Innovation Adoption in Robotic Surgery - A Surgical Innovation Framework using Royal Bournemouth Hospital

Robotic Surgery is studied as an innovative surgical procedure and we examine the way Robotic Surgery is adopted by healthcare professionals in Royal Bournemouth Hospital. This research aims to develop a Surgical Innovation Framework (SIF) that incorporates the broader adoption of surgical innovation for the National Health Service (NHS) in the United Kingdom. The aim of the framework is to assist the NHS in its determination and adoption of surgical innovation. The framework is developed taking into consideration The recent reports by the Department of Health and Social Care, NHS, NICE and existing body of knowledge. The proposed model considers unique characteristics of Robotic Surgery, NHS as the host organization, healthcare professionals as adopters and other elements such as communication channels. An end-to-end communication pathway is developed for the robotic surgery team to identify stakeholders involved in this process

A framework for successful adoption of surgical innovation

Background Innovation Adoption Frameworks are applied in healthcare industry, but surgical innovation does not follow the same models as medical innovation and it is not always adopted fully by members of the team. Purpose The aim of this paper is to develop a framework for successful adoption of surgical innovation. Research design This paper is inspired by design thinking. Based on a pragmatic research philosophy, a mixed method approach was selected including semi-structured interview and focus groups, following a questionnaire. Study sample A sample of five specialists in the field (doctors and managers) were selected for interview. Six focus groups were conducted. On average, five people were involved in each focus groups, 30 participants in total, including consultants, senior and junior ward nurses, health care assistant (HCA), cancer nurse specialist, stoma nurses, theatre senior and junior staff. Data collection/analysis Qualitative data was collected and analyzed using Thematic Analysis. Results Following a design thinking approach; firstly, an initial Surgical Adoption Model was proposed, based on the existing literature. Then, the challenges, processes and teams involved in Robotic Surgery adoption, an existing surgical innovation in a local NHS hospital, were explored. Five main themes were extracted from interviews and focus groups data - ‘Innovation Perception’, ‘Guilty vs. Undervalued’, ‘Knowledge is Power’, ‘Ex-novation’ and ‘Facilitators and Super-users’. This resulted into the development of an adapted Surgical Innovation Framework. Conclusions The Surgical Innovation Framework incorporated the themes extracted from the data. The framework is unique within the field of surgical innovation and is designed with the aim of improving surgical innovation adoption success rate. Future research can trial the framework to evaluate its effectiveness

Design of hybrid multimodal logistic hub network with postponement strategy

This paper aims at suggesting a method allowing to design a logistic hub network in the context of postponement strategy, postponement being performed in hubs having industrial facilities in addition to logistic ones. We propose a two-stage mathematical mixed integer linear programming model for: 1) logistic hub network design 2) postponement location on the designed hub network. The suggested model manages characteristics not yet taken into account simultaneously in the literature: hierarchical logistic structure, postponement strategy, multi-commodity, multi-packaging of goods (raw materials or components vs. final products), multi-period planning. The solutions are compared through services levels and logistic costs

Designing optoelectronic properties by on-surface synthesis: formation and electronic structure of an iron-terpyridine macromolecular complex

Supramolecular chemistry protocols applied on surfaces offer compelling avenues for atomic scale control over organic-inorganic interface structures. In this approach, adsorbate-surface interactions and two-dimensional confinement can lead to morphologies and properties that differ dramatically from those achieved via conventional synthetic approaches. Here, we describe the bottom-up, on-surface synthesis of one-dimensional coordination nanostructures based on an iron (Fe)-terpyridine (tpy) interaction borrowed from functional metal-organic complexes used in photovoltaic and catalytic applications. Thermally activated diffusion of sequentially deposited ligands and metal atoms, and intra-ligand conformational changes, lead to Fe-tpy coordination and formation of these nanochains. Low-temperature Scanning Tunneling Microscopy and Density Functional Theory were used to elucidate the atomic-scale morphology of the system, providing evidence of a linear tri-Fe linkage between facing, coplanar tpy groups. Scanning Tunneling Spectroscopy reveals highest occupied orbitals with dominant contributions from states located at the Fe node, and ligand states that mostly contribute to the lowest unoccupied orbitals. This electronic structure yields potential for hosting photo-induced metal-to-ligand charge transfer in the visible/near-infrared. The formation of this unusual tpy/tri-Fe/tpy coordination motif has not been observed for wet chemistry synthesis methods, and is mediated by the bottom-up on-surface approach used here

