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Journal articleMcLeod M, Karampatakis GD, Heyligen L, et al., 2019,
The impact of implementing a hospital electronic prescribing and administration system on clinical pharmacists' activities - a mixed methods study
, BMC Health Services Research, Vol: 19, Pages: 1-15, ISSN: 1472-6963BackgroundThe increasing adoption of hospital electronic prescribing and medication administration (ePA) systems has driven a wealth of research around the impact on patient safety. Yet relatively little research has sought to understand the effects on staff, particularly pharmacists. We aimed to investigate the effects of ePA on pharmacists’ activities, including interactions with patients and health professionals, and their perceptions of medication safety risks.MethodsA mixed methods study comprising quantitative direct observations of ward pharmacists before and after implementation of ePA in an English hospital, and semi-structured interviews post-ePA. Quantitative data comprised multi-dimensional work activity sampling to establish the proportion of time ward pharmacists spent on different tasks, with whom and where. These data were extrapolated to estimate task duration. Qualitative interviews with pharmacists explored perceived impact on (i) ward activities, (ii) interactions with patients and different health professionals, (iii) locations where tasks were carried out, and (iv) medication errors.ResultsObservations totalled 116 h and 50 min. Task duration analysis suggested screening inpatient medication increased by 16 mins per 10 patients reviewed (p = 0.002), and searching for paper drug charts or computer decreased by 2 mins per 10 patients reviewed (p = 0.001). Pharmacists mainly worked alone (58% of time pre- and 65% post-ePA, p = 0.17), with patient interactions reducing from 5 to 2% of time (p = 0.03). Seven main themes were identified from the interviews, underpinned by a core explanatory concept around the enhanced and shifting role of the ward pharmacist post-ePA. Pharmacists perceived there to be a number of valuable safety features with ePA. However, paradoxically, some of these may have also inadvertently contributed to medication errors.ConclusionThis study provides quantitative and qualitative
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Conference paperKim JA, Wales DJ, Thompson AJ, et al., 2019,
Towards development of fibre-optic surface enhanced Raman spectroscopy probes using 2-photon polymerisation for rapid detection of bacteria
, Plasmonics in Biology and Medicine XVI, Publisher: SPIE, ISSN: 0277-786XIn this study, a variety of direct laser written surface-enhanced Raman spectroscopy (SERS) micro-structures, designed for bacteria detection, are presented. Various SERS micro-structures were designed to achieve both a high density of plasmonic hot spots and a strong probability of interaction between the hot spots and the target bacterial cells. Twophoton polymerization was used for initial fabrication of the polymeric skeletons of the SERS micro-structures, which were then coated with a 50 nm-thick gold layer via e-beam evaporation. The micro-structures were fabricated on glass coverslips and were assessed using a confocal Raman microscope. To this end, Rhodamine 6G was used as an analyte under 785 nm laser illumination. The optimal SERS micro-structures showed approximately 7×103 enhancement in Raman signal (analytical enhancement factor, AEF) at a wavenumber of 600 cm-1. Real-time detection of E. coli in solution was demonstrated using the fabricated SERS platform with low laser powers and a short acquisition time (785 nm, 5 mW, 50 ms).
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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 articleHemming K, Carroll K, Thompson J, et al., 2019,
Quality of stepped-wedge trial reporting can be reliably assessed using an updated CONSORT: crowd-sourcing systematic review
, Journal of Clinical Epidemiology, Vol: 107, Pages: 77-88, ISSN: 0895-4356The Consolidated Standards Of Reporting Trials (CONSORT) extension for the stepped-wedge cluster randomised trial (SW-CRT) is a recently published reporting guideline for SW-CRTs. We assess the quality of reporting of a recent sample of SW-CRTs according to the 26 items in the new guideline using a novel crowd sourcing methodology conducted independently and in duplicate, with random assignment, by 50 reviewers. We assessed reliability of the quality assessments, proposing this as a novel way to assess robustness of items in reporting guidelines.Several items were well reported. Some items were very poorly reported, including several items that have unique requirements for the SW-CRT, such as the rationale for use of the design, description of the design, identification and recruitment of participants within clusters, and concealment of cluster allocation (not reported in more than 50% of the reports). Agreement across items was moderate (median percentage agreement was 76% [IQR 64 to 86]). Agreement was low for several items including the description of the trial design and why trial ended or stopped for example.When reporting SW-CRTs authors should pay particular attention to ensure clear reporting on the exact format of the design with justification, as well as how clusters and individuals were identified for inclusion in the study, and whether this was done before or after randomisation of the clusters, which are crucial for risk of bias assessments. Some items, including why the trial ended might either not be relevant to SW-CRTs, or might be unclearly described in the statement.
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Journal articleMartin G, Khajuria A, Arora S, et al., 2019,
The impact of mobile technology on teamwork and communication in hospitals: a systematic review
, Journal of the American Medical Informatics Association, Vol: 26, Pages: 339-355, ISSN: 1067-5027Objectives: Effective communication is critical to the safe delivery of care but is characterized by outdated technologies. Mobile technology has the potential to transform communication and teamwork but the evidence is currently uncertain. The objective of this systematic review was to summarize the quality and breadth of evidence for the impact of mobile technologies on communication and teamwork in hospitals. Materials and Methods: Electronic databases (MEDLINE, PsycINFO, EMBASE, CINAHL Plus, HMIC, Cochrane Library, and National Institute of Health Research Health Technology Assessment) were searched for English language publications reporting communication- or teamwork-related outcomes from mobile technologies in the hospital setting between 2007 and 2017. Results: We identified 38 publications originating from 30 studies. Only 11% were of high quality and none met best practice guidelines for mobile-technology-based trials. The studies reported a heterogenous range of quantitative, qualitative, and mixed-methods outcomes. There is a lack of high-quality evidence, but nonetheless mobile technology can lead to improvements in workflow, strengthen the quality and efficiency of communication, and enhance accessibility and interteam relationships. Discussion: This review describes the potential benefits that mobile technology can deliver and that mobile technology is ubiquitous among healthcare professionals. Crucially, it highlights the paucity of high-quality evidence for its effectiveness and identifies common barriers to widespread uptake. Limitations include the limited number of participants and a wide variability in methods and reported outcomes. Conclusion: Evidence suggests that mobile technology has the potential to significantly improve communication and teamwork in hospital provided key organizational, technological, and security challenges are tackled and better evidence delivered.
