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Journal articleGoiana-da-Silva F, Cruz-e-Silva D, Carrico M, et al., 2019,
Changing the channel: television health campaigns in Portugal
, Lancet Public Health, Vol: 4, Pages: E179-E179, ISSN: 2468-2667 -
Journal articleMoylan A, Appelbaum N, Clarke J, et al., 2019,
Assessing the agreement of 5 ideal body weight calculations for selecting medication dosages for children with obesity
, JAMA Pediatrics, ISSN: 2168-6203 -
Journal articleGoiana-da-Silva F, Cruz-e-Silva D, Gregorio MJ, et al., 2019,
Nutri-score: A public health tool to improve eating habits in Portugal
, Acta Médica Portuguesa, Vol: 32, Pages: 175-178, ISSN: 1646-0758 -
Journal articleGoiana-da-Silva F, Cruz-e-Silva D, Miraldo M, et al., 2019,
Front-of-pack labelling policies and the need for guidance
, Lancet Public Health, Vol: 4, Pages: E15-E15, ISSN: 2468-2667 -
Journal articleHassen Y, Singh P, Pucher PH, et al., 2018,
Identifying quality markers of a safe surgical ward: an interview study of patients, clinical staff, and administrators
, Surgery, Vol: 163, Pages: 1226-1233, ISSN: 0039-6060BACKGROUND: Postoperative care quality is variable. Risk-adjusted mortality rates differ between institutions despite comparable complication rates. This indicates that there are underlying factors rooted in how care is delivered that determines patient safety. This study aims to evaluate systematically the surgical ward environment with respect to process-driven and structural factors to identify quality markers for safe care, from which new safety metrics may be derived. METHODS: Semistructured interviews of clinicians, nurses, patients and administrators were undertaken for the study. RESULTS: In the study, 97% of staff members recognized the existence of variation in patient safety between surgical wards. Four main error-prone processes were identified: ward rounds (57%), medication prescribing and administration (49%), the presence of outliers (43%), and deficiencies in communication between clinical staff (43%). Structural factors were categorized as organizational or environmental; organizational included shortage in staffing (39%) and use of temporary staff (27%). Environmental factors considered layout and patient visibility to nurses (49%) as well as cleanliness (29%). Safety indicators identified included staff experience level (31%), overall layout of the ward, cleanliness and leadership (all 27% each). The majority of patients (87%) identified staff attentiveness as a safety indicator. CONCLUSION: This study demonstrates that there are a number of factors that may contribute to safety on the surgical ward spanning multiple processes, organizational, and environmental factors. Safety indicators identified across all these categories presents an opportunity to develop broader and more effectual safety improvement measures focusing on multiple areas simultaneously.
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Journal articleFlott K, Darzi A, Gancarczyk S, et al., 2018,
Improving the usefulness and use of patient survey programmes: Views from the frontline
, Journal of Medical Internet Research, Vol: 20, Pages: e141-e141, ISSN: 1438-8871Background: A growing body of evidence suggests a concerning lag between collection of patient experience data and its application in service improvement. This study aims to identify what health care staff perceive to be the barriers and facilitators to using patient-reported feedback and showcase successful examples of doing so.Objective: This study aimed to apply a systems perspective to suggest policy improvements that could support efforts to use data on the frontlines.Methods: Qualitative interviews were conducted in eight National Health Service provider locations in the United Kingdom, which were selected based on National Inpatient Survey scores. Eighteen patient-experience leads were interviewed about using patient-reported feedback with relevant staff. Interviews were transcribed and underwent thematic analysis. Staff-identified barriers and facilitators to using patient experience feedback were obtained.Results: The most frequently cited barriers to using patient reported feedback pertained to interpreting results, understanding survey methodology, presentation of data in both national Care Quality Commission and contractor reports, inability to link data to other sources, and organizational structure. In terms of a wish list for improved practice, staff desired more intuitive survey methodologies, the ability to link patient experience data to other sources, and more examples of best practice in patient experience improvement. Three organizations also provided examples of how they successfully used feedback to improve care.Conclusions: Staff feedback provides a roadmap for policy makers to reconsider how data is collected and whether or not the national regulations on surveys and patient experience data are meeting the quality improvement needs of local organizations.
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Journal articleGohil S, Vuik S, Darzi A, 2018,
Sentiment analysis of health care tweets: review of the methods used.
