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Graham G, Goren N, Sounderajah V, DeSalvo K. Information is a determinant of health. Nat Med 2024; 30:927-928. [PMID: 38351186 DOI: 10.1038/s41591-023-02792-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Affiliation(s)
| | - Nira Goren
- YouTube, San Bruno, CA, USA
- Google, Mountain View, CA, USA
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Chidambaram S, Jain B, Jain U, Mwavu R, Baru R, Thomas B, Greaves F, Jayakumar S, Jain P, Rojo M, Battaglino MR, Meara JG, Sounderajah V, Celi LA, Darzi A. An introduction to digital determinants of health. PLOS Digit Health 2024; 3:e0000346. [PMID: 38175828 PMCID: PMC10766177 DOI: 10.1371/journal.pdig.0000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
In recent years, technology has been increasingly incorporated within healthcare for the provision of safe and efficient delivery of services. Although this can be attributed to the benefits that can be harnessed, digital technology has the potential to exacerbate and reinforce preexisting health disparities. Previous work has highlighted how sociodemographic, economic, and political factors affect individuals' interactions with digital health systems and are termed social determinants of health [SDOH]. But, there is a paucity of literature addressing how the intrinsic design, implementation, and use of technology interact with SDOH to influence health outcomes. Such interactions are termed digital determinants of health [DDOH]. This paper will, for the first time, propose a definition of DDOH and provide a conceptual model characterizing its influence on healthcare outcomes. Specifically, DDOH is implicit in the design of artificial intelligence systems, mobile phone applications, telemedicine, digital health literacy [DHL], and other forms of digital technology. A better appreciation of DDOH by the various stakeholders at the individual and societal levels can be channeled towards policies that are more digitally inclusive. In tandem with ongoing work to minimize the digital divide caused by existing SDOH, further work is necessary to recognize digital determinants as an important and distinct entity.
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Affiliation(s)
- Swathikan Chidambaram
- Department of Surgery & Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, South Kensington Campus, London, United Kingdom
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Urvish Jain
- Dietrich School of Arts and Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Rogers Mwavu
- Mbarara University of Science & Technology, Uganda
| | - Rama Baru
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
| | - Beena Thomas
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - Felix Greaves
- Science, Evidence and Analytics, National Institute for Health and Care Excellence, England, United Kingdom
- Faculty of Medicine, School of Public Health, Imperial College London, United Kingdom
| | - Shruti Jayakumar
- Department of Surgery & Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, South Kensington Campus, London, United Kingdom
| | - Pankaj Jain
- Health Plan Consumer and Provider Technology, Highmark Health, Pittsburgh, Pennsylvania, United States of America
- Department of Marketing, Indiana University of Pennsylvania, Indiana, Pennsylvania, United States of America
| | - Marina Rojo
- Public Health Innovation Lab, Med School, Buenos AIres University, Argentina
| | | | - John G. Meara
- Department of Plastic and Oral Surgery, Longwood Avenue, Boston, Massachusetts, United States of America
| | - Viknesh Sounderajah
- Department of Surgery & Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, South Kensington Campus, London, United Kingdom
| | - Leo Anthony Celi
- Division of Pulmonary, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Laboratory for Computational Physiology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Boston, Massachusetts, United States of America
| | - Ara Darzi
- Department of Surgery & Cancer, Imperial College London, St. Mary’s Hospital, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, South Kensington Campus, London, United Kingdom
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Menon N, Guidozzi N, Chidambaram S, Puri A, Sounderajah V, Ferri L, Griffiths EA, Low D, Maynard N, Mueller C, Pera M, van Berge Henegouwen MI, Watson DI, Zaininotto G, Hanna GB, Markar SR. Research protocol for the Paraesophageal hernia symptom tool, a prospective multi-center cohort study to identify the need and threshold for surgery and assess the symptom response to surgery. Dis Esophagus 2023; 36:doad028. [PMID: 37158194 PMCID: PMC10789234 DOI: 10.1093/dote/doad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Indexed: 05/10/2023]
Abstract
Large hiatus hernias with a significant paraesophageal component (types II-IV) have a range of insidious symptoms. Management of symptomatic hernias includes conservative treatment or surgery. Currently, there is no paraesophageal hernia disease-specific symptom questionnaire. As a result, many clinicians rely on the health-related quality of life questionnaires designed for gastro-esophageal reflux disease (GORD) to assess patients with hiatal hernias pre- and postoperatively. In view of this, a paraesophageal hernia symptom tool (POST) was designed. This POST questionnaire now requires validation and assessment of clinical utility. Twenty-one international sites will recruit patients with paraesophageal hernias to complete a series of questionnaires over a five-year period. There will be two cohorts of patients-patients with paraesophageal hernias undergoing surgery and patients managed conservatively. Patients are required to complete a validated GORD-HRQL, POST questionnaire, and satisfaction questionnaire preoperatively. Surgical cohorts will also complete questionnaires postoperatively at 4-6 weeks, 6 months, 12 months, and then annually for a total of 5 years. Conservatively managed patients will repeat questionnaires at 1 year. The first set of results will be released after 1 year with complete data published after a 5-year follow-up. The main results of the study will be patient's acceptance of the POST tool, clinical utility of the tool, assessment of the threshold for surgery, and patient symptom response to surgery. The study will validate the POST questionnaire and identify the relevance of the questionnaire in routine management of paraesophageal hernias.
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Affiliation(s)
- Nainika Menon
- Department of general surgery, Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK
| | - Nadia Guidozzi
- Department of General Surgery, University of Witwatersrand, Johannesburg, South Africa
| | - Swathikan Chidambaram
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
| | - Aiysha Puri
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
| | - Viknesh Sounderajah
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
| | - Lorenzo Ferri
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ewen A Griffiths
- Department of Surgery, Univeristy of Birmingham National Health Service Trust, Birmingham, UK
| | - Donald Low
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Centre, Seattle, Washington, USA
| | - Nick Maynard
- Department of Surgery, Oxford Upper GI Centre, Churchill Hospital, Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK
| | - Carmen Mueller
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Centre, Seattle, Washington, USA
| | - Manuel Pera
- Section of Gastrointestinal Surgery, Department of Surgery, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - David I Watson
- Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK
| | - Sheraz R Markar
- Department of general surgery, Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK
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Hanna L, Jha R, Sounderajah V, Markar S, Gibbs R. Patient Reported Outcome Measures Used to Assess Quality of Life in Aortic Dissection: a Systematic Scoping Review using COSMIN Methodology. Eur J Vasc Endovasc Surg 2023; 66:343-350. [PMID: 37391013 DOI: 10.1016/j.ejvs.2023.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/25/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE To systematically identify all patient reported outcome measures (PROMs) (quality of life [QOL] instruments or other instrument/methodology) that have been used to date in aortic dissection (AD) and to explore how well these instruments evaluate QOL according to the Consensus based Standards for the selection of health Measurement Instruments (COSMIN) methodology or guideline. DATA SOURCES Embase, MEDLINE, PsycINFO, CINAHL, and Cochrane Library were search on 1st July 2022. REVIEW METHODS This scoping review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) and the COSMIN guidelines for performing systematic reviews of validated PROMs. Studies that reported on any aspect or domain of QOL using a PROM or other instrument or methodology on AD were included. Data synthesis, including psychometric property analysis and risk of bias assessment were performed according to COSMIN guidelines. RESULTS Forty-five studies, published between 1994 and 2021 reporting on 5 874 patients (mean age 63 years, 70.6% male), were included. A total of 39 PROMs were used, and three studies used semi-structured interviews. The majority (69%) of studies were in patients with type A aortic dissection (TAAD). The most common PROM used was the SF-36 (51%). Six studies evaluated one or more psychometric properties of a PROM. Only one of these studies was specifically designed as a validation study. No study reported on content validity. Internal consistency was the most evaluated psychometric property. No study evaluated all the psychometric properties according to COSMIN methodology. The methodological quality used to assess these PROMs was judged to be adequate or very good. CONCLUSION This review highlights the heterogeneity of PROMs or methods used to determine QOL in AD patients. The lack of research regarding a comprehensive evaluation of the psychometric properties of a PROM used in AD highlights the need for the development and validation of a dissection specific PROM. [PROSPERO registration no. CRD42022310477].
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Affiliation(s)
- Lydia Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK.
| | - Rama Jha
- School of Medicine, Imperial College London, London, UK
| | - Viknesh Sounderajah
- Department of Surgery and Cancer, Imperial College London, London, UK; Institute of Global Health Innovation, Imperial College London, London, UK
| | - Sheraz Markar
- Department of Surgery and Cancer, Imperial College London, London, UK; Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Richard Gibbs
- Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
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Patel K, Sounderajah V, Hanna L, Acharya A, Chidambaram S, Normahani P, Markar SR, Bicknell C. Quantifying the burden of survivorship associated with infrarenal abdominal aortic aneurysms. J Vasc Surg 2023; 78:549-557.e23. [PMID: 36813007 DOI: 10.1016/j.jvs.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/31/2023] [Accepted: 02/10/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Survivorship encompasses the physical, psychological, social, functional, and economic experience of a living with a chronic condition for both the patient and their caregiver. It is made up of nine distinct domains and remains understudied in nononcological pathologies, including infrarenal abdominal aortic aneurysmal disease (AAA). This review aims to quantify the extent to which existing AAA literature addresses the burden of survivorship. METHODS The MEDLINE, EMBASE, and PsychINFO databases were searched from 1989 through September 2022. Randomized controlled trials, observational studies, and case series were included. Eligible studies had to detail outcomes related to survivorship in patients with AAA. Owing to the heterogeneity between studies and outcomes, no meta-analysis was conducted. Study quality was assessed with specific risk of bias tools. RESULTS A total of 158 studies were included. Of these, only five (treatment complications, physical functioning, comorbidities, caregivers, and mental health) of the nine domains of survivorship have been studied previously. The available evidence is of variable quality; most studies display a moderate to high risk of bias, are of an observational study design, are based within a limited number of countries, and consist of an insufficient follow-up period. The most frequent complication after EVAR was endoleak. EVAR is associated with poorer long-term outcomes compared with open surgical repair in most studies retrieved. EVAR showed better outcomes in regard to physical functioning in the short term, but this advantage was lost in the long term. The most common comorbidity studied was obesity. No significant differences were found between open surgical repair and EVAR in terms of impact on caregivers. Depression is associated with various comorbidities and increased the risk of a nonhospital discharge. CONCLUSIONS This review highlights the absence of robust evidence regarding survivorship in AAA. As a result, contemporary treatment guidelines rely on historic quality-of-life data that are narrow in scope and nonrepresentative of contemporary clinical practice. As such, there is an urgent need to reevaluate the aims and methodology associated with traditional quality-of-life research moving forward.
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Affiliation(s)
- Kian Patel
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Viknesh Sounderajah
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK; Institute of Global Health Innovation, Imperial College London, London, UK
| | - Lydia Hanna
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Amish Acharya
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK; Institute of Global Health Innovation, Imperial College London, London, UK
| | | | - Pasha Normahani
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Colin Bicknell
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College London, London, UK; Institute of Global Health Innovation, Imperial College London, London, UK
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Graham G, Sounderajah V, Johnson MN. Cardiovascular Health Equity for Survivors of Childhood Cancer: Understanding the Drivers of Cardiovascular Risk. JACC CardioOncol 2023; 5:501-503. [PMID: 37614578 PMCID: PMC10443103 DOI: 10.1016/j.jaccao.2023.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Affiliation(s)
| | - Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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Hanna L, Borsky K, Abdullah AA, Sounderajah V, Marshall DC, Salciccioli JD, Shalhoub J, Gibbs RGJ. Trends in Hospital Admissions, Operative Approaches, and Mortality Related to Abdominal Aortic Aneurysms in England Between 1998 and 2020. Eur J Vasc Endovasc Surg 2023; 66:68-76. [PMID: 36934837 DOI: 10.1016/j.ejvs.2023.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/26/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE To assess trends in abdominal aortic aneurysm (AAA) hospital admissions, interventions, and aneurysm related mortality in England, and to examine the impact of endovascular repair on mortality for the years 1998 - 2020. METHODS Hospital admission and operative approach (endovascular aortic aneurysm repair, or open surgical repair [OSR]) using Hospital Episodes Statistics (HES), and aneurysm related mortality data from the Office for National Statistics for England standardised to the 2013 European Standard Population, were analysed using linear regression and Joinpoint regression analyses. Aneurysm related mortality was compared between the pre-endovascular era (1998 - 2010) and the endovascular era (2011 - 2019). RESULTS A declining trend in hospital admission incidence was observed, mainly due to a decline in ruptured admissions from 34.6 per 100 000 (95% confidence interval [CI] 33.5 - 35.6) to 13.5 per 100 000 (95% CI 12.9 - 14.2; βi = -1.04, r2 = .97, p < .001). Operative interventions have been declining over the last 23 years mainly due to the statistically significant decline in open procedures (41.2 per 100 000 in 2000 [95% CI 40 - 42.3] to 9.6 per 100 000 [95% CI 9.1 - 10.1]; βi = -1.92, r2 = .95; p < .001). There was an increasing trend toward endovascular procedures (5.8 per 100 000 [95% CI 5.3 - 6.2] in 2006 to 16.9 per 100 000 [95% CI 16.2 - 17.5] in 2020; βi = .82, r2 = .30, p = .040). Reductions in aneurysm related mortality due to AAAs were observed for males and females, irrespective of age and rupture status. CONCLUSION A significant decrease in hospital admissions for AAAs was observed over the last 23 years in England, paralleled by a shift toward endovascular repair and a decline in OSR. Declines in aneurysm related mortality were observed overall, and in the endovascular era irrespective of age, sex, and rupture status.
