Imperial College London

PROFESSOR AZEEM MAJEED

Faculty of MedicineSchool of Public Health

Chair - Primary Care and Public Health & Head of Department
 
 
 
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Contact

 

+44 (0)20 7594 3368a.majeed Website

 
 
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Assistant

 

Mrs Pirkko Carmack +44 (0)20 7594 3368

 
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Location

 

Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
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680 results found

Hayhoe B, Kim D, Aylin PP, Majeed FA, Cowie MR, Bottle Aet al., 2019, Adherence to guidelines in management of symptoms suggestive of heart failure in primary care., Heart, Vol: 105, Pages: 678-685

OBJECTIVE: Clinical guidelines on heart failure (HF) suggest timings for investigation and referral in primary care. We calculated the time for patients to achieve key elements in the recommended pathway to diagnosis of HF. METHODS: In this observational study, we used linked primary and secondary care data (Clinical Practice Research Datalink, a database of anonymised electronic records from UK general practices) between 2010 and 2013. Records were examined for presenting symptoms (breathlessness, fatigue, ankle swelling) and key elements of the National Institute for Health and Care Excellence-recommended pathway to diagnosis (serum natriuretic peptide (NP) test, echocardiography, specialist referral). RESULTS: 42 403 patients were diagnosed with HF, of whom 16 597 presented in primary care with suggestive symptoms. 6464 (39%) had recorded NP or echocardiography, and 6043 (36%) specialist referral. Median time from recorded symptom(s) to investigation (NP or echocardiography) was 292 days (IQR 34-844) and to referral 236 days (IQR 42-721). Median time from symptom(s) to diagnosis was 972 days (IQR 337-1468) and to treatment with HF-relevant medication 803 days (IQR 230-1364). Factors significantly affecting timing of referral, treatment and diagnosis included patients' sex (p=0.001), age (p<0.001), deprivation score (p=0.001), comorbidities (p<0.001) and presenting symptom type (p<0.001). CONCLUSIONS: Median times to investigation or referral of patients presenting in primary care with symptoms suggestive of HF considerably exceeded recommendations. There is a need to support clinicians in the diagnosis of HF in primary care, with improved access to investigation and specialist assessment to support timely management.

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Beghi E, Giussani G, Abd-Allah F, Abdela J, Abdelalim A, Abraha HN, Adib MG, Agrawal S, Alandab F, Awasthi A, Ayele Y, Barboza MA, Belachew AB, Biadgo B, Bijani A, Bitew H, Carvalho F, Chaiah Y, Daryani A, Huyen PD, Dubey M, Endries AYY, Eskandarieh S, Faro A, Farzadfar F, Fereshtehnejad S-M, Fernandes E, Fijabi DO, Filip I, Fischer F, Gebre AK, Tsadik AG, Gebremichael TG, Gezae KE, Ghasemi-Kasman M, Weldegwergs KG, Degefa MG, Gnedovskaya E, Hagos TB, Haj-Mirzaian A, Haj-Mirzaian A, Hassen HY, Hay S, Jakovljevic M, Kasaeian A, Kassa TD, Khader YS, Khalil I, Khan EA, Khubchandani J, Kisa A, Krohn KJ, Kulkarni C, Nirayo YL, Mackay MT, Majdan M, Majeed A, Manhertz T, Mehndiratta MM, Mekonen T, Meles HG, Mengistu G, Mohammed S, Naghavi M, Mokdad AH, Mustafa G, Irvani SSN, Long HN, Nichols E, Nixon MR, Ogbo FA, Olagunju AT, Olagunju TO, Owolabi MO, Philips MR, Pinilla-Monsalve GD, Qorbani M, Radfar A, Rafay A, Rahimi-Movaghar V, Reinig N, Sachdev PS, Safari H, Safari S, Safiri S, Sahraian MA, Samy AM, Sarvi S, Sawhney M, Shaikh MA, Sharif M, Singh G, Smith M, Szoeke CE, Tabares-Seisdedos R, Temsah M-H, Temsah O, Tortajada-Girbes M, Bach XT, Tsegay AAT, Ullah I, Venketasubramanian N, Westerman R, Winkler AS, Yimer EM, Yonemoto N, Feigin VL, Vos T, Murray CJLet al., 2019, Global, regional, and national burden of epilepsy, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016, LANCET NEUROLOGY, Vol: 18, Pages: 357-375, ISSN: 1474-4422