, JMIR Public Health and Surveillance, Vol: 4, Pages: e43-e43, ISSN: 2369-2960BACKGROUND: Twitter is a microblogging service where users can send and read short 140-character messages called "tweets." There are several unstructured, free-text tweets relating to health care being shared on Twitter, which is becoming a popular area for health care research. Sentiment is a metric commonly used to investigate the positive or negative opinion within these messages. Exploring the methods used for sentiment analysis in Twitter health care research may allow us to better understand the options available for future research in this growing field. OBJECTIVE: The first objective of this study was to understand which tools would be available for sentiment analysis of Twitter health care research, by reviewing existing studies in this area and the methods they used. The second objective was to determine which method would work best in the health care settings, by analyzing how the methods were used to answer specific health care questions, their production, and how their accuracy was analyzed. METHODS: A review of the literature was conducted pertaining to Twitter and health care research, which used a quantitative method of sentiment analysis for the free-text messages (tweets). The study compared the types of tools used in each case and examined methods for tool production, tool training, and analysis of accuracy. RESULTS: A total of 12 papers studying the quantitative measurement of sentiment in the health care setting were found. More than half of these studies produced tools specifically for their research, 4 used open source tools available freely, and 2 used commercially available software. Moreover, 4 out of the 12 tools were trained using a smaller sample of the study's final data. The sentiment method was trained against, on an average, 0.45% (2816/627,024) of the total sample data. One of the 12 papers commented on the analysis of accuracy of the tool used. CONCLUSIONS: Multiple methods are used for sentiment analysis of tweets in the
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Journal articleWilliams SP, Malik HT, Nicolay CR, et al., 2018,
Interventions to improve employee health and well-being within health care organizations-a systematic review
, Journal of Healthcare Risk Management, Vol: 37, Pages: 25-51, ISSN: 1074-4797In response to an increasing body of evidence on the importance of employee health and well-being (HWB) within health care, there has been a shift in focus from both policymakers and individual organizations toward improving health care employee HWB. However, there is something of a paucity of evidence regarding the impact and value of specific HWB interventions within a health care setting. The aim of this article was to systematically review the literature on this topic utilizing the EMBASE, Global Health, Health Management Information Consortium, MEDLINE, and PsycINFO databases. Forty-four articles were identified and, due to a large degree of heterogeneity, were considered under different headings as to the type of intervention employed: namely, those evaluating changing ways of working, physical health promotion, complementary and alternative medicine, and stress management interventions, and those utilizing multimodal interventions. Our results consider both the efficacy and reliability of each intervention in turn and reflect on the importance of careful study design and measure selection when evaluating the impact of HWB interventions.
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Journal articlePrime M, Attaelmanan I, Imbuldeniya A, et al., 2018,
From Malawi to Middlesex – The case of the Arbutus Drill Cover System as an example of the cost saving potential of frugal innovations for the UK NHS
, BMJ Innovations, Vol: 4, Pages: 103-110, ISSN: 2055-642XBackground Musculoskeletal disease is one of the leading clinical and economic burdens of the UK health system, and the resultant demand for orthopaedic care is only set to increase. One commonly used and one of the most expensive hardware in orthopaedic surgery is the surgical drill and saw. Given financial constraints, the National Health Service (NHS) needs an economic way to address this recurring cost. We share evidence of one frugal innovation with potential for contributing to the NHS’ efficiency saving target of £22 billion by 2020.Methods Exploratory case study methodology was used to develop insights and understanding of the innovations potential for application in the NHS. Following a global search for potential frugal innovations in surgery, the Arbutus Drill Cover System was identified as an innovation with potential to deliver significant cost savings for the NHS in the UK.Results The Arbutus Drill Cover System is up to 94% cheaper than a standard surgical drill available in the UK. Clinical and laboratory tests show that performance, safety and usability are as good as current offerings in high-income countries and significantly better than hand drills typically used in low-and-middle-income countries. The innovation meets all regulatory requirements to be a medical device in the Europe and North America.Conclusions The innovation holds promise in reducing upfront and life span costs for core equipment used in orthopaedic surgery without loss of effectiveness or safety benchmarks. However, the innovation needs to navigate complicated and decentralised procurement processes and clinicians and healthcare leaders need to overcome cognitive bias.