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Journal articleKhanbhai MHF, Flott KM, Darzi A, et al., 2019,
Evaluating digital maturity and patient acceptability of real-time patient experience feedback systems: a systematic review
, Journal of Medical Internet Research, Vol: 21, ISSN: 1438-8871Background:One of the essential elements of a strategic approach to improving patients’ experience is to measure and report on patients’ experiences in real time. Real-time feedback (RTF) is increasingly being collected using digital technology; however, there are several factors that may influence the success of the digital system.Objective:The aim of this review was to evaluate the digital maturity and patient acceptability of real-time patient experience feedback systems.Methods:We systematically searched the following databases to identify papers that used digital systems to collect RTF: The Cochrane Library, Global Health, Health Management Information Consortium, Medical Literature Analysis and Retrieval System Online, EMBASE, PsycINFO, Web of Science, and CINAHL. In addition, Google Scholar and gray literature were utilized. Studies were assessed on their digital maturity using a Digital Maturity Framework on the basis of the following 4 domains: capacity/resource, usage, interoperability, and impact. A total score of 4 indicated the highest level of digital maturity.Results:RTF was collected primarily using touchscreens, tablets, and Web-based platforms. Implementation of digital systems showed acceptable response rates and generally positive views from patients and staff. Patient demographics according to RTF responses varied. An overrepresentation existed in females with a white predominance and in patients aged ≥65 years. Of 13 eligible studies, none had digital systems that were deemed to be of the highest level of maturity. Three studies received a score of 3, 2, and 1, respectively. Four studies scored 0 points. While 7 studies demonstrated capacity/resource, 8 demonstrated impact. None of the studies demonstrated interoperability in their digital systems.Conclusions:Patients and staff alike are willing to engage in RTF delivered using digital technology, thereby disrupting previous paper-based feedback. However, a lack of emphasis on di
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Conference paperVrielink TJCO, Puyal JG-B, Kogkas A, et al., 2019,
Intuitive gaze-control of a robotized flexible endoscope
, 25th IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), Publisher: IEEE, Pages: 1776-1782, ISSN: 2153-0858Flexible endoscopy is a routinely performed procedure that has predominantly remained unchanged for decades despite its many challenges. This paper introduces a novel, more intuitive and ergonomic platform that can be used with any flexible endoscope, allowing easier navigation and manipulation. A standard endoscope is robotized and a gaze control system based on eye-tracking is developed and implemented, allowing hands-free manipulation. The system characteristics and step response has been evaluated using visual servoing. Further, the robotized system has been compared with a manually controlled endoscope during a user study. The users (n=11) showed a preference for the gaze controlled endoscope and a lower task load when the task was performed with the gaze control. In addition, gaze control was related to a higher success rate and a lower time to perform the task. The results presented validate the system's technical performance and demonstrate the intuitiveness of hands-free gaze control in flexible endoscopy.
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Conference paperWang M-Y, Kogkas AA, Darzi A, et al., 2019,
Free-view, 3D gaze-guided, assistive robotic system for activities of daily living
, 25th IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), Publisher: IEEE, Pages: 2355-2361, ISSN: 2153-0858Patients suffering from quadriplegia have limited body motion which prevents them from performing daily activities. We have developed an assistive robotic system with an intuitive free-view gaze interface. The user's point of regard is estimated in 3D space while allowing free head movement and is combined with object recognition and trajectory planning. This framework allows the user to interact with objects using fixations. Two operational modes have been implemented to cater for different eventualities. The automatic mode performs a pre-defined task associated with a gaze-selected object, while the manual mode allows gaze control of the robot's end-effector position on the user's frame of reference. User studies reported effortless operation in automatic mode. A manual pick and place task achieved a success rate of 100% on the users' first attempt.
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Journal articleJoshi M, Ashrafian H, Aufegger L, et al., 2019,
Wearable sensors to improve detection of patient deterioration
, Expert Review of Medical Devices, Vol: 16, Pages: 145-154, ISSN: 1743-4440INTRODUCTION: Monitoring a patient's vital signs forms a basic component of care, enabling the identification of deteriorating patients and increasing the likelihood of improving patient outcomes. Several paper-based track and trigger warning scores have been developed to allow clinical evaluation of a patient and guidance on escalation protocols and frequency of monitoring. However, evidence suggests that patient deterioration on hospital wards is still missed, and that patients are still falling through the safety net. Wearable sensor technology is currently undergoing huge growth, and the development of new light-weight wireless wearable sensors has enabled multiple vital signs monitoring of ward patients continuously and in real time. Areas covered: In this paper, we aim to closely examine the benefits of wearable monitoring applications that measure multiple vital signs; in the context of improving healthcare and delivery. A review of the literature was performed. Expert commentary: Findings suggest that several sensor designs are available with the potential to improve patient safety for both hospital patients and those at home. Larger clinical trials are required to ensure both diagnostic accuracy and usability.
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Conference paperLeiloglou M, Chalau V, Kedrzycki M, et al., 2019,
Snapshot Fluorescence Hyperspectral System for Breast Cancer Surgery Guidance
, Hamlyn Symposium Advanced Biophotonics Workshop
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