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Affiliation(s)
- Lydia Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK.
| | - Kim Borsky
- Medical Data Research Collaborative, London, UK; Department of Plastic Surgery, Salisbury NHS Foundation Trust, Salisbury, UK
| | - Ammar A Abdullah
- Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Viknesh Sounderajah
- Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Institute of Global Health Innovation, Imperial College London, London, UK
| | - Dominic C Marshall
- Medical Data Research Collaborative, London, UK; Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Justin D Salciccioli
- Medical Data Research Collaborative, London, UK; Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Joseph Shalhoub
- Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK; Medical Data Research Collaborative, London, UK
| | - Richard G J Gibbs
- Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
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Acharya A, Judah G, Ashrafian H, Sounderajah V, Johnstone-Waddell N, Harris M, Stevenson A, Darzi A. Investigating the national implementation of SMS and mobile messaging in population screening (The SIPS study). EBioMedicine 2023; 93:104685. [PMID: 37384997 DOI: 10.1016/j.ebiom.2023.104685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 05/25/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND The increasing use of mobile messaging within healthcare, poses challenges for screening programmes, which involve communicating with large, diverse populations. This modified Delphi study aimed to create guidance regarding the use of mobile messaging for screening programmes, to facilitate greater, and equitable screening uptake. METHODS Initial recommendations were derived from a literature review, expert scoping questionnaire, public consultation, and discussion with relevant national organisations. Experts from the fields of public health, screening commissioning, industry and academia voted upon the importance and feasibility of these recommendations across two consensus rounds, using a 5-point Likert scale. Items reaching consensus, defined a priori at 70%, on importance and feasibility formed 'core' recommendations. Those reaching this threshold on importance only, were labelled 'desirable'. All items were subsequently discussed at an expert meeting to confirm suitability. FINDINGS Of the initial 101 items, 23 reached consensus regarding importance and feasibility. These 'core' items were divided across six domains: message content, timing, delivery, evaluation, security, and research considerations. 'Core' items such as explicitly specifying the sender and the role of patient involvement in development of screening message research had the highest agreement. A further 17 'desirable' items reached consensus regarding importance, but not feasibility, including the integration into GP services to enable telephone verification. INTERPRETATION These findings forming national guidance for services, will enable programmes to overcome implementation challenges and facilitate uptake of screening invitations. By providing a list of desirable items, this study provides areas for future consideration, as technological innovation in messaging continues to grow. FUNDING NIHR Imperial Patient Safety Translational Research Centre.
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Affiliation(s)
- Amish Acharya
- Institute of Global Health Innovation, Imperial College London, London, W2 1NY, United Kingdom.
| | - Gaby Judah
- Institute of Global Health Innovation, Imperial College London, London, W2 1NY, United Kingdom
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, W2 1NY, United Kingdom
| | - Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London, London, W2 1NY, United Kingdom
| | | | - Mike Harris
- Department of Health and Social Care, London, SW1H 0EU, United Kingdom; Public Health England, London, United Kingdom
| | - Anne Stevenson
- Department of Health and Social Care, London, SW1H 0EU, United Kingdom; Public Health England, London, United Kingdom
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, W2 1NY, United Kingdom
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Ong ZZ, Sadek Y, Liu X, Qureshi R, Liu SH, Li T, Sounderajah V, Ashrafian H, Ting DSW, Said DG, Mehta JS, Burton MJ, Dua HS, Ting DSJ. Diagnostic performance of deep learning in infectious keratitis: a systematic review and meta-analysis protocol. BMJ Open 2023; 13:e065537. [PMID: 37164459 PMCID: PMC10173987 DOI: 10.1136/bmjopen-2022-065537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 04/27/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Infectious keratitis (IK) represents the fifth-leading cause of blindness worldwide. A delay in diagnosis is often a major factor in progression to irreversible visual impairment and/or blindness from IK. The diagnostic challenge is further compounded by low microbiological culture yield, long turnaround time, poorly differentiated clinical features and polymicrobial infections. In recent years, deep learning (DL), a subfield of artificial intelligence, has rapidly emerged as a promising tool in assisting automated medical diagnosis, clinical triage and decision-making, and improving workflow efficiency in healthcare services. Recent studies have demonstrated the potential of using DL in assisting the diagnosis of IK, though the accuracy remains to be elucidated. This systematic review and meta-analysis aims to critically examine and compare the performance of various DL models with clinical experts and/or microbiological results (the current 'gold standard') in diagnosing IK, with an aim to inform practice on the clinical applicability and deployment of DL-assisted diagnostic models. METHODS AND ANALYSIS This review will consider studies that included application of any DL models to diagnose patients with suspected IK, encompassing bacterial, fungal, protozoal and/or viral origins. We will search various electronic databases, including EMBASE and MEDLINE, and trial registries. There will be no restriction to the language and publication date. Two independent reviewers will assess the titles, abstracts and full-text articles. Extracted data will include details of each primary studies, including title, year of publication, authors, types of DL models used, populations, sample size, decision threshold and diagnostic performance. We will perform meta-analyses for the included primary studies when there are sufficient similarities in outcome reporting. ETHICS AND DISSEMINATION No ethical approval is required for this systematic review. We plan to disseminate our findings via presentation/publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022348596.
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Affiliation(s)
- Zun Zheng Ong
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Youssef Sadek
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Xiaoxuan Liu
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Riaz Qureshi
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Su-Hsun Liu
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Daniel Shu Wei Ting
- Duke-NUS Medical School, National University of Singapore, Singapore
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Dalia G Said
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
- Research Institute of Ophthalmology, Cairo, Egypt
| | - Jodhbir S Mehta
- Duke-NUS Medical School, National University of Singapore, Singapore
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Harminder Singh Dua
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Darren Shu Jeng Ting
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
- Birmingham and Midland Eye Centre, Birmingham, UK
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Elghazaly H, Howard T, Sanjay S, Mohamed OG, Sounderajah V, Mehar Z, Davies AH, Jaffer U, Normahani P. Evaluating the prognostic performance of bedside tests used for peripheral arterial disease diagnosis in the prediction of diabetic foot ulcer healing. BMJ Open Diabetes Res Care 2023; 11:11/2/e003110. [PMID: 36918215 PMCID: PMC10016246 DOI: 10.1136/bmjdrc-2022-003110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/21/2022] [Indexed: 03/15/2023] Open
Abstract
INTRODUCTION Diabetic foot ulceration (DFU) is a common and challenging complication of diabetes. Risk stratification can guide further management. We aim to evaluate the prognostic performance of bedside tests used for peripheral arterial disease (PAD) diagnosis to predict DFU healing. RESEARCH DESIGN AND METHODS Testing for Arterial Disease in Diabetes (TrEAD) was a prospective observational study comparing the diagnostic performance of commonly used tests for PAD diagnosis. We performed a secondary analysis assessing whether these could predict DFU healing. Follow-up was performed prospectively for 12 months. The primary outcome was sensitivity for predicting ulcer healing. Secondary endpoints were specificity, predictive values, and likelihood ratios for ulcer healing. RESULTS 123 of TrEAD participants with DFU were included. In 12 months, 52.8% of ulcers healed. The best negative diagnostic likelihood ratio (NDLR) was observed for the podiatry ankle duplex scan (PAD-scan) monophasic or biphasic with adverse features(NDLR 0.35, 95% CI 0.14-0.90). The highest positive likelihood ratios were observed for toe brachial pressure index of ≤0.2 (positive diagnostic likelihood ratio (PDLR) 7.67, 95% CI 0.91-64.84) and transcutaneous pressure of oxygen of ≤20 mm Hg (PDLR 2.68, 95% CI 0.54-13.25). Cox proportional hazards modeling demonstrated significantly greater probabilities of healing with triphasic waveforms (HR=2.54, 95% CI 1.23-5.3, p=0.012) and biphasic waveforms with non-adverse features (HR=13.67, 95% CI 4.78-39.1, p<0.001) on PAD-scan. CONCLUSIONS No single test performed well enough to be used in isolation as a prognostic marker for the prediction of DFU healing. TRIAL REGISTRATION NUMBER NCT04058626.
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Affiliation(s)
- Hussein Elghazaly
- Section of Vascular Surgery, Imperial College London, London, UK
- Imperial Vascular Unit, Imperial College NHS Healthcare Trust, London, UK
| | - Theodore Howard
- Imperial Vascular Unit, Imperial College NHS Healthcare Trust, London, UK
| | - Sharan Sanjay
- Imperial Vascular Unit, Imperial College NHS Healthcare Trust, London, UK
| | - Omer G Mohamed
- Imperial Vascular Unit, Imperial College NHS Healthcare Trust, London, UK
| | - Viknesh Sounderajah
- Section of Vascular Surgery, Imperial College London, London, UK
- Imperial Vascular Unit, Imperial College NHS Healthcare Trust, London, UK
| | - Zaheer Mehar
- Department of Vascular Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Alun H Davies
- Section of Vascular Surgery, Imperial College London, London, UK
- Imperial Vascular Unit, Imperial College NHS Healthcare Trust, London, UK
| | - Usman Jaffer
- Section of Vascular Surgery, Imperial College London, London, UK
- Imperial Vascular Unit, Imperial College NHS Healthcare Trust, London, UK
| | - Pasha Normahani
- Section of Vascular Surgery, Imperial College London, London, UK
- Imperial Vascular Unit, Imperial College NHS Healthcare Trust, London, UK
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11
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Cacciamani GE, Chu TN, Sanford DI, Abreu A, Duddalwar V, Oberai A, Kuo CCJ, Liu X, Denniston AK, Vasey B, McCulloch P, Wolff RF, Mallett S, Mongan J, Kahn CE, Sounderajah V, Darzi A, Dahm P, Moons KGM, Topol E, Collins GS, Moher D, Gill IS, Hung AJ. PRISMA AI reporting guidelines for systematic reviews and meta-analyses on AI in healthcare. Nat Med 2023; 29:14-15. [PMID: 36646804 DOI: 10.1038/s41591-022-02139-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
- AI Center at USC Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA.
- Department of Radiology, University of Southern California, Los Angeles, CA, USA.
- Center for Image-Guided and Focal Therapy for Prostate Cancer, Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
- Norris Comprehensive Cancer Center, Institute of Urology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Timothy N Chu
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- AI Center at USC Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Daniel I Sanford
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- AI Center at USC Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Andre Abreu
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- AI Center at USC Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
- Center for Image-Guided and Focal Therapy for Prostate Cancer, Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, Institute of Urology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Vinay Duddalwar
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
- USC Radiomics Laboratory, Keck School of Medicine, Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Assad Oberai
- Department of Aerospace and Mechanical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - C-C Jay Kuo
- Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, CA, USA
| | - Xiaoxuan Liu
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Alastair K Denniston
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- Health Data Research, London, UK
| | - Baptiste Vasey
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Peter McCulloch
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Sue Mallett
- Centre for Medical Imaging, University College London, London, UK
| | - John Mongan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
- Center for Intelligent Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Charles E Kahn
- Department of Radiology and Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Philipp Dahm
- Minneapolis VAMC, Urology Section and University of Minnesota, Department of Urology, Minneapolis, MN, USA
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Eric Topol
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, USA
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Inderbir S Gill
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- AI Center at USC Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
- Department of Radiology, University of Southern California, Los Angeles, CA, USA
- Center for Image-Guided and Focal Therapy for Prostate Cancer, Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, Institute of Urology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Andrew J Hung
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- AI Center at USC Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, Institute of Urology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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12
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Bolous NS, Graetz DE, Ashrafian H, Barlow J, Bhakta N, Sounderajah V, Dowdeswell B. Harnessing a clinician-led governance model to overcome healthcare tribalism and drive innovation: a case study of Northumbria NHS Foundation Trust. J Health Organ Manag 2022; ahead-of-print:1-16. [PMID: 36520658 PMCID: PMC10430796 DOI: 10.1108/jhom-05-2022-0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 05/26/2022] [Accepted: 10/04/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Healthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-led governance model, implemented at a National Health Service (NHS) trust, to investigate whether it successfully overcame tribalism and helped drive innovation. DESIGN/METHODOLOGY/APPROACH This was a convergent mixed-methods study including qualitative and quantitative data collected in parallel. Qualitative data included 27 semi-structured interviews with representatives from four professional groups. Quantitative data were collected through a verbally administered survey and scored on a 10-point scale. FINDINGS The trust arranged its services under five autonomous business units, with a clinician and a manager sharing the leadership role at each unit. According to interviewees replies, this equivalent authority was cascaded down and enabled breaking down professional siloes, which in turn aided in the adoption of an innovative clinical model restructure. PRACTICAL IMPLICATIONS This study contributes to the literature by characterizing a real-world example in which healthcare tribalism was mitigated while reflecting on the advantages yielded as a result. ORIGINALITY/VALUE Previous studies from all over the world identified major differences in the perspectives of different healthcare professional groups. In the United Kingdom, clinicians largely felt cut off from decision-making and dissatisfied with their managerial role. The study findings explain a governance model that allowed harmony and inclusion of different professions. Given the long-standing strains on healthcare systems worldwide, stakeholders can leverage the study findings for guidance in developing and implementing innovative managerial approaches.