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Sripa P, Hayhoe B, Garg P, Majeed A, Greenfield Get al., 2019, Impact of GP gatekeeping on quality of care, and health outcomes, use, and expenditure: a systematic review., Br J Gen Pract

BACKGROUND: GPs often act as gatekeepers, authorising patients' access to specialty care. Gatekeeping is frequently perceived as lowering health service use and health expenditure. However, there is little evidence suggesting that gatekeeping is more beneficial than direct access in terms of patient- and health-related outcomes. AIM: To establish the impact of GP gatekeeping on quality of care, health use and expenditure, and health outcomes and patient satisfaction. DESIGN AND SETTING: A systematic review. METHOD: The databases MEDLINE, PreMEDLINE, Embase, and the Cochrane Library were searched for relevant articles using a search strategy. Two authors independently screened search results and assessed the quality of studies. RESULTS: Electronic searches identified 4899 studies (after removing duplicates), of which 25 met the inclusion criteria. Gatekeeping was associated with better quality of care and appropriate referral for further hospital visits and investigation. However, one study reported unfavourable outcomes for patients with cancer under gatekeeping, and some concerns were raised about the accuracy of diagnoses made by gatekeepers. Gatekeeping resulted in fewer hospitalisations and use of specialist care, but inevitably was associated with more primary care visits. Patients were less satisfied with gatekeeping than direct-access systems. CONCLUSION: Gatekeeping was associated with lower healthcare use and expenditure, and better quality of care, but with lower patient satisfaction. Survival rate of patients with cancer in gatekeeping schemes was significantly lower than those in direct access, although primary care gatekeeping was not otherwise associated with delayed patient referral. The long-term outcomes of gatekeeping arrangements should be carefully studied before devising new gatekeeping policies.

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Huckvale K, Wang CJ, Majeed A, Car Jet al., 2019, Digital health at fifteen: more human (more needed), BMC MEDICINE, Vol: 17, ISSN: 1741-7015

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Fadahunsi KP, Akinlua JT, O'Connor S, Wark PA, Gallagher J, Carroll C, Majeed A, O'Donoghue Jet al., 2019, Protocol for a systematic review and qualitative synthesis of information quality frameworks in eHealth., BMJ Open, Vol: 9

INTRODUCTION: Electronic health (eHealth) applications have become a very large repository of health information which informs critical decisions relating to the diagnosis, treatment and prognosis of patients. Poor information quality (IQ) within eHealth may compromise patient safety. Evaluation of IQ in eHealth is therefore necessary to promote patient safety. An IQ framework specifies what aspects of information to assess and how to conduct the assessment. This systematic review aims to identify dimensions within existing IQ frameworks in eHealth and develop a new IQ framework for the assessment of eHealth. METHOD AND ANALYSIS: We will search Embase, Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature, Maternity and Infant Care, PsycINFO (American Psychological Association), Global Health, Scopus, ProQuest Dissertations and Theses Global, Health Management Information Consortium and reference lists of relevant publications for articles published in English until November 2018. Studies will be selected by two independent reviewers based on prespecified eligibility criteria. Two reviewers will independently extract data in each eligible study using a prepiloted Microsoft Excel data extraction form. Thematic synthesis will be employed to define IQ dimensions and develop a new IQ framework for eHealth. ETHICS AND DISSEMINATION: Ethical approval is not required for this systematic review as primary data will not be collected. The result of the review will be disseminated through publication in an academic journal and scientific conferences. PROSPERO REGISTRATION NUMBER: CRD42018097142.

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Foley K, Alturkistani A, Carter A, Stenfors T, Blum E, Car J, Majeed A, Brindley D, Meinert Eet al., 2019, Massive Open Online Courses (MOOC) Evaluation Methods: Protocol for a Systematic Review, JMIR RESEARCH PROTOCOLS, Vol: 8, ISSN: 1929-0748

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Car J, Carlstedt-Duke J, Car LT, Posadzki P, Whiting P, Zary N, Atun R, Majeed A, Campbell Jet al., 2019, Digital Education in Health Professions: The Need for Overarching Evidence Synthesis, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 21, ISSN: 1438-8871

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Meinert E, Alturkistani A, Osama T, Halioua-Haubold C-L, Car J, Majeed A, Wells G, MacLaren RE, Brindley Det al., 2019, Digital Technology in Somatic and Gene Therapy Trials of Pediatric Patients With Ocular Diseases: Protocol for a Scoping Review, JMIR RESEARCH PROTOCOLS, Vol: 8, Pages: 241-247, ISSN: 1929-0748

