors in 2441 institutions and 74 countries/regions worldwise are included in the analyses. Since the discovery of MMD, output of publications has shown an upward trend. Japan, the United States, China, and South Korea are 4 major countries in MMD. The United States has the strongest cooperation with other countries. China's Capital Medical University is the output-leading institution worldwide, followed by Seoul National University and Tohoku University. The 3 authors with the most published articles are Kiyohiro Houkin, Dong Zhang, and Satoshi Kuroda. World Neurosurgery, Neurosurgery, and Stroke are the most recognized journals for researchers. Hemorrhagic moyamoya disease, susceptibility gene, and arterial spin are the primary focus areas of MMD research. "Rnf213,""vascular disorder," and "progress" are the top keywords. CONCLUSIONS We analyzed publications of global scientific research on MMD systematically by bibliometric methods. This study can provide one of the most comprehensive and accurate analyses for MMD scholars worldwide.
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Affiliation(s)
- Cong Wang
- Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University, Shanghai, P. R. China
| | - Dewei Kong
- Postgraduate Training Base at Shanghai Gongli Hospital, Ningxia Medical University, Shanghai, P. R. China
| | - Huiling Song
- The Second People's Hospital of Nantong, Nantong, Jiangsu Province, P. R. China
| | - Jiajia Liu
- School of Medicine, Shanghai University, Shanghai, P. R. China
| | - Manman Qi
- School of Medicine, Shanghai University, Shanghai, P. R. China
| | - Longxuan Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China.
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Garas G, Roland NJ, Lancaster J, Zammit M, Manon VA, Davies K, Jones TM, De M, Holsinger FC, Prestwich RJD, Fleming JC. Novel Strategies for Managing Retropharyngeal Lymph Node Metastases in Head and Neck and Thyroid Cancer with Transoral Robotic Surgery (TORS). Ann Surg Oncol 2022; 29:7881-7890. [PMID: 35842533 DOI: 10.1245/s10434-022-12208-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/01/2022] [Indexed: 12/18/2022]
Abstract
Retropharyngeal metastases are encountered in a variety of head and neck malignancies, imposing significant surgical challenges owing to their distinct location and proximity to neurovascular structures. Radiotherapy is the recommended treatment in most cases owing to its oncological efficacy. However, retropharyngeal irradiation affects the superior pharyngeal constrictor muscles and parotid glands, with the potential for long-term dysphagia and xerostomia. A younger oropharyngeal and thyroid cancer patient demographic is trending, fueling interest in treatment de-escalation strategies. Consequently, reducing radiotoxicity and its long-term effects is of special relevance in modern head and neck oncology practice. Through its unique ability to safely extirpate these traditionally difficult-to-access retropharyngeal lymph nodes via a natural orifice, TransOral Robotic Surgery (TORS) can considerably lower the surgical morbidity of retropharyngeal lymph node dissection (RPLND), compared with current existing approaches. This review summarizes the latest developments in the field, exposing current research gaps and discusses specific clinical settings where TORS could enable treatment de-escalation. In early-stage node-negative oropharyngeal cancer, single-modality surgical treatment with TORS RPLND may improve risk stratification of metastasis and recurrence in this region. TORS RPLND is also a potentially viable treatment option in salvage of an isolated retropharyngeal node recurrence or in the primary setting of a thyroid malignancy with a single positive retropharyngeal node. In time, TORS RPLND may provide an alternative de-escalation strategy in these three scenarios. However, with the reported morbidities, further prospective trials with long-term follow-up data are required to prove oncological safety and functional benefits over existing strategies.
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Affiliation(s)
- George Garas
- Head and Neck Unit, Department of Otorhinolaryngology and Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, UK.
| | - Nick J Roland
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jeffrey Lancaster
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Matthew Zammit
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Victoria A Manon
- Department of Oral and Maxillofacial Surgery, The University of Texas at Houston, Houston, TX, USA
| | - Katharine Davies
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Terry M Jones
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Mriganka De
- Head and Neck Unit, Department of Otorhinolaryngology and Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, UK
| | - Floyd C Holsinger
- Department of Otorhinolaryngology and Head and Neck Surgery, Stanford School of Medicine, Stanford, CA, USA
| | - Robin J D Prestwich
- Department of Clinical Oncology, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jason C Fleming
- Liverpool Head and Neck Centre, Department of Otorhinolaryngology and Head & Neck Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Cleft Lip and Palate Research in Low- and Middle-income Countries: A Scientometric Analysis. Plast Reconstr Surg Glob Open 2022; 10:e4122. [PMID: 35186648 PMCID: PMC8846345 DOI: 10.1097/gox.0000000000004122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Abstract
Cleft lip and palate (CLP) comprise over 90% of the world’s congenital anomalies and cause significant disability worldwide, while disproportionally burdening low- and middle-income countries (LMICs). Research can help inform strategies that reduce disparities in accessing CLP care. We performed a scientometric analysis of CLP research in LMICs to identify influential contributors and themes.
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Panzarasa P, Griffiths CJ, Sastry N, De Simoni A. Social Medical Capital: How Patients and Caregivers Can Benefit From Online Social Interactions. J Med Internet Res 2020; 22:e16337. [PMID: 32720910 PMCID: PMC7420688 DOI: 10.2196/16337] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/14/2020] [Accepted: 03/30/2020] [Indexed: 11/13/2022] Open
Abstract
The rapid growth of online health communities and the increasing availability of relational data from social media provide invaluable opportunities for using network science and big data analytics to better understand how patients and caregivers can benefit from online conversations. Here, we outline a new network-based theory of social medical capital that will open up new avenues for conducting large-scale network studies of online health communities and devising effective policy interventions aimed at improving patients' self-care and health.