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Affiliation(s)
- Nancy S. Bolous
- Department of Global Pediatric Medicine
,
St Jude Children’s Research Hospital
, Memphis, Tennessee,
USA
| | - Dylan E. Graetz
- Department of Global Pediatric Medicine
,
St Jude Children’s Research Hospital
, Memphis, Tennessee,
USA
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London
, London,
UK
- Department of Surgery and Cancer,
Imperial College London
, London,
UK
| | - James Barlow
- Business School,
Imperial College London
, London,
UK
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine
,
St Jude Children’s Research Hospital
, Memphis, Tennessee,
USA
| | - Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London
, London,
UK
- Department of Surgery and Cancer,
Imperial College London
, London,
UK
| | - Barrie Dowdeswell
- Management Center Innsbruck, Internationale Hochschule GmbH
, Innsbruck,
Austria
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13
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Hanna L, Sounderajah V, Abdullah A, Marshall D, Salciccioli J, Shalhoub J, Gibbs R. Trends in Thoracic Aortic Aneurysm Hospital Admissions, Interventions, and Mortality in England between 1998 and 2020: An Observational Study. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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14
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Ganapathi S, Palmer J, Alderman JE, Calvert M, Espinoza C, Gath J, Ghassemi M, Heller K, Mckay F, Karthikesalingam A, Kuku S, Mackintosh M, Manohar S, Mateen BA, Matin R, McCradden M, Oakden-Rayner L, Ordish J, Pearson R, Pfohl SR, Rostamzadeh N, Sapey E, Sebire N, Sounderajah V, Summers C, Treanor D, Denniston AK, Liu X. Tackling bias in AI health datasets through the STANDING Together initiative. Nat Med 2022; 28:2232-2233. [PMID: 36163296 DOI: 10.1038/s41591-022-01987-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Shaswath Ganapathi
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jo Palmer
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joseph E Alderman
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.,Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK.,NIHR Applied Research Collaborative West Midlands University of Birmingham, Birmingham, UK
| | | | - Jacqui Gath
- Patient Partner, Birmingham, UK.,Patient Partner, Sheffield, UK
| | - Marzyeh Ghassemi
- Department of Electrical Engineering and Computer Science; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Francis Mckay
- The Ethox Centre and the Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Stephanie Kuku
- Institute of Women's Health, University College London, London, UK.,Hardian Health, London, UK
| | | | | | - Bilal A Mateen
- Institute of Health Informatics, University College London, London, UK.,The Wellcome Trust, London, UK
| | - Rubeta Matin
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Melissa McCradden
- Department of Bioethics, Hospital for Sick Children, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Oakden-Rayner
- Australian Institute for Machine Learning, University of Adelaide, Adelaide, South Australia, Australia
| | - Johan Ordish
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Russell Pearson
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | | | | | - Elizabeth Sapey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Neil Sebire
- Health Data Research, London, UK.,Great Ormond Street Hospital for Children, London, UK
| | - Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Charlotte Summers
- Wolfson Lung Injury Unit, Heart and Lung Research Institute, University of Cambridge, Cambrdige, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Darren Treanor
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.,University of Leeds, Leeds, UK.,Department of Clinical Pathology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Alastair K Denniston
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.,Health Data Research, London, UK
| | - Xiaoxuan Liu
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. .,Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. .,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.
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15
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Acharya A, Judah G, Ashrafian H, Sounderajah V, Johnstone-Waddell N, Harris M, Stevenson A, Darzi A. Investigating the implementation of mobile messaging in population screening programmes: a modified Delphi study. Lancet 2022; 400 Suppl 1:S15. [PMID: 36929957 DOI: 10.1016/s0140-6736(22)02225-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mobile messaging is an increasingly important health-care communication tool. Screening programmes pose unique challenges because of the large, diverse populations invited, who might have not interacted with services previously. This study aimed to provide guidance on how screening programmes in England can effectively implement mobile messaging services. METHODS Experts based in England, from public health, policy, screening provision, communications, and academia were recruited to this Delphi study. Recommendations were derived from an evidence synthesis involving a literature review, expert scoping questionnaire, public consultation, and discussion with relevant national organisations. Experts voted upon the importance and feasibility of recommendations across two consensus rounds, using a five-point Likert scale. Items reaching consensus, defined a priori at 70%, on importance and feasibility formed core recommendations. Those reaching this threshold on importance only, were labelled desirable. All items were discussed at an expert meeting to determine suitability. Ethical approval was obtained (20IC6088), and participants provided informed consent. FINDINGS 33 experts representing all 11 screening programmes were enrolled, with 100% retention across rounds. Of the initial 101 items, 23 (23%) reached consensus. These core recommendations were divided across six domains: message content, timing, delivery, evaluation, security, and research. They included the use of general practitioner endorsement and limiting message length to 320 characters. A further 17 items were considered desirable; for example, introducing greater functionality such as bidirectional and tailored messaging. INTERPRETATION Findings will facilitate the effective use of mobile messaging across screening and will form national guidance for services. This guidance will enable programmes to overcome implementation challenges and facilitate uptake of screening invitations. As representation of experts was skewed toward cancer versus non-cancer screening programmes, the generalisability of these findings must be carefully considered. However, the list of desirable items provides areas for future consideration for all programmes, as technological innovation in messaging grows. FUNDING National Institute for Health and Care Research Imperial Patient Safety Translational Research Centre.
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Affiliation(s)
- Amish Acharya
- Institute of Global Health Innovation, Imperial College London, London, UK.
| | - Gaby Judah
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, UK
| | | | | | - Mike Harris
- UK Department of Health and Social Care, London, UK
| | | | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK
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16
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Chidambaram S, Sounderajah V, Maynard N, Owen R, Markar SR. Evaluation of tumor regression by neoadjuvant chemotherapy regimens for esophageal adenocarcinoma: a systematic review and meta-analysis. Dis Esophagus 2022; 36:6712698. [PMID: 36151055 PMCID: PMC9885734 DOI: 10.1093/dote/doac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/31/2022] [Accepted: 08/11/2022] [Indexed: 02/02/2023]
Abstract
Locally advanced esophageal adenocarcinomas (EACs) are treated with multimodal therapy, namely surgery, neoadjuvant chemotherapy (NAC) or chemoradiotherapy (CRT) depending on patient and tumor level factors. Yet, there is little consensus on choice of the optimum systemic therapy. To compare the pathological complete response (pCR) after FLOT, non-FLOT-based chemotherapy and chemoradiotherapy regimes in patients with EACs. A systematic review of the literature was performed using MEDLINE, EMBASE, the Cochrane Review and Scopus databases. Studies were included if they had investigated the use of chemo(radio)therapy regimens in the neoadjuvant setting for EAC and reported the pCR rates. A meta-analysis of proportions was performed to compare the pooled pCR rates between FLOT, non-FLOT and CRT cohorts. We included 22 studies that described tumor regression post-NAC. Altogether, 1,056 patients had undergone FLOT or DCF regimes, while 1,610 patients had received ECF or ECX. The pCR rates ranged from 3.3% to 54% for FLOT regimes, while pCR ranged between 0% and 31% for ECF/ECX protocols. Pooled random-effects meta-meta-analysis of proportions showed a statistically significant higher incidence of pCR in FLOT-based chemotherapy at 0.148 (95%CI: 0.080, 0.259) compared with non-FLOT-based chemotherapy at 0.074 (95%CI: 0.042, 0.129). However, pCR rates were significantly highest at 0.250 (95%CI: 0.202, 0.306) for CRT. The use of enhanced FLOT-based regimens have improved the pCR rates for chemotherapeutic regimes but still falls short of pathological outcomes from CRT. Further work can characterize clinical responses to neoadjuvant therapy and determine whether an organ-preservation strategy is feasible.
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Affiliation(s)
| | | | - Nick Maynard
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Richard Owen
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Sheraz R Markar
- Address correspondence to: Mr Sheraz R. Markar MBChB, PhD (Imperial), PhD (Karolinska), FRCS, Department of Surgery, Churchill Hospital, Old Road, Headington, Oxford OX3 7LE, UK.
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17
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Chidambaram S, Maheswaran Y, Patel K, Sounderajah V, Hashimoto DA, Seastedt KP, McGregor AH, Markar SR, Darzi A. Using Artificial Intelligence-Enhanced Sensing and Wearable Technology in Sports Medicine and Performance Optimisation. Sensors (Basel) 2022; 22:6920. [PMID: 36146263 PMCID: PMC9502817 DOI: 10.3390/s22186920] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Wearable technologies are small electronic and mobile devices with wireless communication capabilities that can be worn on the body as a part of devices, accessories or clothes. Sensors incorporated within wearable devices enable the collection of a broad spectrum of data that can be processed and analysed by artificial intelligence (AI) systems. In this narrative review, we performed a literature search of the MEDLINE, Embase and Scopus databases. We included any original studies that used sensors to collect data for a sporting event and subsequently used an AI-based system to process the data with diagnostic, treatment or monitoring intents. The included studies show the use of AI in various sports including basketball, baseball and motor racing to improve athletic performance. We classified the studies according to the stage of an event, including pre-event training to guide performance and predict the possibility of injuries; during events to optimise performance and inform strategies; and in diagnosing injuries after an event. Based on the included studies, AI techniques to process data from sensors can detect patterns in physiological variables as well as positional and kinematic data to inform how athletes can improve their performance. Although AI has promising applications in sports medicine, there are several challenges that can hinder their adoption. We have also identified avenues for future work that can provide solutions to overcome these challenges.
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Affiliation(s)
- Swathikan Chidambaram
- Department of Surgery & Cancer, Imperial College London, St. Mary’s Hospital, London W2 1NY, UK
- Institute of Global Health Innovation, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Yathukulan Maheswaran
- Department of Surgery & Cancer, Imperial College London, St. Mary’s Hospital, London W2 1NY, UK
| | - Kian Patel
- Department of Surgery & Cancer, Imperial College London, St. Mary’s Hospital, London W2 1NY, UK
| | - Viknesh Sounderajah
- Department of Surgery & Cancer, Imperial College London, St. Mary’s Hospital, London W2 1NY, UK
- Institute of Global Health Innovation, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Daniel A. Hashimoto
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | | | - Alison H. McGregor
- Musculoskeletal Laboratory, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, White City Campus, London W12 OBZ, UK
| | - Sheraz R. Markar
- Department of Surgery & Cancer, Imperial College London, St. Mary’s Hospital, London W2 1NY, UK
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden
- Nuffield Department of Surgical Sciences, Department of Surgery, Churchill Hospital, Old Road, Headington, Oxford OX3 7LE, UK
| | - Ara Darzi
- Department of Surgery & Cancer, Imperial College London, St. Mary’s Hospital, London W2 1NY, UK
- Institute of Global Health Innovation, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
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18
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Wallace W, Chan C, Chidambaram S, Hanna L, Iqbal F, Acharya A, Normahani P, Ashrafian H, Markar S, Sounderajah V, Darzi A. 471 Assessing the Accuracy and Bias of Digital Symptom Checkers with Myocardial Infarction Patients. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Aim
The accuracy and safety of symptom checkers in diagnosing and triaging patients is of concern; especially those with life-threatening conditions. The study's aims were to: 1. assess the accuracy of symptom checkers in diagnosing and triaging myocardial infarctions (MI) and, 2. determine whether differences in gender or presentation type exist.
Method
This prospective diagnostic accuracy study assessed 8 symptom checkers using 100 MI patients of various presentations: typical or atypical. The ability of a symptom checker in providing MI as the first diagnosis (D1) and the first 3 (D3) diagnoses were diagnostic accuracy measures. Triage advice was deemed correct if the symptom checker recommended seeking emergency treatment.
Results
Symptom checkers correctly diagnosed 48.0±31.4% of cases with MI first. D3 accuracy was 72.6±20.2%. Mean triage accuracy was 82.6±12.6%.
24.0±16.2% of atypical cases had a correct primary diagnosis. D3 accuracy for atypical MI was 43.8±20.6%, significantly lower than that of typical MI (p<0.01). Atypical case triage accuracy was 52.7±20.0%, significantly lower than typical cases (84.2±14.7%, p<0.01).
10.0% of the atypical female cases were diagnosed correctly with MI as the first diagnosis. Female atypical cases had significantly lower accuracy than typical female cases for all accuracy measures (p<0.01).
Conclusions
Symptom checkers generally provide low accuracy for diagnosing MI. Approximately 20% of cases were under-triaged. Results varied between symptom checkers: patients who presented with atypical symptoms tended to be under-diagnosed and under-triaged, especially those who were female. This demonstrated potential gender bias and therefore raises questions regarding symptom checker regulation and safety.