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Journal articleAhmed I, Ahmad NS, Ali S, et al., 2018,
Medication adherence apps: A review and content analysis
, JMIR mHealth and uHealth, Vol: 6, ISSN: 2291-5222Background:Medication adherence is a costly and damaging problem for both healthcare providers and patients alike. Patients adhere to only 50% of drugs prescribed for chronic diseases in developed nations. Digital health has paved the way for innovative smartphone solutions to tackle this challenge. However, despite the numerous applications (apps) available claiming to improve adherence, a thorough review of adherence applications has not been carried out to date.Objective:(i)To review medication adherence apps (otherwise known as mAdherence app) in the Apple App store and the Google Play repository in terms of their evidence base, medical professional involvement in development, and strategies used to facilitate behaviour change and improve adherence.(ii)To provide a system of classification for these apps. Methods:In April 2015, relevant mAdherence apps were identified by systematically searching the Apple and Google Play app stores using a combination of relevant search terms. Data extracted for each app included app store source, app price, documentation of healthcare professional (HCP) involvement during app development and evidence base for each respective app.Free apps were downloaded to explore the strategies used to promote medication adherence. Testing involved a standardised medication regimen of three reminders over a four-hour period. Non-adherence features designed to enhance user experience were also documented.Results:The App repository search identified a total of 5889 applications. 806 fulfilled the inclusion criteria initially and were tested. 682 applications were further analysed for data extraction. Of these, 61.7% were free for testing, 8.5% were inaccessible and 29.8% required payment. Of the 421 free applications, 13.8% were developed with HCP involvement and an evidence base was identified in only 0.95%. Of the paid apps, 4.4% had HCP involvement, 0.5% had a documented evidence base and 0.5% had both. 31% of inaccessible apps were produce
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Journal articleDewa LH, Murray K, Thibaut B, et al., 2018,
Identifying research priorities for patient safety in mental health: an international expert Delphi study
, BMJ Open, Vol: 8, ISSN: 2044-6055Objective Physical healthcare has dominated the patient safety field; research in mental healthcare is not as extensive but findings from physical healthcare cannot be applied to mental healthcare because it delivers specialised care that faces unique challenges. Therefore, a clearer focus and recognition of patient safety in mental health as a distinct research area is still needed. The study aim is to identify future research priorities in the field of patient safety in mental health.Design Semistructured interviews were conducted with the experts to ascertain their views on research priorities in patient safety in mental health. A three-round online Delphi study was used to ascertain consensus on 117 research priority statements.Setting and participants Academic and service user experts from the USA, UK, Switzerland, Netherlands, Ireland, Denmark, Finland, Germany, Sweden, Australia, New Zealand and Singapore were included.Main outcome measures Agreement in research priorities on a five-point scale.Results Seventy-nine statements achieved consensus (>70%). Three out of the top six research priorities were patient driven; experts agreed that understanding the patient perspective on safety planning, on self-harm and on medication was important.Conclusions This is the first international Delphi study to identify research priorities in safety in the mental field as determined by expert academic and service user perspectives. A reasonable consensus was obtained from international perspectives on future research priorities in patient safety in mental health; however, the patient perspective on their mental healthcare is a priority. The research agenda for patient safety in mental health identified here should be informed by patient safety science more broadly and used to further establish this area as a priority in its own right. The safety of mental health patients must have parity with that of physical health patients to achieve this.
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Journal articleDarzi A, 2017,
A British Perspective on the American College of Surgeons Conversation About Firearm Safety.