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Meinert E, Alturkistani A, Foley KA, Osama T, Car J, Majeed A, Van Velthoven M, Wells G, Brindley Det al., 2019, Blockchain Implementation in Health Care: Protocol for a Systematic Review, JMIR RESEARCH PROTOCOLS, Vol: 8, Pages: 153-159, ISSN: 1929-0748

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Hayhoe B, Greenfield G, Majeed A, 2019, Is it getting easier to obtain antibiotics in the UK?, BRITISH JOURNAL OF GENERAL PRACTICE, Vol: 69, Pages: 54-55, ISSN: 0960-1643

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Bottle A, Kim D, Hayhoe B, Majeed A, Aylin P, Clegg A, Cowie MRet al., 2019, Frailty and comorbidity predict first hospitalisation after heart failure diagnosis in primary care: population-based observational study in England., Age Ageing

Background: frailty has only recently been recognised as important in patients with heart failure (HF), but little has been done to predict the first hospitalisation after diagnosis in unselected primary care populations. Objectives: to predict the first unplanned HF or all-cause admission after diagnosis, comparing the effects of comorbidity and frailty, the latter measured by the recently validated electronic frailty index (eFI). Design: observational study. Setting: primary care in England. Subjects: all adult patients diagnosed with HF in primary care between 2010 and 2013. Methods: we used electronic health records of patients registered with primary care practices sending records to the Clinical Practice Research Datalink (CPRD) in England with linkage to national hospital admissions and death data. Competing-risk time-to-event analyses identified predictors of first unplanned hospitalisation for HF or for any condition after diagnosis. Results: of 6,360 patients, 9% had an emergency hospitalisation for their HF, and 39% had one for any cause within a year of diagnosis; 578 (9.1%) died within a year without having any emergency admission. The main predictors of HF admission were older age, elevated serum creatinine and not being on a beta-blocker. The main predictors of all-cause admission were age, comorbidity, frailty, prior admission, not being on a beta-blocker, low haematocrit and living alone. Frailty effects were largest in patients aged under 85. Conclusions: this study suggests that frailty has predictive power beyond its comorbidity components. HF patients in the community should be assessed for frailty, which should be reflected in future HF guidelines.

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Chang KC-M, Vamos EP, Palladino R, Majeed A, Lee JT, Millett Cet al., 2019, Impact of the NHS Health Check on inequalities in cardiovascular disease risk: a difference-in-differences matching analysis, JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, Vol: 73, Pages: 11-18, ISSN: 0143-005X

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James SL, Theadom A, Ellenbogen RG, Bannick MS, Mountjoy-Venning WC, Lucchesi LR, Abbasi N, Abdulkader R, Abraha HN, Adsuar JC, Afarideh M, Agrawal S, Ahmadi A, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akinyemi RO, Akseer N, Alahdab F, Alebel A, Alghnam SA, Ali BA, Alsharif U, Altirkawi K, Andrei CL, Anjomshoa M, Ansari H, Ansha MG, Antonio CAT, Appiah SCY, Ariani F, Asefa NG, Asgedom SW, Atique S, Awasthi A, Quintanilla BPA, Ayuk TB, Azzopardi PS, Badali H, Badawi A, Balalla S, Banstola A, Barker-Collo SL, Barnighausen TW, Bedi N, Behzadifar M, Behzadifar M, Bekele BB, Belachew AB, Belay YA, Bennett DA, Bensenor IM, Berhane A, Beuran M, Bhalla A, Bhaumik S, Bhutta ZA, Biadgo B, Biffino M, Bijani A, Bililign N, Birungi C, Boufous S, Brazinova A, Brown AW, Car M, Cardenas R, Carrero JJ, Carvalho F, Castaneda-Orjuela CA, Catala-Lopez F, Chaiah Y, Champs AP, Chang J-C, Choi J-YJ, Christopher DJ, Cooper C, Crowe CS, Dandona L, Dandona R, Daryani A, Davitoiu DV, Degefa MG, Demoz GT, Deribe K, Djalalinia S, Huyen PD, Doku DT, Drake TM, Dubey M, Dubljanin E, El-Khatib Z, Eskandarieh S, Esteghamati A, Esteghamati S, Faro A, Farzadfar F, Farzaei MH, Fereshtehnejad S-M, Fernandes E, Feyissa GT, Filip I, Fischer F, Fukumoto T, Ganji M, Gankpe FG, Gebre AK, Gebrehiwot TT, Gezae KE, Gopalkrishna G, Goulart AC, Haagsma JA, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Haro JM, Hassankhani H, Hassen HY, Havmoeller R, Hawley C, Hay SI, Hegazy MI, Hendrie D, Henok A, Hibstu DT, Hoffman HJ, Hole MK, Rad EH, Hosseini SM, Hostiuc S, Hu G, Hussen MA, Ilesanmi OS, Irvani SN, Jakovljevic M, Jayaraman S, Jha RP, Jonas JB, Jones KM, Shushtari ZJ, Jozwiak JJ, Jurisson M, Kabir A, Kahsay A, Kahssay M, Kalani R, Karch A, Kasaeian A, Kassa GM, Kassa TD, Kassa ZY, Kengne AP, Khader YS, Khafaie MA, Khalid N, Khalil I, Khan EA, Khan MS, Khang Y-H, Khazaie H, Khoja AT, Khubchandani J, Kiadaliri AA, Kim D, Kim Y-E, Kisa A, Koyanagi A, Krohn KJ, Defo BK, Bicer BK, Kumar GA, Kumar M, Lallet al., 2019, Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016, LANCET NEUROLOGY, Vol: 18, Pages: 56-87, ISSN: 1474-4422