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Affiliation(s)
- W Wallace
- Imperial College London , London , United Kingdom
| | - C Chan
- Imperial College London , London , United Kingdom
| | | | - L Hanna
- Imperial College London , London , United Kingdom
| | - F Iqbal
- Imperial College London , London , United Kingdom
| | - A Acharya
- Imperial College London , London , United Kingdom
| | - P Normahani
- Imperial College London , London , United Kingdom
| | - H Ashrafian
- Imperial College London , London , United Kingdom
| | - S Markar
- Karolinska Institutet , Stockholm , Sweden
- University of Oxford , Oxford , United Kingdom
| | | | - A Darzi
- Imperial College London , London , United Kingdom
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19
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Wallace W, Chan C, Chidambaram S, Hanna L, Iqbal FM, Acharya A, Normahani P, Ashrafian H, Markar SR, Sounderajah V, Darzi A. The diagnostic and triage accuracy of digital and online symptom checker tools: a systematic review. NPJ Digit Med 2022; 5:118. [PMID: 35977992 PMCID: PMC9385087 DOI: 10.1038/s41746-022-00667-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 07/25/2022] [Indexed: 11/09/2022] Open
Abstract
Digital and online symptom checkers are an increasingly adopted class of health technologies that enable patients to input their symptoms and biodata to produce a set of likely diagnoses and associated triage advice. However, concerns regarding the accuracy and safety of these symptom checkers have been raised. This systematic review evaluates the accuracy of symptom checkers in providing diagnoses and appropriate triage advice. MEDLINE and Web of Science were searched for studies that used either real or simulated patients to evaluate online or digital symptom checkers. The primary outcomes were the diagnostic and triage accuracy of the symptom checkers. The QUADAS-2 tool was used to assess study quality. Of the 177 studies retrieved, 10 studies met the inclusion criteria. Researchers evaluated the accuracy of symptom checkers using a variety of medical conditions, including ophthalmological conditions, inflammatory arthritides and HIV. A total of 50% of the studies recruited real patients, while the remainder used simulated cases. The diagnostic accuracy of the primary diagnosis was low across included studies (range: 19–37.9%) and varied between individual symptom checkers, despite consistent symptom data input. Triage accuracy (range: 48.8–90.1%) was typically higher than diagnostic accuracy. Overall, the diagnostic and triage accuracy of symptom checkers are variable and of low accuracy. Given the increasing push towards adopting this class of technologies across numerous health systems, this study demonstrates that reliance upon symptom checkers could pose significant patient safety hazards. Large-scale primary studies, based upon real-world data, are warranted to demonstrate the adequate performance of these technologies in a manner that is non-inferior to current best practices. Moreover, an urgent assessment of how these systems are regulated and implemented is required.
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Affiliation(s)
- William Wallace
- Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK
| | - Calvin Chan
- Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK
| | - Swathikan Chidambaram
- Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK
| | - Lydia Hanna
- Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK
| | - Fahad Mujtaba Iqbal
- Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK.,Institute of Global Health Innovation, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Amish Acharya
- Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK.,Institute of Global Health Innovation, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Pasha Normahani
- Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Sheraz R Markar
- Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Nuffield Department of Surgery, Churchill Hospital, University of Oxford, OX3 7LE, Oxford, UK
| | - Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
| | - Ara Darzi
- Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK.,Institute of Global Health Innovation, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
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20
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Hanna L, Lam K, Agbeko A, Amoako J, Ashrafian H, Sounderajah V, Abdullah A, Gibbs R. Coverage of the Coeliac Artery During Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-Analysis. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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21
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Chidambaram S, Patel NM, Sounderajah V, Alfieri R, Bonavina L, Cheong E, Cockbain A, D’Journo XB, Ferri L, Griffiths EA, Grimminger P, Gronnier C, Gutschow C, Hedberg J, Kauppila JH, Lagarde S, Low D, Nafteux P, Nieuwenhuijzen G, Nilsson M, Rosati R, Schroeder W, Smithers BM, van Berge Henegouwen MI, van Hillegesberg R, Watson DI, Vohra R, Maynard N, Markar SR. Identifying a core symptom set triggering radiological and endoscopic investigations for suspected recurrent esophago-gastric cancer: a modified Delphi consensus process. Dis Esophagus 2022; 36:6647503. [PMID: 35858213 PMCID: PMC9817822 DOI: 10.1093/dote/doac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/03/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND There is currently a lack of evidence-based guidelines regarding surveillance for recurrence after esophageal and gastric (OG) cancer surgical resection, and which symptoms should prompt endoscopic or radiological investigations for recurrence. The aim of this study was to develop a core symptom set using a modified Delphi consensus process that should guide clinicians to carry out investigations to look for suspected recurrent OG cancer in previously asymptomatic patients. METHODS A web-based survey of 42 questions was sent to surgeons performing OG cancer resections at high volume centers. The first section evaluated the structure of follow-up and the second, determinants of follow-up. Two rounds of a modified Delphi consensus process and a further consensus workshop were used to determine symptoms warranting further investigations. Symptoms with a 75% consensus agreement as suggestive of recurrent cancer were included in the core symptom set. RESULTS 27 surgeons completed the questionnaires. A total of 70.3% of centers reported standardized surveillance protocols, whereas 3.7% of surgeons did not undertake any surveillance in asymptomatic patients after OG cancer resection. In asymptomatic patients, 40.1% and 25.9% of centers performed routine imaging and endoscopy, respectively. The core set that reached consensus, consisted of eight symptoms that warranted further investigations included; dysphagia to solid food, dysphagia to liquids, vomiting, abdominal pain, chest pain, regurgitation of foods, unexpected weight loss and progressive hoarseness of voice. CONCLUSION There is global variation in monitoring patients after OG cancer resection. Eight symptoms were identified by the consensus process as important in prompting radiological or endoscopic investigation for suspected recurrent malignancy. Further randomized controlled trials are necessary to link surveillance strategies to survival outcomes and evaluate prognostic value.
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Affiliation(s)
| | - Nikhil M Patel
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Rita Alfieri
- Department of Surgical Oncology, Veneto Institute of Oncology-IRCCS, Padova, Italy
| | - Luigi Bonavina
- Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS Padua, Italy
| | - Edward Cheong
- Department of Upper Gastrointestinal Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Andy Cockbain
- Department of Upper Gastrointestinal Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Xavier Benoit D’Journo
- Department of Thoracic Surgery, Aix-Marseille University, North Hospital, Marseille, France
| | - Lorenzo Ferri
- Department of Thoracic Surgery and Upper Gastrointestinal Surgery, McGill University, Montréal, Canada
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham, UK,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Peter Grimminger
- Department of General Surgery, University of Mainz, Mainz, Germany
| | | | - Christian Gutschow
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Jakob Hedberg
- Section of Gastrointestinal Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Joonas H Kauppila
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,Department of Surgery, Oulu University Hospital, University of Oulu, Oulo, Finland
| | - Sjoerd Lagarde
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Donald Low
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Philippe Nafteux
- Department of Thoracic Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Wolfgang Schroeder
- Department of General, Visceral, Cancer and Transplantation Surgery, University of Cologne, Cologne, Germany
| | - B Mark Smithers
- Upper GI and Soft Tissue Unit, Academy of Surgery, Princess Alexandra Hospital, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | | | | | - David I Watson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, Australia,Department of Surgery, Flinders Medical Center, Adelaide, Australia
| | - Ravinder Vohra
- Department of Esophagogastric Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nick Maynard
- Department of Upper GI Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sheraz R Markar
- Address correspondence to: Sheraz R. Markar, Department of Upper Gastrointestinal Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Headington, Oxford OX3 7LE, UK.
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22
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Puri A, Patel NM, Sounderajah V, Ferri L, Griffiths EA, Low D, Maynard N, Mueller C, Pera M, van Berge Henegouwen MI, Watson DI, Zaninotto G, Hanna GB, Markar SR. Development of the ParaOesophageal hernia SympTom (POST) tool. Br J Surg 2022; 109:727-732. [PMID: 35640625 PMCID: PMC10364681 DOI: 10.1093/bjs/znac139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/28/2022] [Accepted: 04/14/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this study was to develop a symptom severity instrument (ParaOesophageal hernia SympTom (POST) tool) specific to para-oesophageal hernia (POH). METHODS The POST tool was developed in four stages. The first was establishment of a Steering Committee. In the second stage, items were generated through a systematic review and online scoping survey of international experts. In the third stage, a three-round modified Delphi consensus process was conducted with a group of international experts who were asked to rate the importance of candidate items. An a priori threshold for inclusion was set at 80 per cent. The modified Delphi process culminated in a consensus meeting to develop the first iteration of the tool. In the final stage, two international patient workshops were held to assess the content validity and acceptability of the POST tool. RESULTS The systematic review and scoping survey generated 64 symptoms, refined to 20 for inclusion in the modified Delphi consensus process. Twenty-six global experts participated in the Delphi consensus process. Five symptoms reached consensus across two rounds: difficulty getting solid foods down, chest pain after meals, difficulty getting liquids down, shortness of breath only after meals, and an early feeling of fullness after eating. The subsequent patient workshops deemed these five symptoms to be relevant and suggested that reflux should be included; these were taken forward to create the final POST tool. CONCLUSION The POST tool is the first instrument designed to capture POH-specific symptoms. It will allow clinicians to standardize reporting of symptoms of POH and evaluate the response to surgical intervention.
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Affiliation(s)
- Aiysha Puri
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nikhil M Patel
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Lorenzo Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Donald Low
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Centre, Seattle, Washington, USA
| | - Nick Maynard
- Oxford Oesophagogastric Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carmen Mueller
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Manuel Pera
- Department of Surgery, University Hospital del Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam University Medical Centres, Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - David I Watson
- Flinders University, Discipline of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | | | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Nuffield Department of Surgery, University of Oxford, Oxford, UK
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23
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Chidambaram S, Sounderajah V, Maynard N, Markar SR. Evaluation of post-operative surveillance strategies for esophageal and gastric cancers: a systematic review and meta-analysis. Dis Esophagus 2022; 35:6628787. [PMID: 35788834 DOI: 10.1093/dote/doac034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/02/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is no consensus or guidelines internationally to inform clinicians of how patients should be monitored for recurrence after esophagogastric resections. AIM This systematic review and meta-analysis summarizes the latest evidence investigating the usefulness of surveillance protocols in patients who underwent esophagectomy or gastrectomy. METHODS A systematic review of the literature was performed using MEDLINE, EMBASE, the Cochrane Review and Scopus databases. Articles were evaluated for the use of surveillance strategies including history-taking, physical examination, imaging modalities and endoscopy for monitoring patients post-gastrectomy or esophagectomy. Studies that compared surveillance strategies and reported detection of recurrence and post-recurrence survival were also included in the meta-analysis. RESULTS Fifteen studies that described a surveillance protocol for post-operative patients were included in the review. Seven studies were used in the meta-analysis. Random-effects analysis demonstrated a statistically significant higher post-recurrence survival (standardized mean difference [SMD] 14.15, 95% CI 1.40-27.26, p = 0.03) with imaging-based planned surveillance post-esophagectomy. However, the detection of recurrence (OR 1.76, 95% CI 0.78-3.97, p = 0.17) for esophageal cancers as well as detection of recurrence (OR 0.73, 95% CI 0.11-5.12, p = 0.76) and post-recurrence survival (SMD 6.42, 95% CI -2.16-18.42, p = 0.14) for gastric cancers were not significantly different with planned surveillance. CONCLUSION There is no consensus on whether surveillance carries prognostic survival benefit or how surveillance should be carried out. Surveillance may carry prognostic benefit for patients who underwent surgery for esophageal cancer. Randomized controlled trials are required to evaluate the survival benefits of intensive surveillance strategies, determine the ideal surveillance protocol and tailor it to the appropriate population.
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Affiliation(s)
| | | | - Nick Maynard
- Department of Upper GI Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.,Department of Upper GI Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK
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24
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Normahani P, Sounderajah V, Mandic D, Jaffer U. Machine learning-based classification of arterial spectral waveforms for the diagnosis of peripheral artery disease in the context of diabetes: A proof-of-concept study. Vasc Med 2022; 27:450-456. [PMID: 35734808 DOI: 10.1177/1358863x221105113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Point-of-care duplex ultrasound has emerged as a promising test for the diagnosis of peripheral artery disease (PAD). However, the interpretation of morphologically diverse Doppler arterial spectral waveforms is challenging and associated with wide inter-observer variation. The aim of this study is to evaluate the utility of machine learning techniques for the diagnosis of PAD from Doppler arterial spectral waveforms sampled at the level of the ankle in patients with diabetes. METHODS In two centres, 590 Doppler arterial spectral waveform images (PAD 369, no-PAD 221) from 305 patients were prospectively collected. Doppler arterial spectral waveform signals were reconstructed. Blinded full lower-limb reference duplex ultrasound results were used to label waveform according to PAD status (i.e., PAD, no-PAD). Statistical metrics and multiscale wavelet variance were extracted as discriminatory features. A long short-term memory (LSTM) network was used for the classification of raw signals, and logistic regression (LR) and support vector machines (SVM) were used for classification of extracted features. Signals and feature vectors were randomly divided into training (80%) and testing (20%) sets. RESULTS The highest overall accuracy was achieved using a logistic regression model with a combination of statistical and multiscale wavelet variance features, with 88% accuracy, 92% sensitivity, and 82% specificity. The area under the receiver operating characteristics curve (AUC) was 0.93. CONCLUSION We have constructed a machine learning algorithm with high discriminatory ability for the diagnosis of PAD using Doppler arterial spectral waveforms sampled at the ankle vessels.