, Annals of Surgery, Vol: 267, Pages: 430-431, ISSN: 0003-4932 -
Conference paperPrime M, Bhatti Y, Harris M, et al., 2017,
Frugal innovations for healthcare: a toolkit for innovators
, Academy of Management conference, Publisher: Academy of Management, ISSN: 2151-6561Global health systems face significant challenges over the coming years to meet the increasing demands of ageing populations, the growing burden of chronic disease and the exponential cost of healthcare delivery. In response innovators from around the world are beginning to develop solutions that focus on reducing the cost of care; widen access to care; and challenge the dogma that more is better. So-called frugal innovations are defined as “means or ends, to do more with less, for the many” (Bhatti, 2014). This paper seeks to ask, “How can we identify frugal innovations for healthcare and how are they achieving frugality?” with the specific objective of developing a frugal innovation toolkit for healthcare. An emergent, embedded, mixed-methods research strategy was employed. A pilot study was used to develop the Frugal Innovation for Healthcare - Identification Tool (FIH-ID tool). A larger study was undertaken to identify a cohort of frugal innovations, evaluate the application of the FIH-ID tool, and assess the processes and strategies employed by frugal innovators. 56 semi-structured interviews were undertaken with 90 representatives of 28 healthcare innovations exhibiting at the World Innovation Summit for Health (WISH) 2015. 15 frugal innovations for healthcare were identified. Inter-observer agreement for application of the FIH-ID tool demonstrated a high proportion of agreement (Po = 0.714), and a “fair” Cohen’s Kappa score (K = 0.499). A thematic analysis identified key strategies applied by individuals or organizations to produce frugal innovations. These include: the application of new information & communication technologies; harnessing existing networks; simplification; changing the location of care; and task-shifting. This paper presents a toolkit of strategies for identifying and creating frugal innovations for healthcare. This research suggests that the FIH-ID tool is a reliable means of identifying exampl
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Journal articlebhatti Y, taylor A, harris M, et al., 2017,
Global Lessons In Frugal Innovation To Improve Health Care Delivery In The United States
, Health Affairs, Vol: 36, Pages: 1912-1919, ISSN: 0278-2715In a 2015 global study of low-cost or frugal innovations, we identified five leading innovations that scaled successfully in their original contexts and that may provide insights for scaling such innovations in the United States. We describe common themes among these diverse innovations, critical factors for their translation to the United States to improve the efficiency and quality of health care, and lessons for the implementation and scaling of other innovations. We highlight promising trends in the United States that support adapting these innovations, including growing interest in moving care out of health care facilities and into community and home settings; the growth of alternative payment models and incentives to experiment with new approaches to population health and care delivery; and the increasing use of diverse health professionals, such as community health workers and advanced practice providers. Our findings should inspire policy makers and health care professionals and inform them about the potential for globally sourced frugal innovations to benefit US health care.
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Journal articleHarris MJ, Marti J, Watt H, et al., 2017,
Explicit Bias Toward High-Income Country Research: A Randomized, Blinded, Crossover Experiment Of English Clinicians
, Health Affairs, Vol: 36, Pages: 1997-2004, ISSN: 0278-2715Unconscious bias may interfere with the interpretation of research from some settings, particularly from lower-income countries. Most studies of this phenomenon have relied on indirect outcomes such as article citation counts and publication rates; few have addressed or proven the effect of unconscious bias in evidence interpretation. In this randomized, blinded crossover experiment in a sample of 347 English clinicians, we demonstrate that changing the source of a research abstract from a low- to a high-income country significantly improves how it is viewed, all else being equal. Using fixed-effects models, we measured differences in ratings for strength of evidence, relevance, and likelihood of referral to a peer. Having a high-income-country source had a significant overall impact on respondents’ ratings of relevance and recommendation to a peer. Unconscious bias can have far-reaching implications for the diffusion of knowledge and innovations from low-income countries.
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Journal articleShetty K, Poo SXW, Sriskandarajah K, et al., 2017,
"The longest way round is the shortest way home": an overhaul of surgical ward rounds
, World Journal of Surgery, Vol: 42, Pages: 937-949, ISSN: 1432-2323BACKGROUND: Ward rounds, a keystone of hospital surgical practice, have recently been under the spotlight. Poor-quality ward rounds can lead to a greater number of adverse events, thereby cascading to an increased financial strain on our already burdened healthcare systems. Faced with mounting pressures from both outside and inside health organizations, concerted efforts are required to restore it back into prominence where it can no longer take a backseat to the other duties of a surgeon. METHODS: The nucleus of this narrative review is derived from an extensive literature search on surgical ward rounds. RESULTS: In this review, we focus on the need for reforms, current characteristics of surgical ward rounds, obstacles encountered by competing interests and proposed solutions in delivery of effective ward rounds that can meet with newly laid guidelines. CONCLUSION: Ward rounds should be standardized and prioritized to improve patient care.
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Journal articleHosny SG, Johnston MJ, Pucher PH, et al., 2017,
Barriers to the implementation and uptake of simulation-based training programs in general surgery: a multinational qualitative study.