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Feigin VL, Nguyen G, Cercy K, Johnson CO, Alam T, Parmar PG, Abajobir AA, Abate KH, Abd-Allah F, Abejie AN, Abyu GY, Ademi Z, Agarwal G, Ahmed MB, Akinyemi RO, Al-Raddadi R, Aminde LN, Amlie-Lefond C, Ansari H, Asayesh H, Asgedom SW, Atey TM, Ayele HT, Banach M, Banerjee A, Barac A, Barker-Collo SL, Barnighausen T, Barregard L, Basu S, Bedi N, Behzadifar M, Bejot Y, Bennett DA, Bensenor IM, Berhe DF, Boneya DJ, Brainin M, Campos-Nonato IR, Caso V, Castaneda-Orjuela CA, Rivas JC, Catala-Lopez F, Christensen H, Criqui MH, Damasceno A, Dandona L, Dandona R, Davletov K, de Courten B, deVeber G, Dokova K, Edessa D, Endres M, Faraon EJA, Farvid MS, Fischer F, Foreman K, Forouzanfar MH, Gall SL, Gebrehiwot TT, Geleijnse JM, Gillum RF, Giroud M, Goulart AC, Gupta R, Gupta R, Hachinski V, Hamadeh RR, Hankey GJ, Hareri HA, Havmoeller R, Hay SI, Hegazy MI, Hibstu DT, James SL, Jeemon P, John D, Jonas JB, Jozwiak J, Kalani R, Kandel A, Kasaeian A, Kengne AP, Khader YS, Khan AR, Khang Y-H, Khubchandani J, Kim D, Kim YJ, Kivimaki M, Kokubo Y, Kolte D, Kopec JA, Kosen S, Kravchenko M, Krishnamurthi R, Kumar GA, Lafranconi A, Lavados PM, Legesse Y, Li Y, Liang X, Lo WD, Lorkowski S, Lotufo PA, Loy CT, Mackay MT, Abd El Razek HM, Mahdavi M, Majeed A, Malekzadeh R, Malta DC, Mamun AA, Mantovani LG, Martins SCO, Mate KK, Mazidi M, Mehata S, Meier T, Melaku YA, Mendoza W, Mensah GA, Meretoja A, Mezgebe HB, Miazgowski T, Miller TR, Ibrahim NM, Mohammed S, Mokdad AH, Moosazadeh M, Moran AE, Musa KI, Negoi RI, Minh N, Nguyen QL, Nguyen TH, Tran TT, Nguyen TT, Ningrum DNA, Norrving B, Noubiap JJ, O'Donnell MJ, Olagunju AT, Onuma OK, Owolabi MO, Parsaeian M, Patton GC, Piradov M, Pletcher MA, Pourmalek F, Prakash V, Qorbani M, Rahman M, Rahman MA, Rai RK, Ranta A, Rawaf D, Rawaf S, Renzaho AMN, Robinson SR, Sahathevan R, Sahebkar A, Salomon JA, Santalucia P, Santos IS, Sartorius B, Schutte AE, Sepanlou SG, Shafieesabet A, Shaikh MA, Shamsizadeh M, Sheth KN, Sisay M, Shin M-J, Shiue I, Silvaet al., 2018, Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016, New England Journal of Medicine, Vol: 379, Pages: 2429-2437, ISSN: 0028-4793