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Affiliation(s)
- Pasha Normahani
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Viknesh Sounderajah
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danilo Mandic
- Department of Electrical and Electronic Engineering, Imperial College London, London, UK
| | - Usman Jaffer
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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25
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Unsworth H, Wolfram V, Dillon B, Salmon M, Greaves F, Liu X, MacDonald T, Denniston AK, Sounderajah V, Ashrafian H, Darzi A, Ashurst C, Holmes C, Weller A. Building an evidence standards framework for artificial intelligence-enabled digital health technologies. Lancet Digit Health 2022; 4:e216-e217. [PMID: 35337640 DOI: 10.1016/s2589-7500(22)00030-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/04/2022] [Indexed: 11/25/2022]
Affiliation(s)
| | - Verena Wolfram
- National Institute for Health and Care Excellence, London, UK
| | - Bernice Dillon
- National Institute for Health and Care Excellence, London, UK
| | - Mark Salmon
- National Institute for Health and Care Excellence, London, UK
| | - Felix Greaves
- National Institute for Health and Care Excellence, London, UK
| | - Xiaoxuan Liu
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Trystan MacDonald
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alastair K Denniston
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London, London W2 1NY, UK.
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London W2 1NY, UK
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London W2 1NY, UK
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26
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Sounderajah V, Ashrafian H, Karthikesalingam A, Markar SR, Normahani P, Collins GS, Bossuyt PM, Darzi A. Developing Specific Reporting Standards in Artificial Intelligence Centred Research. Ann Surg 2022; 275:e547-e548. [PMID: 35120063 DOI: 10.1097/sla.0000000000005294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | | | - Sheraz R Markar
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Pasha Normahani
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Patrick M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, University of Amsterdam, the Netherlands
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
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27
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Chidambaram S, Maheswaran Y, Chan C, Hanna L, Ashrafian H, Markar SR, Sounderajah V, Alverdy JC, Darzi A. (Mis)Communicating The Microbiome: A Cross-Sectional Assessment of Social Media Video Content (Preprint). JMIR Form Res 2022; 6:e37546. [PMID: 35576578 PMCID: PMC9152718 DOI: 10.2196/37546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Social media platforms such as YouTube are integral tools for disseminating information about health and wellness to the public. However, anecdotal reports have cited that the human gut microbiome has been a particular focus of dubious, misleading, and, on occasion, harmful media content. Despite these claims, there have been no published studies investigating this phenomenon within popular social media platforms. Objective The aim of this study is to (1) evaluate the accuracy and reliability of the content in YouTube videos related to the human gut microbiome and (2) investigate the correlation between content engagement metrics and video quality, as defined by validated criteria. Methods In this cross-sectional study, videos about the human gut microbiome were searched for on the United Kingdom version of YouTube on September 20, 2021. The 600 most-viewed videos were extracted and screened for relevance. The contents and characteristics of the videos were extracted and independently rated using the DISCERN quality criteria by 2 researchers. Results Overall, 319 videos accounting for 62,354,628 views were included. Of the 319 videos, 73.4% (n=234) were produced in North America and 78.7% (n=251) were uploaded between 2019 and 2021. A total of 41.1% (131/319) of videos were produced by nonprofit organizations. Of the videos, 16.3% (52/319) included an advertisement for a product or promoted a health-related intervention for financial purposes. Videos by nonmedical education creators had the highest total and preferred viewership. Daily viewership was the highest for videos by internet media sources. The average DISCERN and Health on the Net Foundation Code of Conduct scores were 49.5 (SE 0.68) out of 80 and 5.05 (SE 2.52) out of 8, respectively. DISCERN scores for videos by medical professionals (mean 53.2, SE 0.17) were significantly higher than for videos by independent content creators (mean 39.1, SE 5.58; P<.001). Videos including promotional materials had significantly lower DISCERN scores than videos without any advertisements or product promotion (P<.001). There was no correlation between DISCERN scores and total viewership, daily viewership, or preferred viewership (number of likes). Conclusions The overall quality and reliability of information about the human gut microbiome on YouTube is generally poor. Moreover, there was no correlation between the quality of a video and the level of public engagement. The significant disconnect between reliable sources of information and the public suggests that there is an immediate need for cross-sector initiatives to safeguard vulnerable viewers from the potentially harmful effects of misinformation.
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Affiliation(s)
| | | | - Calvin Chan
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Lydia Hanna
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Hutan Ashrafian
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Sheraz R Markar
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Gastrointestinal Surgery, Churchill Hospital, Oxford University Hospitals National Health Service Trust, Oxford, United Kingdom
| | - Viknesh Sounderajah
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - John C Alverdy
- Department of Surgery, University of Chicago, Chicago, IL, United States
| | - Ara Darzi
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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28
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Aggarwal R, Visram S, Martin G, Sounderajah V, Gautama S, Jarrold K, Klaber R, Maxwell S, Neal J, Pegg J, Redhead J, King D, Ashrafian H, Darzi A. Defining the Enablers and Barriers to the Implementation of Large-scale, Health Care–Related Mobile Technology: Qualitative Case Study in a Tertiary Hospital Setting. JMIR Mhealth Uhealth 2022; 10:e31497. [PMID: 35133287 PMCID: PMC8864527 DOI: 10.2196/31497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/11/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022] Open
Abstract
Background The successful implementation of clinical smartphone apps in hospital settings requires close collaboration with industry partners. A large-scale, hospital-wide implementation of a clinical mobile app for health care professionals developed in partnership with Google Health and academic partners was deployed on a bring-your-own-device basis using mobile device management at our UK academic hospital. As this was the first large-scale implementation of this type of innovation in the UK health system, important insights and lessons learned from the deployment may be useful to other organizations considering implementing similar technology in partnership with commercial companies. Objective The aims of this study are to define the key enablers and barriers and to propose a road map for the implementation of a hospital-wide clinical mobile app developed in collaboration with an industry partner as a data processor and an academic partner for independent evaluation. Methods Semistructured interviews were conducted with high-level stakeholders from industry, academia, and health care providers who had instrumental roles in the implementation of the app at our hospital. The interviews explored the participants’ views on the enablers and barriers to the implementation process. The interviews were analyzed using a broadly deductive approach to thematic analysis. Results In total, 14 participants were interviewed. Key enablers identified were the establishment of a steering committee with high-level clinical involvement, well-defined roles and responsibilities between partners, effective communication strategies with end users, safe information governance precautions, and increased patient engagement and transparency. Barriers identified were the lack of dedicated resources for mobile change at our hospital, risk aversion, unclear strategy and regulation, and the implications of bring-your-own-device and mobile device management policies. The key lessons learned from the deployment process were highlighted, and a road map for the implementation of large-scale clinical mobile apps in hospital settings was proposed. Conclusions Despite partnering with one of the world’s biggest technology companies, the cultural and technological change required for mobile working and implementation in health care was found to be a significant challenge. With an increasing requirement for health care organizations to partner with industry for advanced mobile technologies, the lessons learned from our implementation can influence how other health care organizations undertake a similar mobile change and improve the chances of successful widespread mobile transformation.
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Affiliation(s)
- Ravi Aggarwal
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Sheena Visram
- Department of Computer Science, University College London, London, United Kingdom
| | - Guy Martin
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Sanjay Gautama
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Kevin Jarrold
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Robert Klaber
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Shona Maxwell
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John Neal
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jack Pegg
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Julian Redhead
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dominic King
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
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Hanna L, Lam K, Agbeko AE, Amoako JK, Ashrafian H, Sounderajah V, Abdullah A. Coverage of the coeliac artery during thoracic endovascular aortic repair: A systematic review and meta-analysis. Eur J Vasc Endovasc Surg 2022; 63:828-837. [DOI: 10.1016/j.ejvs.2022.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 02/07/2022] [Accepted: 02/20/2022] [Indexed: 11/16/2022]
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Jayakumar S, Sounderajah V, Normahani P, Harling L, Markar SR, Ashrafian H, Darzi A. Quality assessment standards in artificial intelligence diagnostic accuracy systematic reviews: a meta-research study. NPJ Digit Med 2022; 5:11. [PMID: 35087178 PMCID: PMC8795185 DOI: 10.1038/s41746-021-00544-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 11/28/2021] [Indexed: 01/05/2023] Open
Abstract
Artificial intelligence (AI) centred diagnostic systems are increasingly recognised as robust solutions in healthcare delivery pathways. In turn, there has been a concurrent rise in secondary research studies regarding these technologies in order to influence key clinical and policymaking decisions. It is therefore essential that these studies accurately appraise methodological quality and risk of bias within shortlisted trials and reports. In order to assess whether this critical step is performed, we undertook a meta-research study evaluating adherence to the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool within AI diagnostic accuracy systematic reviews. A literature search was conducted on all studies published from 2000 to December 2020. Of 50 included reviews, 36 performed the quality assessment, of which 27 utilised the QUADAS-2 tool. Bias was reported across all four domains of QUADAS-2. Two hundred forty-three of 423 studies (57.5%) across all systematic reviews utilising QUADAS-2 reported a high or unclear risk of bias in the patient selection domain, 110 (26%) reported a high or unclear risk of bias in the index test domain, 121 (28.6%) in the reference standard domain and 157 (37.1%) in the flow and timing domain. This study demonstrates the incomplete uptake of quality assessment tools in reviews of AI-based diagnostic accuracy studies and highlights inconsistent reporting across all domains of quality assessment. Poor standards of reporting act as barriers to clinical implementation. The creation of an AI-specific extension for quality assessment tools of diagnostic accuracy AI studies may facilitate the safe translation of AI tools into clinical practice.
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Affiliation(s)
- Shruti Jayakumar
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Viknesh Sounderajah
- Department of Surgery and Cancer, Imperial College London, London, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Pasha Normahani
- Department of Surgery and Cancer, Imperial College London, London, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Leanne Harling
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Thoracic Surgery, Guy's Hospital, London, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
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Sounderajah V, Normahani P, Aggarwal R, Jayakumar S, Markar SR, Ashrafian H, Darzi A. Reporting Standards and Quality Assessment Tools in Artificial Intelligence–Centered Healthcare Research. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Acharya A, Judah G, Ashrafian H, Sounderajah V, Johnstone-Waddell N, Stevenson A, Darzi A. Investigating the Implementation of SMS and Mobile Messaging in Population Screening (the SIPS Study): Protocol for a Delphi Study. JMIR Res Protoc 2021; 10:e32660. [PMID: 34941542 PMCID: PMC8734915 DOI: 10.2196/32660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/16/2021] [Accepted: 11/21/2021] [Indexed: 12/31/2022] Open
Abstract
Background The use of mobile messaging, including SMS, and web-based messaging in health care has grown significantly. Using messaging to facilitate patient communication has been advocated in several circumstances, including population screening. These programs, however, pose unique challenges to mobile communication, as messaging is often sent from a central hub to a diverse population with differing needs. Despite this, there is a paucity of robust frameworks to guide implementation. Objective The aim of this protocol is to describe the methods that will be used to develop a guide for the principles of use of mobile messaging for population screening programs in England. Methods This modified Delphi study will be conducted in two parts: evidence synthesis and consensus generation. The former will include a review of literature published from January 1, 2000, to October 1, 2021. This will elicit key themes to inform an online scoping questionnaire posed to a group of experts from academia, clinical medicine, industry, and public health. Thematic analysis of free-text responses by two independent authors will elicit items to be used during consensus generation. Patient and Public Involvement and Engagement groups will be convened to ensure that a comprehensive item list is generated that represents the public’s perspective. Each item will then be anonymously voted on by experts as to its importance and feasibility of implementation in screening during three rounds of a Delphi process. Consensus will be defined a priori at 70%, with items considered important and feasible being eligible for inclusion in the final recommendation. A list of desirable items (ie, important but not currently feasible) will be developed to guide future work. Results The Institutional Review Board at Imperial College London has granted ethical approval for this study (reference 20IC6088). Results are expected to involve a list of recommendations to screening services, with findings being made available to screening services through Public Health England. This study will, thus, provide a formal guideline for the use of mobile messaging in screening services and will provide future directions in this field. Conclusions The use of mobile messaging has grown significantly across health care services, especially given the COVID-19 pandemic, but its implementation in screening programs remains challenging. This modified Delphi approach with leading experts will provide invaluable insights into facilitating the incorporation of messaging into these programs and will create awareness of future developments in this area. International Registered Report Identifier (IRRID) PRR1-10.2196/32660
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Affiliation(s)
- Amish Acharya
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Gaby Judah
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | | | | | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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Chidambaram S, Sounderajah V, Maynard N, Underwood T, Markar S. P-OGC04 Evaluation of post-operative surveillance strategies for oesophago-gastric cancers in the United Kingdom. Br J Surg 2021. [DOI: 10.1093/bjs/znab430.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Oesophago-gastric malignancies are associated with a high recurrence rate, yet there is a lack of evidence to inform guidelines for the standardisation and structure of post-operative surveillance after curatively intended treatment. This study aimed to capture the variation in post-operative surveillance strategies across the United Kingdom and Ireland, and enquire the opinions and beliefs around surveillance from practicing clinicians.
Methods
A web based survey consisting of forty questions was sent to surgeons or allied health professionals performing or involved in surgical care for oesophago-gastric cancers at high volume centers in the United Kingdom (UK). Respondents from each centre completed the survey on what best represented their centre. The first section of the survey evaluated the timing and components of follow-ups, and their variation between centres. The second section evaluated respondents perspective on how surveillance can be structured.