, Journal of Surgical Research, Vol: 220, Pages: 419-426.e2, ISSN: 0022-4804BACKGROUND: Despite evidence demonstrating the advantages of simulation training in general surgery, it is not widely integrated into surgical training programs worldwide. The aim of this study was to identify barriers and facilitators to the implementation and uptake of surgical simulation training programs. METHODS: A multinational qualitative study was conducted using semi-structured interviews of general surgical residents and experts. Each interview was audio recorded, transcribed verbatim, and underwent emergent theme analysis. All data were anonymized and results pooled. RESULTS: A total of 37 individuals participated in the study. Seventeen experts (Program Directors and Surgical Attendings with an interest in surgical education) and 20 residents drawn from the United States, Canada, United Kingdom, France, and Japan were interviewed. Barriers to simulation-based training were identified based on key themes including financial cost, access, and translational benefit. Participants described cost (89%) and access (76%) as principal barriers to uptake. Common facilitators included a mandatory requirement to complete simulation training (78%) and on-going assessment of skills (78%). Participants felt that simulation training could improve patient outcomes (76%) but identified a lack of evidence to demonstrate benefit (38%). There was a consensus that simulation training has not been widely implemented (70%). CONCLUSIONS: There are multiple barriers to the implementation of surgical simulation training programs, however, there is agreement that these programs could potentially improve patient outcomes. Identifying these barriers enable the targeted use of facilitators to deliver simulation training programs.
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Journal articleVuik SI, Fontana G, Mayer E, et al., 2017,
Do hospitalisations for Ambulatory Care Sensitive Conditions reflect low access to primary care? An observational cohort study of primary care utilisation prior to hospitalisation
, BMJ Open, Vol: 7, ISSN: 2044-6055Objectives To explore whether hospitalisations for ambulatory care sensitive conditions (ACSCs) are associated with low access to primary care.Design Observational cohort study over 2008 to 2012 using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases.Setting English primary and secondary care.Participants A random sample of 300 000 patients.Main outcome measures Emergency hospitalisation for an ACSC.Results Over the long term, patients with ACSC hospitalisations had on average 2.33 (2.17 to 2.49) more general practice contacts per 6 months than patients with similar conditions who did not require hospitalisation. When accounting for the number of diagnosed ACSCs, age, gender and GP practice through a nested case–control method, the difference was smaller (0.64 contacts), but still significant (p<0.001).In the short-term analysis, measured over the 6 months prior to hospitalisation, patients used more GP services than on average over the 5 years. Cases had significantly (p<0.001) more primary care contacts in the 6 months before ACSC hospitalisations (7.12, 95% CI 6.95 to 7.30) than their controls during the same 6 months (5.57, 95% CI 5.43 to 5.72). The use of GP services increased closer to the time of hospitalisation, with a peak of 1.79 (1.74 to 1.83) contacts in the last 30 days before hospitalisation.Conclusions This study found no evidence to support the hypothesis that low access to primary care is the main driver of ACSC hospitalisations. Other causes should also be explored to understand how to use ACSC admission rates as quality metrics, and to develop the appropriate interventions.
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Journal articleIssa H, Kulasabanathan K, Darzi A, et al., 2017,
Shared learning in an interconnected world: the role of international health partnerships.
, Journal of the Royal Society of Medicine, Vol: 110, Pages: 316-319, ISSN: 0141-0768 -
Journal articleCarter AW, Mandavia R, Mayer E, et al., 2017,
Systematic review of economic analyses in patient safety: a protocol designed to measure development in the scope and quality of evidence.
, BMJ Open, Vol: 7, ISSN: 2044-6055INTRODUCTION: Recent avoidable failures in patient care highlight the ongoing need for evidence to support improvements in patient safety. According to the most recent reviews, there is a dearth of economic evidence related to patient safety. These reviews characterise an evidence gap in terms of the scope and quality of evidence available to support resource allocation decisions. This protocol is designed to update and improve on the reviews previously conducted to determine the extent of methodological progress in economic analyses in patient safety. METHODS AND ANALYSIS: A broad search strategy with two core themes for original research (excluding opinion pieces and systematic reviews) in 'patient safety' and 'economic analyses' has been developed. Medline, Econlit and National Health Service Economic Evaluation Database bibliographic databases will be searched from January 2007 using a combination of medical subject headings terms and research-derived search terms (see table 1). The method is informed by previous reviews on this topic, published in 2012. Screening, risk of bias assessment (using the Cochrane collaboration tool) and economic evaluation quality assessment (using the Drummond checklist) will be conducted by two independent reviewers, with arbitration by a third reviewer as needed. Studies with a low risk of bias will be assessed using the Drummond checklist. High-quality economic evaluations are those that score >20/35. A qualitative synthesis of evidence will be performed using a data collection tool to capture the study design(s) employed, population(s), setting(s), disease area(s), intervention(s) and outcome(s) studied. Methodological quality scores will be compared with previous reviews where possible. Effect size(s) and estimate uncertainty will be captured and used in a quantitative synthesis of high-quality evidence, where possible. ETHICS AND DISSEMINATION: Formal ethical approval is not required as primary data will not be collected. T
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