BackgroundThe lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases.MethodsWe used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate.ResultsThe estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle–SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calcul

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Foley K, Alturkistani A, Carter A, Stenfors T, Blum E, Car J, Majeed F, Brindley D, Meinert Eet al., MOOC evaluation methods: a systematic review protocol, JMIR Research Protocols, ISSN: 1929-0748

Massive open online courses (MOOCs) have increased in popularity in recent years. They target a wide variety of learners and use novel teaching approaches, yet often exhibit low completion rates (10%). It is important to evaluate MOOCs to determine their impact and effectiveness, but little is known at this point about the methodologies that should be used for evaluation.

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Hayhoe B, Cowling TE, Pillutla V, Garg P, Majeed A, Harris Met al., 2018, Integrating a nationally scaled workforce of community health workers in primary care: a modelling study, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 111, Pages: 453-461, ISSN: 0141-0768

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Ahmad A, Laverty AA, Alexakis C, Cowling T, Saxena S, Majeed A, Pollok RCGet al., 2018, Changing nationwide trends in endoscopic, medical and surgical admissions for inflammatory bowel disease: 2003-2013, BMJ OPEN GASTROENTEROLOGY, Vol: 5, ISSN: 2054-4774

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Zunt JR, Kassebaum NJ, Blake N, Glennie L, Wright C, Nichols E, Abd-Allah F, Abdela J, Abdelalim A, Adamu AA, Adib MG, Ahmadi A, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akseer N, Al-Raddadi RM, Alahdab F, Alene KA, Aljunid SM, AlMazora MA, Khalid, Alvis-Guzman N, Animut MD, Anjomshoa M, Ansha MG, Asghar RJ, Avokpaho EFGA, Awasthi A, Badali H, Barac A, Baernighausen TW, Bassat Q, Bedi N, Belachew AB, Bhattacharyya K, Bhutta ZA, Bijani A, Butt ZA, Carvalho F, Castaneda-Orjuela CA, Chitheer A, Choi J-YJ, Christopher DJ, Dang AK, Daryani A, Demoz GT, Djalalinia S, Huyen PD, Dubey M, Dubljanin E, Duken EE, Zaki MES, Elyazar IR, Fakhim H, Fernandes E, Fischer F, Fukumoto T, Ganji M, Gebre AK, Gebremeskel A, Gessner BD, Gopalani SV, Guo Y, Gupta R, Hailu GB, Haj-Mirzaian A, Hamidi S, Hay S, Henok A, Irvani SSN, Jha RP, Jurisson M, Kahsay A, Karami M, Karch A, Kasaeian A, Kassa TD, Kefale AT, Khader YS, Khalil IA, Khan EA, Khang Y-H, Khubchandani J, Kimokoti RW, Kisa A, Lami FH, Levi M, Li S, Loy CT, Majdan M, Majeed A, Mantovani LG, Martins-Melo FR, McAlinden C, Mehta V, Melese A, Memish ZA, Mengistu G, Mestrovic T, Mezgebe HB, Miazgowski B, Milosevic B, Mokdad AH, Monasta L, Moradi G, Moraga P, Mousavi SM, Mueller UO, Murthy S, Mustafa G, Naheed A, Naik G, Newton CRJ, Nirayo YL, Nixon MR, Ofori-Asenso R, Ogbo FA, Olagunju TO, Olusanya BO, Ortiz JR, Owolabi MO, Patel S, Pinilla-Monsalve GD, Postma MJ, Qorbani M, Rafiei A, Rahimi-Movaghar V, Reiner RC, Renzaho AMN, Rezai MS, Roba KT, Ronfani L, Roshandel G, Rostami A, Safari S, Safiri S, Sagar R, Samy AM, Milicevic MMS, Sartorius B, Sarvi S, Sawhney M, Saxena S, Shafieesabet A, Shaikh MA, Sharif M, Shigematsu M, Si S, Skiadaresi E, Smith M, Somayaji R, Sufiyan MB, Tawye NY, Temsah M-H, Tortajada-Girbes M, Khanh BT, Ukwaja KN, Ullah I, Vujcic IS, Wagnew F, Waheed Y, Weldegwergs KG, Winkler AS, Wiyeh AB, Wiysonge CS, Wyper GMA, Yimer EM, Yonemoto N, Zaidi Z, Zenebe ZM, Feigin VL, Vos T, Murray CJLet al., 2018, Global, regional, and national burden of meningitis, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016, Lancet Neurology, Vol: 17, Pages: 1061-1082, ISSN: 1474-4422