Results
Thirty five surgeons from 25 centers consisting 28 consultants, 6 senior trainees and 1 specialist nurse had completed the questionnaire. 45.7% of responders arranged clinical follow-up at 2-4 weeks. Twenty responders had a specific post-operative surveillance protocol for their patients. Of these, 31.4% had a standardised protocol for all patients, while 25.7% tailored it to patient needs. Patient preference, comorbidities and chance of recurrence were considered as major factors for necessitating more intense surveillance than currently practised.
Conclusions
There is a significant variation in how patients are monitored after surgery between centers in the UK. Randomised controlled trials are necessary to link surveillance strategies to both survival outcomes and quality of life of patients and to evaluate the prognostic value of different post-operative surveillance strategies.
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Affiliation(s)
| | | | - Nick Maynard
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Tim Underwood
- University of Southampton, Southampton, United Kingdom
| | - Sheraz Markar
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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Puri A, Patel N, Sounderajah V, Ferri L, Griffiths E, Low D, Maynard N, Mueller C, Pera M, van Berge Henegouwen M, Watson D, Zaninotto G, Hanna G, Markar S. O-BN01 The para-oesophageal hernia symptom tool (post): A modified delphi consensus study. Br J Surg 2021. [DOI: 10.1093/bjs/znab429.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Patients with a para-oesophageal hernia (POH) report a complex range of symptoms and quality of life (QOL) issues. Clinicians often utilise existing health related quality of life tools to (1) identify patients who are eligible for surgical management and (2) to evaluate the benefit of surgical intervention. However, the most commonly used tools for this purpose are not disease specific. As such, crucial POH specific symptoms which impact QOL may not be captured. In order to address this issue, a modified Delphi consensus study was undertaken to establish a HRQOL instrument specific to POH.
Methods
A two-round modified Delphi consensus study was conducted with a group of international experts. Participants were identified through (1) their authorship in landmark POH studies and (2) the professional networks of the study investigators. Prior to the Delphi process, a scoping survey was undertaken in order to generate a list of candidate items. Participants were asked to rate the items’ importance in assessing patients with POH using a 5-point Likert scale. The a priori threshold for inclusion was 80% for scores of 4 or 5. If consensus was not achieved, the item was carried through to the next round.
Results
The candidate list of items consisted of 64 symptoms, refined to 20 for inclusion within the first modified Delphi round. Four symptoms; ‘difficulty getting solid foods down’, ‘chest pain after meals’, ‘difficulty getting liquids down’ and ‘shortness of breath only after meals’, reached consensus threshold of 80% in the first round and one additional symptom, ‘early feeling of fullness after eating’, reached consensus in the second. A total of 26 participants took part in the first and 24 in the second round. These five symptoms have been identified to form the initial version of the Para-Oesophageal Hernia Symptom Tool (POST).
Conclusions
POST is the first tool that aims to capture POH-specific symptoms that impact upon HRQOL. Prior to clinical use, this tool will be presented in international patient workshops to assess its construct validity. Following this, we aim to assess the content validity of the tool through a longitudinal study in a cohort of patients with POH who are undergoing repair. We hope that this tool will serve as a decision support tool for clinicians who are evaluating the risk-benefit of surgical intervention in this cohort of patients.
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Affiliation(s)
- Aiysha Puri
- Imperial College London, London, United Kingdom
| | | | | | | | - Ewen Griffiths
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- University of Birmingham, Birmingham, United Kingdom
| | - Donald Low
- Virginia Mason Medical Center, Seattle, USA
| | - Nick Maynard
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Manuel Pera
- University Hospital del Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - David Watson
- Flinders Medical Centre, Adelaide, Australia
- Flinders University, Adelaide, Australia
| | | | | | - Sheraz Markar
- Imperial College London, London, United Kingdom
- Karolinska Institutet, Stockholm, Sweden
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Acharya A, Sounderajah V, Ashrafian H, Darzi A, Judah G. A systematic review of interventions to improve breast cancer screening health behaviours. Prev Med 2021; 153:106828. [PMID: 34624390 DOI: 10.1016/j.ypmed.2021.106828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 12/17/2022]
Abstract
Whilst breast cancer screening has been implemented in many countries, uptake is often suboptimal. Consequently, several interventions targeting non-attendance behaviour have been developed. This systematic review aims to appraise the successes of interventions, identifying and comparing the specific techniques they use to modify health behaviours. A literature search (PROSPERO CRD42020212090) between January 2005 and December 2020 using PubMed, Medline, PsycInfo, EMBASE and Google Scholar was conducted. Studies which investigated patient-facing interventions to increase attendance at breast cancer screening appointments were included. Details regarding the intervention delivery, theoretical background, and contents were extracted, as was quantitative data on the impact on attendance rates, compared to control measures. Interventions were also coded using the Behavioural Change Techniques (BCT) Taxonomy. In total fifty-four studies, detailing eighty interventions, met the inclusion criteria. Only 50% of interventions reported a significant impact on screening attendance. Thirty-two different BCTs were used, with 'prompts/cues' the most commonly incorporated (77.5%), however techniques from the group 'covert learning' had the greatest pooled effect size 0.12 (95% CI 0.05-0.19, P < 0·01, I2 = 91.5%). 'Problem solving' was used in the highest proportion of interventions that significantly increased screening attendance (69.0%). 70% of the interventions were developed using behavioural theories. These results show interventions aimed at increasing screening uptake are often unsuccessful. Commonly used approaches which focus upon explaining the consequences of not attending mammograms were often ineffective. Problem solving, however, has shown promise. These techniques should be investigated further, as should emerging technologies which can enable interventions to be feasibly translated at a population-level.
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Affiliation(s)
- Amish Acharya
- Institute of Global Health Innovation, Imperial College London, London W2 1NY, United Kingdom; Imperial Patient Safety and Translational Research Centre, Imperial College London, W2 1NY, United Kingdom
| | - Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London, London W2 1NY, United Kingdom
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London W2 1NY, United Kingdom.
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London W2 1NY, United Kingdom; Imperial Patient Safety and Translational Research Centre, Imperial College London, W2 1NY, United Kingdom
| | - Gaby Judah
- Imperial Patient Safety and Translational Research Centre, Imperial College London, W2 1NY, United Kingdom
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Chidambaram S, Sounderajah V, Maynard N, Markar SR. ASO Author Reflections: Applications of Artificial Intelligence in Oesophago-Gastric Malignancies-Present Work and Future Directions. Ann Surg Oncol 2021; 29:1991-1992. [PMID: 34792695 PMCID: PMC8810447 DOI: 10.1245/s10434-021-10907-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022]
Abstract
Our paper highlights the use of artificial intelligence (AI) in oesophageal and gastric malignancies with acceptable levels of accuracy for both diagnostic and surveillance purposes. Here, we comment on the past, present and future work necessary for incorporating AI into the clinical framework and practice.
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Affiliation(s)
| | - Viknesh Sounderajah
- Department of Surgery and Cancer, Imperial College London, London, UK.,Institute of Global Health Innovation, Imperial College London, London, UK
| | - Nick Maynard
- Department of Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK. .,Department of Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK. .,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Chidambaram S, Sounderajah V, Maynard N, Markar SR. Diagnostic Performance of Artificial Intelligence-Centred Systems in the Diagnosis and Postoperative Surveillance of Upper Gastrointestinal Malignancies Using Computed Tomography Imaging: A Systematic Review and Meta-Analysis of Diagnostic Accuracy. Ann Surg Oncol 2021; 29:1977-1990. [PMID: 34762214 PMCID: PMC8810479 DOI: 10.1245/s10434-021-10882-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/11/2021] [Indexed: 12/24/2022]
Abstract
Background Upper gastrointestinal cancers are aggressive malignancies with poor prognosis, even following multimodality therapy. As such, they require timely and accurate diagnostic and surveillance strategies; however, such radiological workflows necessitate considerable expertise and resource to maintain. In order to lessen the workload upon already stretched health systems, there has been increasing focus on the development and use of artificial intelligence (AI)-centred diagnostic systems. This systematic review summarizes the clinical applicability and diagnostic performance of AI-centred systems in the diagnosis and surveillance of esophagogastric cancers. Methods A systematic review was performed using the MEDLINE, EMBASE, Cochrane Review, and Scopus databases. Articles on the use of AI and radiomics for the diagnosis and surveillance of patients with esophageal cancer were evaluated, and quality assessment of studies was performed using the QUADAS-2 tool. A meta-analysis was performed to assess the diagnostic accuracy of sequencing methodologies. Results Thirty-six studies that described the use of AI were included in the qualitative synthesis and six studies involving 1352 patients were included in the quantitative analysis. Of these six studies, four studies assessed the utility of AI in gastric cancer diagnosis, one study assessed its utility for diagnosing esophageal cancer, and one study assessed its utility for surveillance. The pooled sensitivity and specificity were 73.4% (64.6–80.7) and 89.7% (82.7–94.1), respectively. Conclusions AI systems have shown promise in diagnosing and monitoring esophageal and gastric cancer, particularly when combined with existing diagnostic methods. Further work is needed to further develop systems of greater accuracy and greater consideration of the clinical workflows that they aim to integrate within.
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Affiliation(s)
| | - Viknesh Sounderajah
- Department of Surgery and Cancer, Imperial College London, London, UK.,Institute of Global Health Innovation, Imperial College London, London, UK
| | - Nick Maynard
- Department of Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK. .,Department of Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK. .,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Chidambaram S, Sounderajah V, Maynard N, Markar SR. ASO Visual Abstract: Diagnostic Performance of Artificial Intelligence-Centered Systems in the Diagnosis and Postoperative Surveillance of Upper Gastrointestinal Malignancies Using Computed Tomography Imaging: A Systematic Review and Meta-Analysis of Diagnostic Accuracy. Ann Surg Oncol 2021. [PMID: 34762212 DOI: 10.1245/s10434-021-10959-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Viknesh Sounderajah
- Department of Surgery and Cancer, Imperial College London, London, UK.,Institute of Global Health Innovation, Imperial College London, London, UK
| | - Nick Maynard
- Department of Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK. .,Department of Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK. .,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Sounderajah V, Ashrafian H, Rose S, Shah NH, Ghassemi M, Golub R, Kahn CE, Esteva A, Karthikesalingam A, Mateen B, Webster D, Milea D, Ting D, Treanor D, Cushnan D, King D, McPherson D, Glocker B, Greaves F, Harling L, Ordish J, Cohen JF, Deeks J, Leeflang M, Diamond M, McInnes MDF, McCradden M, Abràmoff MD, Normahani P, Markar SR, Chang S, Liu X, Mallett S, Shetty S, Denniston A, Collins GS, Moher D, Whiting P, Bossuyt PM, Darzi A. A quality assessment tool for artificial intelligence-centered diagnostic test accuracy studies: QUADAS-AI. Nat Med 2021; 27:1663-1665. [PMID: 34635854 DOI: 10.1038/s41591-021-01517-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London, London, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sherri Rose
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Nigam H Shah
- Center for Biomedical Informatics Research, Stanford University, Stanford, CA, USA
| | - Marzyeh Ghassemi
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Robert Golub
- Journal of the American Medical Association (JAMA), Chicago, IL, USA
| | - Charles E Kahn
- University of Pennsylvania, Philadelphia, Pennsylvania, PA, USA
| | | | | | | | | | - Dan Milea
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Daniel Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Darren Treanor
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
- Department of Clinical Pathology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | | | - Dominic King
- Institute of Global Health Innovation, Imperial College London, London, UK
- Optum, London, UK
| | | | - Ben Glocker
- Faculty of Engineering, Department of Computing, Imperial College London, London, UK
| | - Felix Greaves
- National Institute for Health and Care Excellence, London, UK
| | - Leanne Harling
- Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Johan Ordish
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Jérémie F Cohen
- Department of Pediatrics, Centre of Research in Epidemiology and Statistics, Inserm UMR 1153, Necker- Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Jon Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mariska Leeflang
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Matthew D F McInnes
- Departments of Radiology and Epidemiology, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Melissa McCradden
- Department of Bioethics, The Hospital for Sick Kids, Toronto, Ontario, Canada
| | - Michael D Abràmoff
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - Pasha Normahani
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Chang
- Annals of Internal Medicine, American College of Physicians, Philadelphia, PA, USA
| | - Xiaoxuan Liu
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Health Data Research UK, London, UK
| | - Susan Mallett
- Centre for Medical Imaging, University College London, London, UK
| | | | - Alastair Denniston
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Health Data Research UK, London, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David Moher
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Penny Whiting
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Patrick M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
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41
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Chidambaram S, Sounderajah V, Maynard N, Underwood T, Markar SR. Evaluation of postoperative surveillance strategies for esophago-gastric cancers in the UK and Ireland. Dis Esophagus 2021; 35:6356673. [PMID: 34426840 PMCID: PMC8832533 DOI: 10.1093/dote/doab057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/10/2021] [Accepted: 07/28/2021] [Indexed: 12/11/2022]
Abstract
Esophago-gastric malignancies are associated with a high recurrence rate; yet there is a lack of evidence to inform guidelines for the standardization and structure of postoperative surveillance after curatively intended treatment. This study aimed to capture the variation in postoperative surveillance strategies across the UK and Ireland, and enquire the opinions and beliefs around surveillance from practicing clinicians. A web-based survey consisting of 40 questions was sent to surgeons or allied health professionals performing or involved in surgical care for esophago-gastric cancers at high-volume centers in the UK. Respondents from each center completed the survey on what best represented their center. The first section of the survey evaluated the timing and components of follow-ups, and their variation between centers. The second section evaluated respondents perspective on how surveillance can be structured. Thirty-five respondents from 27 centers consisting 28 consultants, 6 senior trainees and 1 specialist nurse had completed the questionnaire; 45.7% of responders arranged clinical follow-up at 2-4 weeks. Twenty responders had a specific postoperative surveillance protocol for their patients. Of these, 31.4% had a standardized protocol for all patients, while 25.7% tailored it to patient needs. Patient preference, comorbidities and chance of recurrence were considered as major factors for necessitating more intense surveillance than currently practiced. There is a significant variation in how patients are monitored after surgery between centers in the UK. Randomized controlled trials are necessary to link surveillance strategies to both survival outcomes and quality of life of patients and to evaluate the prognostic value of different postoperative surveillance strategies.