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Affiliation(s)
- Pietro Panzarasa
- School of Business and Management, Queen Mary University of London, London, United Kingdom
| | - Christopher J Griffiths
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Nishanth Sastry
- Department of Computer Science, University of Surrey, Surrey, United Kingdom
| | - Anna De Simoni
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, United Kingdom
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Ke L, Lu C, Shen R, Lu T, Ma B, Hua Y. Knowledge Mapping of Drug-Induced Liver Injury: A Scientometric Investigation (2010-2019). Front Pharmacol 2020; 11:842. [PMID: 32581801 PMCID: PMC7291871 DOI: 10.3389/fphar.2020.00842] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/22/2020] [Indexed: 12/12/2022] Open
Abstract
Background Drug-induced liver injury (DILI) is a common adverse event, which compromises the safety of numerous drugs, poses a significant risk to patient health, and enhances healthcare expenditures. Many articles have been recently published on DILI related research, though no relevant scientometric study has been published yet. This scientometric study was aimed at comprehensively analyzing the knowledge base and emerging topics on DILI. Methods The articles and reviews related to DILI, published from 2010 to 2019 in the Web of Science Core Collection (WoSCC), were retrieved on March 15, 2020, using relevant keywords. Four different scientometric software (HistCite, VOSviewer, CiteSpace, and R-bibliometrix) was used to conduct this scientometric study. Results A total of 1,995 publications were retrieved (including 1,550 articles and 445 reviews) from 592 academic journals with 56,273 co-cited references in 10 languages by 2,331 institutions from 79 countries/regions. The majority of publications (n = 727, 36.44%) were published in the United States, and the University of North Carolina contributed the most publications (n = 89, 4.46%). The most productive academic journal on DILI was the Toxicological Sciences [n = 79, 3.96%; impact factor (IF) 2018 = 3.564], and Hepatology was the first co-cited journal (n = 7,383, IF 2018 = 14.971). Fontana RJ and Teschke R may have significant influence on DILI research, with more publications (n = 46; n = 39) and co-citations (n = 382; n = 945). Definition, incidence rate or clinical characteristics, etiology or pathogenesis (such as the character of the innate immune system, the regulation of cell-death pathways, and susceptible HLA-B*5701 genotype), identification of main drugs and causality assessment (criteria and methods) were the knowledge base for DILI research. Exploring the microscopic mechanism (such as the organelle dysfunction and cytotoxicity induced by drugs, and exploration of role of neutrophils in DILI using mouse models) and developed newer approaches to prevent DILI (such as the prospective HLA-B*5701 screening and in vitro approaches for assessing the potential risk of candidate drugs for DILI) were the recent major topics for DILI research. Conclusion This scientometric study comprehensively reviewed the publications related to DILI during the past decade using quantitative and qualitative methods. This information would provide references for scholars, researching on DILI.
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Affiliation(s)
- Lixin Ke
- Department of Liver Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Cuncun Lu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Rui Shen
- Department of Liver Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tingting Lu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Bin Ma
- Key Laboratory of Preclinical Study for New Drug of Gansu Province, School of Basic Medical Science, Lanzhou University, Lanzhou, China
| | - Yunpeng Hua
- Department of Liver Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Garas G, Cingolani I, Patel VM, Panzarasa P, Darzi A, Athanasiou T. Evaluating the implications of Brexit for research collaboration and policy: a network analysis and simulation study. BMJ Open 2019; 9:e025025. [PMID: 31506256 PMCID: PMC6747879 DOI: 10.1136/bmjopen-2018-025025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 04/20/2019] [Accepted: 07/08/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the role of the European Union (EU) as a research collaborator in the UK's success as a global leader in healthcare research and innovation and quantify the impact that Brexit may have. DESIGN Network and regression analysis of scientific collaboration, followed by simulation models based on alternative scenarios. SETTING International real-world collaboration network among all countries involved in robotic surgical research and innovation. PARTICIPANTS 772 organisations from industry and academia nested within 56 countries and connected through 2397 collaboration links. MAIN OUTCOME MEASURES Research impact measured through citations and innovation value measured through the innovation index. RESULTS Globally, the UK ranks third in robotic surgical innovation, and the EU constitutes its prime collaborator. Brokerage opportunities and collaborators' geographical diversity are associated with a country's research impact (c=211.320 and 244.527, respectively; p<0·01) and innovation (c=18.819 and 30.850, respectively; p<0·01). Replacing EU collaborators with US ones is the only strategy that could benefit the UK, but on the condition that US collaborators are chosen among the top-performing ones, which is likely to be very difficult and costly, at least in the short term. CONCLUSIONS This study suggests what has long been argued, namely that the UK-EU research partnership has been mutually beneficial and that its continuation represents the best possible outcome for both negotiating parties. However, the uncertainties raised by Brexit necessitate looking beyond the EU for potential research partners. In the short term, the UK's best strategy might be to try and maintain its academic links with the EU. In the longer term, strategic relationships with research powerhouses, including the USA, China and India, are likely to be crucial for the UK to remain a global innovation leader.
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Affiliation(s)
- George Garas
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - Isabella Cingolani
- Big Data and Analytical Unit, Imperial College London, St. Mary's Hospital, London, UK
| | - Vanash M Patel
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - Pietro Panzarasa
- School of Business and Management, Queen Mary University of London, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
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