BackgroundAcute meningitis has a high case-fatality rate and survivors can have severe lifelong disability. We aimed to provide a comprehensive assessment of the levels and trends of global meningitis burden that could help to guide introduction, continuation, and ongoing development of vaccines and treatment programmes.MethodsThe Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2016 study estimated meningitis burden due to one of four types of cause: pneumococcal, meningococcal, Haemophilus influenzae type b, and a residual category of other causes. Cause-specific mortality estimates were generated via cause of death ensemble modelling of vital registration and verbal autopsy data that were subject to standardised data processing algorithms. Deaths were multiplied by the GBD standard life expectancy at age of death to estimate years of life lost, the mortality component of disability-adjusted life-years (DALYs). A systematic analysis of relevant publications and hospital and claims data was used to estimate meningitis incidence via a Bayesian meta-regression tool. Meningitis deaths and cases were split between causes with meta-regressions of aetiological proportions of mortality and incidence, respectively. Probabilities of long-term impairment by cause of meningitis were applied to survivors and used to estimate years of life lived with disability (YLDs). We assessed the relationship between burden metrics and Socio-demographic Index (SDI), a composite measure of development based on fertility, income, and education.FindingsGlobal meningitis deaths decreased by 21·0% from 1990 to 2016, from 403 012 (95% uncertainty interval [UI] 319 426–458 514) to 318 400 (265 218–408 705). Incident cases globally increased from 2·50 million (95% UI 2·19–2·91) in 1990 to 2·82 million (2·46–3·31) in 2016. Meningitis mortality and incidence were closely related to SDI. The highest mortality rates an

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Roth GA, Collaborotors GBDCD, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah L, Abdela J, Abdelalim A, Abdollahpour I, Abdulkader RS, Abebe HT, Abebe M, Abebe Z, Abejie AN, Abera SF, Abil OZ, Abraha HN, Abrham AR, Abu-Raddad LJ, Accrombessi MMK, Acharya D, Adamu AA, Adebayo O, Adedoyin RA, Adekanmbi V, Adookunboh O, Adhena BM, Adib MG, Admasie A, Afshin A, Agarwal G, Agesa KM, Agrawal A, Agrawal S, Ahmadi A, Ahmadi M, Ahmed MB, Ahmed S, Aichour AN, Aichour I, Aichour MTF, Akbari ME, Akinyeniti RO, Akseer N, Al-Aly Z, Al-Eyadhy A, Al-Raddadi RM, Alandab F, Alam K, Alam T, Alebel A, Alene KA, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Alonso J, Altirkawi K, Alvis-Guzman N, Amare AT, Aminde LN, Amini E, Ammar W, Amoako YA, Anber NH, Andrei CL, Androudi S, Animut MD, Anjomshoa M, Ansari H, Aniha MG, Antonio CAT, Anwari P, Aremu O, Arnlov J, Arora A, Arora M, Artaman A, Aryal KK, Asayesh H, Asfaw ET, Ataro Z, Atique S, Atre SR, Ausloos M, Avokpaho EFGA, Awasthi A, Quintattilla BPA, Ayele Y, Ayer R, Azzopardi PS, Babazadeh A, Bacha U, Badali H, Badawi A, Bali AG, Ballesteros KE, Banach M, Banerjee K, Bannick MS, Banoub JAM, Barboza MA, Barker-Collo SL, Barnighausen TW, Barquera S, Barrero L, Bassat Q, Base S, Baune BT, Baynes HW, Bazargan-Hejazi S, Beth N, Beghi E, Behzadifar M, Behzadifar M, Bejot Y, Bekele BB, Belacliew AB, Belay E, Belay YA, Bell ML, Bello AK, Bennett DA, Bensenor IM, Berman AF, Bernabe E, Bernstein RS, Bertolacci GJ, Beuran M, Beyranvand T, Bhalla A, Bhattarai S, Bhaumik S, Bhutta ZA, Biadgo B, Biehl MH, Bijani A, Bikbov B, Bilano V, Bililign N, Bin Sayeed MS, Bisanzio D, Biswas T, Blacker BF, Basara BB, Borschmann R, Bosetti C, Bozorgmehr K, Brady OJ, Brant LC, Brayne C, Brazinova A, Breitborde NJK, Brenner H, Briant PS, Britton G, Brugha T, Busse R, Butt ZA, Callender CSKH, Campos-Nonato IR, Rincon JCC, Cano J, Car M, Cardenas R, Carreras G, Carrero JJ, Carter A, Carvalho F, Castaneda-Orjuet al., 2018, Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017, LANCET, Vol: 392, Pages: 1736-1788, ISSN: 0140-6736