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Affiliation(s)
| | | | - Nick Maynard
- Department of Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, UK
| | - Tim Underwood
- Department of Gastrointestinal Surgery, University of Southampton, UK
| | - Sheraz R Markar
- Address correspondence to: Sheraz R Markar, Department of Surgery, Churchill Hospital, Old Road, Headington, Oxford OX3 7LE, UK.
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42
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Patel K, Sounderajah V, Normahani P, Acharya A, Ashrafian H, Bicknell C. O41 Quantifying the burden of survivorship associated with infra-renal abdominal aortic aneurysm repair: a systematic review. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Survivorship encompasses the physical, psychological, social, functional and economic experience of living with a chronic condition for both patients and their caregivers. It comprises 9 distinct domains and remains understudied in non-oncological pathologies, including infra-renal abdominal aortic aneurysmal disease (IRAAA). This review aims to quantify the extent to which existing IRAAA literature addresses the burden of survivorship in patients following surgical intervention.
Method
The databases; MEDLINE, EMBASE and PsychINFO, were searched from 1989 through to July 2020. Randomised controlled trials, observational studies and case series studies were included. Eligible studies had to detail outcomes related to survivorship following IRAAA surgery. Due to heterogeneity between studies and outcomes, no meta-analysis was conducted. Study quality was assessed with specific risk of bias tools.
Result
112 studies were included and only 4 of the 9 domains of survivorship have been previously studied—treatment complications, physical functioning, co-morbidities and caregivers. The available evidence is of variable quality; the majority of studies display a moderate to high risk of bias, are of an observational study design, are based within a limited number of countries and consist of an insufficient follow up period.
Conclusion
This review highlights the absence of robust evidence regarding survivorship following IRAAA surgery, regardless of repair modality. Consequently, contemporary treatment guidelines are reliant upon historic quality of life data that is narrow in scope and non-representative of contemporary clinical practice. As such, there is an urgent need to re-evaluate the scope and methodology associated with this research theme moving forwards.
Take-home Message
There is an urgent need to re-evaluate the scope and methodology associated with traditional quality of life centred IRAAA studies moving forwards in order to better empower patient decision making as well as inform treatment guidelines and health policy initiatives.
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Affiliation(s)
- K Patel
- 1Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - V Sounderajah
- 1Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - P Normahani
- 1Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Acharya
- 1Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - H Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - C Bicknell
- 1Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
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43
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Patel NM, Puri A, Sounderajah V, Ferri L, Griffiths E, Low D, Maynard N, Mueller C, Pera M, van Berge Henegouwen MI, Watson DI, Zaninotto G, Hanna GB, Markar SR. Quality of life and symptom assessment in paraesophageal hernias: a systematic literature review of reporting standards. Dis Esophagus 2021; 34:6090336. [PMID: 33434921 DOI: 10.1093/dote/doaa134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Paraesophageal hernias (PEH) present with a range of symptoms affecting physical and mental health. This systematic review aims to assess the quality of reporting standards for patients with PEH, identify the most frequently used quality of life (QOL) and symptom severity assessment tools in PEH and to ascertain additional symptoms reported by these patients not captured by these tools. METHODS A systematic literature review according to PRISMA protocols was carried out following a literature search of MEDLINE, Embase and Cochrane databases for studies published between January 1960 and May 2020. Published abstracts from conference proceedings were included. Data on QOL tools used and reported symptoms were extracted. RESULTS This review included 220 studies reporting on 28 353 patients. A total of 46 different QOL and symptom severity tools were used across all studies, and 89 different symptoms were reported. The most frequently utilized QOL tool was the Gastro-Esophageal Reflux Disease-Health related quality of life questionnaire symptom severity instrument (47.7%), 57.2% of studies utilized more than 2 QOL tools and 'dysphagia' was the most frequently reported symptom, in 55.0% of studies. Notably, respiratory and cardiovascular symptoms, although less common than GI symptoms, were reported and included 'dyspnea' reported in 35 studies (15.9%). CONCLUSIONS There lacks a QOL assessment tool that captures the range of symptoms associated with PEH. Reporting standards for this cohort must be improved to compare patient outcomes before and after surgery. Further investigations must seek to develop a PEH specific tool, that encompasses the relative importance of symptoms when considering surgical intervention and assessing symptomatic improvement following surgery.
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Affiliation(s)
- Nikhil M Patel
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Aiysha Puri
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Lorenzo Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ewen Griffiths
- Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Donald Low
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Nick Maynard
- Oxford Esophagogastric Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carmen Mueller
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Manuel Pera
- Department of Surgery, University Hospital del Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | | | - David I Watson
- Flinders University, Discipline of Surgery, Flinders Medical Centre, Adelaide, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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44
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Chan C, Sounderajah V, Daniels E, Acharya A, Clarke J, Yalamanchili S, Normahani P, Markar S, Ashrafian H, Darzi A. The Reliability and Quality of YouTube Videos as a Source of Public Health Information Regarding COVID-19 Vaccination: Cross-sectional Study. JMIR Public Health Surveill 2021; 7:e29942. [PMID: 34081599 PMCID: PMC8274673 DOI: 10.2196/29942] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Recent emergency authorization and rollout of COVID-19 vaccines by regulatory bodies has generated global attention. As the most popular video-sharing platform globally, YouTube is a potent medium for the dissemination of key public health information. Understanding the nature of available content regarding COVID-19 vaccination on this widely used platform is of substantial public health interest. OBJECTIVE This study aimed to evaluate the reliability and quality of information on COVID-19 vaccination in YouTube videos. METHODS In this cross-sectional study, the phrases "coronavirus vaccine" and "COVID-19 vaccine" were searched on the UK version of YouTube on December 10, 2020. The 200 most viewed videos of each search were extracted and screened for relevance and English language. Video content and characteristics were extracted and independently rated against Health on the Net Foundation Code of Conduct and DISCERN quality criteria for consumer health information by 2 authors. RESULTS Forty-eight videos, with a combined total view count of 30,100,561, were included in the analysis. Topics addressed comprised the following: vaccine science (n=18, 58%), vaccine trials (n=28, 58%), side effects (n=23, 48%), efficacy (n=17, 35%), and manufacturing (n=8, 17%). Ten (21%) videos encouraged continued public health measures. Only 2 (4.2%) videos made nonfactual claims. The content of 47 (98%) videos was scored to have low (n=27, 56%) or moderate (n=20, 42%) adherence to Health on the Net Foundation Code of Conduct principles. Median overall DISCERN score per channel type ranged from 40.3 (IQR 34.8-47.0) to 64.3 (IQR 58.5-66.3). Educational channels produced by both medical and nonmedical professionals achieved significantly higher DISCERN scores than those of other categories. The highest median DISCERN scores were achieved by educational videos produced by medical professionals (64.3, IQR 58.5-66.3) and the lowest median scores by independent users (18, IQR 18-20). CONCLUSIONS The overall quality and reliability of information on COVID-19 vaccines on YouTube remains poor. Videos produced by educational channels, especially by medical professionals, were higher in quality and reliability than those produced by other sources, including health-related organizations. Collaboration between health-related organizations and established medical and educational YouTube content producers provides an opportunity for the dissemination of high-quality information on COVID-19 vaccination. Such collaboration holds potential as a rapidly implementable public health intervention aiming to engage a wide audience and increase public vaccination awareness and knowledge.
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Affiliation(s)
- Calvin Chan
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Viknesh Sounderajah
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Elisabeth Daniels
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Amish Acharya
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Jonathan Clarke
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Department of Mathematics, Imperial College London, London, United Kingdom
| | - Seema Yalamanchili
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Pasha Normahani
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Sheraz Markar
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Hutan Ashrafian
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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45
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Sounderajah V, Ashrafian H, Golub RM, Shetty S, De Fauw J, Hooft L, Moons K, Collins G, Moher D, Bossuyt PM, Darzi A, Karthikesalingam A, Denniston AK, Mateen BA, Ting D, Treanor D, King D, Greaves F, Godwin J, Pearson-Stuttard J, Harling L, McInnes M, Rifai N, Tomasev N, Normahani P, Whiting P, Aggarwal R, Vollmer S, Markar SR, Panch T, Liu X. Developing a reporting guideline for artificial intelligence-centred diagnostic test accuracy studies: the STARD-AI protocol. BMJ Open 2021; 11:e047709. [PMID: 34183345 PMCID: PMC8240576 DOI: 10.1136/bmjopen-2020-047709] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/08/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Standards for Reporting of Diagnostic Accuracy Study (STARD) was developed to improve the completeness and transparency of reporting in studies investigating diagnostic test accuracy. However, its current form, STARD 2015 does not address the issues and challenges raised by artificial intelligence (AI)-centred interventions. As such, we propose an AI-specific version of the STARD checklist (STARD-AI), which focuses on the reporting of AI diagnostic test accuracy studies. This paper describes the methods that will be used to develop STARD-AI. METHODS AND ANALYSIS The development of the STARD-AI checklist can be distilled into six stages. (1) A project organisation phase has been undertaken, during which a Project Team and a Steering Committee were established; (2) An item generation process has been completed following a literature review, a patient and public involvement and engagement exercise and an online scoping survey of international experts; (3) A three-round modified Delphi consensus methodology is underway, which will culminate in a teleconference consensus meeting of experts; (4) Thereafter, the Project Team will draft the initial STARD-AI checklist and the accompanying documents; (5) A piloting phase among expert users will be undertaken to identify items which are either unclear or missing. This process, consisting of surveys and semistructured interviews, will contribute towards the explanation and elaboration document and (6) On finalisation of the manuscripts, the group's efforts turn towards an organised dissemination and implementation strategy to maximise end-user adoption. ETHICS AND DISSEMINATION Ethical approval has been granted by the Joint Research Compliance Office at Imperial College London (reference number: 19IC5679). A dissemination strategy will be aimed towards five groups of stakeholders: (1) academia, (2) policy, (3) guidelines and regulation, (4) industry and (5) public and non-specific stakeholders. We anticipate that dissemination will take place in Q3 of 2021.
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Affiliation(s)
- Viknesh Sounderajah
- Department of Surgery and Cancer, Imperial College London, Paddington, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, Paddington, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Robert M Golub
- Journal of the American Medical Association, Chicago, Illinois, USA
| | | | | | - Lotty Hooft
- Cochrane Netherlands, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Karel Moons
- Cochrane Netherlands, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Gary Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David Moher
- Centre for Journalology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Patrick M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, Paddington, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
| | | | - Alastair K Denniston
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Health Data Research UK, London, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | | | - Daniel Ting
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | | | | | - Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | | | - Leanne Harling
- Department of Surgery and Cancer, Imperial College London, Paddington, UK
| | - Matthew McInnes
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Nader Rifai
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Pasha Normahani
- Department of Surgery and Cancer, Imperial College London, Paddington, UK
| | - Penny Whiting
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Ravi Aggarwal
- Department of Surgery and Cancer, Imperial College London, Paddington, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
| | | | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, Paddington, UK
| | - Trishan Panch
- Division of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Xiaoxuan Liu
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Health Data Research UK, London, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
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46
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Iqbal FM, Lam K, Sounderajah V, Clarke JM, Ashrafian H, Darzi A. Characteristics and predictors of acute and chronic post-COVID syndrome: A systematic review and meta-analysis. EClinicalMedicine 2021; 36:100899. [PMID: 34036253 PMCID: PMC8141371 DOI: 10.1016/j.eclinm.2021.100899] [Citation(s) in RCA: 163] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A significant proportion of individuals experience lingering and debilitating symptoms following acute COVID-19 infection. The National Institute for Health and Care Excellence (NICE) have coined the persistent cluster of symptoms as post-COVID syndrome. This has been further sub-categorised into acute post-COVID syndrome for symptoms persisting three weeks beyond initial infection and chronic post-COVID syndrome for symptoms persisting beyond twelve weeks. The aim of this review was to detail the prevalence of clinical features and identify potential predictors for acute and chronic post-COVID syndrome. METHODS A systematic literature search, with no language restrictions, was performed to identify studies detailing characteristics and outcomes related to survivorship of post-COVID syndrome. The last search was performed on 6 March 2021 and all pre-dating published articles included. A means of proportion meta-analysis was performed to quantify characteristics of acute and chronic post-COVID syndrome. Study quality was assessed with a specific risk of bias tool. PROSPERO Registration: CRD42020222855. FINDINGS A total of 43 studies met the eligibility criteria; of which, 38 allowed for meta-analysis. Fatigue and dyspnoea were the most prevalent symptoms in acute post-COVID (0·37 and 0·35) and fatigue and sleep disturbance in chronic post-COVID syndrome (0·48 and 0·44), respectively. The available evidence is generally of poor quality, with considerable risk of bias, and are of observational design. INTERPRETATION In conclusion, this review highlights that flaws in data capture and interpretation, noted in the uncertainty within our meta-analysis, affect the applicability of current knowledge. Policy makers and researchers must focus on understanding the impact of this condition on individuals and society with appropriate funding initiatives and global collaborative research.