The Incremental Cooperative Design of Preventive Healthcare Networks

This document is the Accepted Manuscript version of the following article: Soheil Davari, 'The incremental cooperative design of preventive healthcare networks', Annals of Operations Research, first published online 27 June 2017. Under embargo. Embargo end date: 27 June 2018. The final publication is available at Springer via http://dx.doi.org/10.1007/s10479-017-2569-1.In the Preventive Healthcare Network Design Problem (PHNDP), one seeks to locate facilities in a way that the uptake of services is maximised given certain constraints such as congestion considerations. We introduce the incremental and cooperative version of the problem, IC-PHNDP for short, in which facilities are added incrementally to the network (one at a time), contributing to the service levels. We first develop a general non-linear model of this problem and then present a method to make it linear. As the problem is of a combinatorial nature, an efficient Variable Neighbourhood Search (VNS) algorithm is proposed to solve it. In order to gain insight into the problem, the computational studies were performed with randomly generated instances of different settings. Results clearly show that VNS performs well in solving IC-PHNDP with errors not more than 1.54%.Peer reviewe

Increased mRNA expression of CDKN2A is a transcriptomic marker of clinically aggressive meningiomas

Homozygous deletion of CDKN2A/B was recently incorporated into the World Health Organization classification for grade 3 meningiomas. While this marker is overall rare in meningiomas, its relationship to other CDKN2A alterations on a transcriptomic, epigenomic, and copy number level has not yet been determined. We therefore utilized multidimensional molecular data of 1577 meningioma samples from 6 independent cohorts enriched for clinically aggressive meningiomas to comprehensively interrogate the spectrum of CDKN2A alterations through DNA methylation, copy number variation, transcriptomics, and proteomics using an integrated molecular approach. Homozygous CDKN2A/B deletions were identified in only 7.1% of cases but were associated with significantly poorer outcomes compared to tumors without these deletions. Heterozygous CDKN2A/B deletions were identified in 2.6% of cases and had similarly poor outcomes as those with homozygous deletions. Among tumors with intact CDKN2A/B (without a homozygous or heterozygous deletion), we found a distinct difference in outcome based on mRNA expression of CDKN2A, with meningiomas that had elevated mRNA expression (CDKN2Ahigh) having a significantly shorter time to recurrence. The expression of CDKN2A was independently prognostic after accounting for copy number loss and consistently increased with WHO grade and more aggressive molecular and methylation groups irrespective of cohort. Despite the discordant and mutually exclusive status of the CDKN2A gene in these groups, both CDKN2Ahigh meningiomas and meningiomas with CDKN2A deletions were enriched for similar cell cycle pathways but at different checkpoints. High mRNA expression of CDKN2A was also associated with gene hypermethylation, Rb-deficiency, and lack of response to CDK inhibition. p16 immunohistochemistry could not reliably differentiate between meningiomas with and without CDKN2A deletions but appeared to correlate better with mRNA expression. These findings support the role of CDKN2A mRNA expression as a biomarker of clinically aggressive meningiomas with potential therapeutic implications

Multiplexed identification, quantification and genotyping of infectious agents using a semiconductor biochip

The emergence of pathogens resistant to existing antimicrobial drugs is a growing worldwide health crisis that threatens a return to the pre-antibiotic era. To decrease the overuse of antibiotics, molecular diagnostics systems are needed that can rapidly identify pathogens in a clinical sample and determine the presence of mutations that confer drug resistance at the point of care. We developed a fully integrated, miniaturized semiconductor biochip and closed-tube detection chemistry that performs multiplex nucleic acid amplification and sequence analysis. The approach had a high dynamic range of quantification of microbial load and was able to perform comprehensive mutation analysis on up to 1,000 sequences or strands simultaneously in <2 h. We detected and quantified multiple DNA and RNA respiratory viruses in clinical samples with complete concordance to a commercially available test. We also identified 54 drug-resistance-associated mutations that were present in six genes of Mycobacterium tuberculosis, all of which were confirmed by next-generation sequencing

Quality of life outcomes in incidental and operated meningiomas (QUALMS): a cross-sectional cohort study.

INTRODUCTION: Few studies have evaluated meningioma patients' longer-term health-related quality of life (HRQoL) following diagnosis and treatment, particularly in those with incidental, actively monitored tumours. METHODS: A single-center, cross-sectional study was completed. Adult patients with surgically managed or actively monitored meningioma with more than five years of follow-up were included. The patient-reported outcome measures RAND SF-36, EORTC QLQ-C30 and QLQ-BN20 were used to evaluate HRQoL. HRQoL scores were compared to normative population data. Outcome determinants were evaluated using multivariate linear regression analysis. RESULTS: 243 patient responses were analyzed, and the mean time from diagnosis was 9.8 years (range 5.0-40.3 years). Clinically relevant, statistically significant HRQoL impairments were identified across several SF-36 and QLQ-C30 domains. Increasing education level (β = 2.9, 95% CI 0.9 to 4.9), P = .004), employment (β = 7.7, 95% CI 2.2 to 13.1, P = .006) and absence of postoperative complications (β=-6.7, 95% CI -13.2 to (-)0.3, P = .041) were associated with a better QLQ-C30 summary score. Other tumour and treatment variables were not. CONCLUSION: This study highlights the longer-term disease burden of patients with meningioma nearly one decade after diagnosis or surgery. Patients with actively monitored meningioma have similar HRQoL to operated meningioma patients. Healthcare professionals should be mindful of HRQoL impairments and direct patients to sources of support as needed