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Affiliation(s)
- Fahad M Iqbal
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London W2 1NY, UK
- Institute of Global Health Innovation, Faculty Building, South Kensington Campus, Kensington SW7 2AZ, London, UK
| | - Kyle Lam
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London W2 1NY, UK
- Institute of Global Health Innovation, Faculty Building, South Kensington Campus, Kensington SW7 2AZ, London, UK
| | - Viknesh Sounderajah
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London W2 1NY, UK
- Institute of Global Health Innovation, Faculty Building, South Kensington Campus, Kensington SW7 2AZ, London, UK
| | - Jonathan M Clarke
- Institute of Global Health Innovation, Faculty Building, South Kensington Campus, Kensington SW7 2AZ, London, UK
- EPSRC Centre for Mathematics of Precision Healthcare, Imperial College London, London SW7 2AZ, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London W2 1NY, UK
- Institute of Global Health Innovation, Faculty Building, South Kensington Campus, Kensington SW7 2AZ, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London W2 1NY, UK
- Institute of Global Health Innovation, Faculty Building, South Kensington Campus, Kensington SW7 2AZ, London, UK
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47
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Markar SR, Sounderajah V, Johar A, Zaninotto G, Castoro C, Lagergren P, Elliott JA, Gisbertz SS, Mariette C, Alfieri R, Huddy J, Pinto E, Scarpa M, Klevebro F, Sunde B, Murphy CF, Greene C, Ravi N, Piessen G, Brenkman H, Ruurda J, van Hillegersberg R, Lagarde SM, Wijnhoven BP, Pera M, Roigg J, Castro S, Matthijsen R, Findlay J, Antonowicz S, Maynard N, McCormack O, Ariyarathenam A, Sanders G, Cheong E, Jaunoo S, Allum W, van Lanschot J, Nilsson M, Reynolds JV, van Berge Henegouwen MI, Hanna GB. Patient-reported outcomes after oesophagectomy in the multicentre LASER study. Br J Surg 2021; 108:1090-1096. [PMID: 33975337 PMCID: PMC10364861 DOI: 10.1093/bjs/znab124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 03/19/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Data on the long-term symptom burden in patients surviving oesophageal cancer surgery are scarce. The aim of this study was to identify the most prevalent symptoms and their interactions with health-related quality of life. METHODS This was a cross-sectional cohort study of patients who underwent oesophageal cancer surgery in 20 European centres between 2010 and 2016. Patients had to be disease-free for at least 1 year. They were asked to complete a 28-symptom questionnaire at a single time point, at least 1 year after surgery. Principal component analysis was used to assess for clustering and association of symptoms. Risk factors associated with the development of severe symptoms were identified by multivariable logistic regression models. RESULTS Of 1081 invited patients, 876 (81.0 per cent) responded. Symptoms in the preceding 6 months associated with previous surgery were experienced by 586 patients (66.9 per cent). The most common severe symptoms included reduced energy or activity tolerance (30.7 per cent), feeling of early fullness after eating (30.0 per cent), tiredness (28.7 per cent), and heartburn/acid or bile regurgitation (19.6 per cent). Clustering analysis showed that symptoms clustered into six domains: lethargy, musculoskeletal pain, dumping, lower gastrointestinal symptoms, regurgitation/reflux, and swallowing/conduit problems; the latter two were the most closely associated. Surgical approach, neoadjuvant therapy, patient age, and sex were factors associated with severe symptoms. CONCLUSION A long-term symptom burden is common after oesophageal cancer surgery.
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Affiliation(s)
- S R Markar
- Department Surgery and Cancer, Imperial College London, London, UK.,Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - V Sounderajah
- Department Surgery and Cancer, Imperial College London, London, UK
| | - A Johar
- Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - G Zaninotto
- Department Surgery and Cancer, Imperial College London, London, UK
| | - C Castoro
- Unit of Surgical Oncology of the Oesophagus and Digestive Tract, Veneto Institute of Oncology, Padua, Italy
| | - P Lagergren
- Department Surgery and Cancer, Imperial College London, London, UK.,Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - J A Elliott
- Department of Surgery, Trinity Centre for Health Sciences, St James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - S S Gisbertz
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - C Mariette
- Department of Digestive and Oncological Surgery, University of Lille, Claude Huriez University Hospital, F-59000 Lille, France
| | - R Alfieri
- Unit of Surgical Oncology of the Oesophagus and Digestive Tract, Veneto Institute of Oncology, Padua, Italy
| | - J Huddy
- Department Surgery and Cancer, Imperial College London, London, UK
| | - E Pinto
- Unit of Surgical Oncology of the Oesophagus and Digestive Tract, Veneto Institute of Oncology, Padua, Italy
| | - M Scarpa
- Unit of Surgical Oncology of the Oesophagus and Digestive Tract, Veneto Institute of Oncology, Padua, Italy
| | - F Klevebro
- Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - B Sunde
- Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - C F Murphy
- Department of Surgery, Trinity Centre for Health Sciences, St James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - C Greene
- Department of Surgery, Trinity Centre for Health Sciences, St James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - N Ravi
- Department of Surgery, Trinity Centre for Health Sciences, St James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - G Piessen
- Department of Digestive and Oncological Surgery, University of Lille, Claude Huriez University Hospital, F-59000 Lille, France
| | - H Brenkman
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - J Ruurda
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - S M Lagarde
- Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - B P Wijnhoven
- Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - M Pera
- Department of Surgery, University Hospital del Mar, Barcelona, Spain
| | - J Roigg
- Department of Surgery, University Hospital del Mar, Barcelona, Spain
| | - S Castro
- Department of Surgery, University Hospital del Mar, Barcelona, Spain
| | - R Matthijsen
- Department of Gastrointestinal Surgery, ETZ Tildburg, Tildburg, the Netherlands
| | - J Findlay
- Oesophago-gastric Centre, Churchill Hospital, University of Oxford, Oxford, UK
| | - S Antonowicz
- Oesophago-gastric Centre, Churchill Hospital, University of Oxford, Oxford, UK
| | - N Maynard
- Oesophago-gastric Centre, Churchill Hospital, University of Oxford, Oxford, UK
| | - O McCormack
- Department of Oesophago-Gastric Surgery, Royal Marsden Hospital, London, UK
| | - A Ariyarathenam
- Department of Oesophago-Gastric Surgery, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - G Sanders
- Department of Oesophago-Gastric Surgery, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - E Cheong
- Department of Upper Gastrointestinal Surgery, Norfolk and Norwich Hospitals NHS Trust, Norwich, UK
| | - S Jaunoo
- Department of Upper Gastrointestinal Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - W Allum
- Department of Oesophago-Gastric Surgery, Royal Marsden Hospital, London, UK
| | - J van Lanschot
- Department of Surgery, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - M Nilsson
- Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - J V Reynolds
- Department of Surgery, Trinity Centre for Health Sciences, St James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - M I van Berge Henegouwen
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - G B Hanna
- Department Surgery and Cancer, Imperial College London, London, UK
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Denning M, Goh ET, Tan B, Kanneganti A, Almonte M, Scott A, Martin G, Clarke J, Sounderajah V, Markar S, Przybylowicz J, Chan YH, Sia CH, Chua YX, Sim K, Lim L, Tan L, Tan M, Sharma V, Ooi S, Winter Beatty J, Flott K, Mason S, Chidambaram S, Yalamanchili S, Zbikowska G, Fedorowski J, Dykowska G, Wells M, Purkayastha S, Kinross J. Determinants of burnout and other aspects of psychological well-being in healthcare workers during the Covid-19 pandemic: A multinational cross-sectional study. PLoS One 2021; 16:e0238666. [PMID: 33861739 PMCID: PMC8051812 DOI: 10.1371/journal.pone.0238666] [Citation(s) in RCA: 165] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/21/2021] [Indexed: 01/09/2023] Open
Abstract
The Covid-19 pandemic has placed unprecedented pressure on healthcare systems and workers around the world. Such pressures may impact on working conditions, psychological wellbeing and perception of safety. In spite of this, no study has assessed the relationship between safety attitudes and psychological outcomes. Moreover, only limited studies have examined the relationship between personal characteristics and psychological outcomes during Covid-19. From 22nd March 2020 to 18th June 2020, healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaire comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory (OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression. Of 3,537 healthcare workers who participated in the study, 2,364 (67%) screened positive for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant predictors of burnout included patient-facing roles: doctor (OR 2.10; 95% CI 1.49-2.95), nurse (OR 1.38; 95% CI 1.04-1.84), and 'other clinical' (OR 2.02; 95% CI 1.45-2.82); being redeployed (OR 1.27; 95% CI 1.02-1.58), bottom quartile SAQ score (OR 2.43; 95% CI 1.98-2.99), anxiety (OR 4.87; 95% CI 3.92-6.06) and depression (OR 4.06; 95% CI 3.04-5.42). Significant factors inversely correlated with burnout included being tested for SARS-CoV-2 (OR 0.64; 95% CI 0.51-0.82) and top quartile SAQ score (OR 0.30; 95% CI 0.22-0.40). Significant factors associated with anxiety and depression, included burnout, gender, safety attitudes and job role. Our findings demonstrate a significant burden of burnout, anxiety, and depression amongst healthcare workers. A strong association was seen between SARS-CoV-2 testing, safety attitudes, gender, job role, redeployment and psychological state. These findings highlight the importance of targeted support services for at risk groups and proactive SARS-CoV-2 testing of healthcare workers.
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Affiliation(s)
- Max Denning
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Ee Teng Goh
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Benjamin Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Abhiram Kanneganti
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Melanie Almonte
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Alasdair Scott
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Guy Martin
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jonathan Clarke
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Viknesh Sounderajah
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sheraz Markar
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jan Przybylowicz
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Ying Xian Chua
- Pioneer Polyclinic, National University Polyclinic, National University Health System, Singapore, Singapore
| | - Kang Sim
- Institute of Mental Health, Singapore, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lucas Lim
- Department of Forensic Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Lifeng Tan
- Division of Healthy Ageing, Alexandra Hospital, Singapore, Singapore
| | - Melanie Tan
- Department of Geriatric Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Vijay Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shirley Ooi
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Emergency Medicine Department, National University Hospital, Singapore, Singapore
| | | | - Kelsey Flott
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sam Mason
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | - Seema Yalamanchili
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Gabriela Zbikowska
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | - Grazyna Dykowska
- Department of Economics of Health and Medical Law, Medical University of Warsaw, Poland
| | - Mary Wells
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sanjay Purkayastha
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - James Kinross
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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49
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Aggarwal R, Sounderajah V, Martin G, Ting DSW, Karthikesalingam A, King D, Ashrafian H, Darzi A. Diagnostic accuracy of deep learning in medical imaging: a systematic review and meta-analysis. NPJ Digit Med 2021; 4:65. [PMID: 33828217 PMCID: PMC8027892 DOI: 10.1038/s41746-021-00438-z] [Citation(s) in RCA: 201] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/25/2021] [Indexed: 12/19/2022] Open
Abstract
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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Affiliation(s)
- Ravi Aggarwal
- Institute of Global Health Innovation, Imperial College London, London, UK
| | | | - Guy Martin
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Daniel S W Ting
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore
| | | | - Dominic King
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, UK.
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK
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50
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Iqbal FM, Lam K, Sounderajah V, Elkin S, Ashrafian H, Darzi A. Understanding the survivorship burden of long COVID. EClinicalMedicine 2021; 33:100767. [PMID: 33649741 PMCID: PMC7904277 DOI: 10.1016/j.eclinm.2021.100767] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Fahad M. Iqbal
- Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK
- Institute of Global Health Innovation, Imperial College London, South Kensington Campus, Kensington, London, SW7 2AZ, UK
| | - Kyle Lam
- Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK
- Institute of Global Health Innovation, Imperial College London, South Kensington Campus, Kensington, London, SW7 2AZ, UK
| | - Viknesh Sounderajah
- Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK
- Institute of Global Health Innovation, Imperial College London, South Kensington Campus, Kensington, London, SW7 2AZ, UK
| | - Sarah Elkin
- Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK
- Institute of Global Health Innovation, Imperial College London, South Kensington Campus, Kensington, London, SW7 2AZ, UK
| | - Hutan Ashrafian
- Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK
- Institute of Global Health Innovation, Imperial College London, South Kensington Campus, Kensington, London, SW7 2AZ, UK
- Corresponding author.
| | - Ara Darzi
- Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, W2 1NY, UK
- Institute of Global Health Innovation, Imperial College London, South Kensington Campus, Kensington, London, SW7 2AZ, UK
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