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James SLG, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdollahpour I, Abdulkader RS, Abebe Z, Abera SF, Abil OZ, Abraha HN, Abu-Raddad LJ, Abu-Rmeileh NME, Accrombessi MMK, Acharya D, Acharya P, Ackerman IN, Adamu AA, Adebayo OM, Adekanmbi V, Adetokunboh OO, Adib MG, Adsuar JC, Afanvi KA, Afarideh M, Afshin A, Agarwal G, Agesa KM, Aggarwal R, Aghayan SA, Agrawal S, Ahmadi A, Ahmadi M, Ahmadieh H, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akinyemiju T, Akseer N, Al-Aly Z, Al-Eyadhy A, Al-Mekhlafi HM, Al-Raddadi RM, Alahdab F, Alam K, Alam T, Alashi A, Alavian SM, Alene KA, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Alouani MML, Altirkawi K, Alvis-Guzman N, Amare AT, Aminde LN, Ammar W, Amoako YA, Anber NH, Andrei CL, Androudi S, Animut MD, Anjomshoa M, Ansha MG, Antonio CAT, Anwari P, Arabloo J, Arauz A, Aremu O, Ariani F, Armoon B, Arnlov J, Arora A, Artaman A, Aryal KK, Asayesh H, Asghar RJ, Ataro Z, Atre SR, Ausloos M, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Quintanilla BPA, Ayer R, Azzopardi PS, Babazadeh A, Badali H, Badawi A, Bali AG, Ballesteros KE, Ballew SH, Banach M, Banoub JAM, Banstola A, Barac A, Barboza MA, Barker-Collo SL, Barnighausen TW, Barrero LH, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Bejot Y, Belachew AB, Belay YA, Bel ML, Bello AK, Bensenor IM, Bernabe E, Bernstein RS, Beuran M, Beyranvand T, Bhala N, Bhattarai S, Bhaumik S, Bhutta ZA, Biadgo B, Bijani A, Bikbov B, Bilano V, Bililign N, Bin Sayeed MS, Bisanzio D, Blacker BF, Blyth FM, Bou-Orm IR, Boufous S, Bourne R, Brady OJ, Brainin M, Brant LC, Brazinova A, Breitborde NJK, Brenner H, Briant PS, Briggs AM, Briko AN, Britton G, Brugha T, Buchbinder R, Busse R, Butt ZA, Cahuana-Hurtado L, Cano J, Cardenas R, Carrero JJ, Carter A, Carvalho F, Castaneda-Orjuela CA, Rivas JC, Castro F, Catala-Lopez F, Cercy KM, Cerin E, Chaiah Y, Chang AR, Chang H-Y, Chang J-C, Charlsoet al., 2018, Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017, LANCET, Vol: 392, Pages: 1789-1858, ISSN: 0140-6736

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Stanaway JD, Afshin A, Gakidou E, Lim SS, Abate D, Abate KH, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdollahpour I, Abdulkader RS, Abebe M, Abebe Z, Abera SF, Abil OZ, Abraha HN, Abrham AR, Abu-Raddad LJ, Abu-Rmeileh NME, Accrombessi MMK, Acharya D, Acharya P, Adamu AA, Adane AA, Adebayo OM, Adedoyin RA, Adekanmbi V, Ademi Z, Adetokunboh O, Adib MG, Admasie A, Adsuar JC, Afanvi KA, Afarideh M, Agarwal G, Aggarwal A, Aghayan SA, Agrawal A, Agrawal S, Ahmadi A, Ahmadi M, Ahmadieh H, Ahmed MB, Aichour AN, Aichour I, Aichour MTE, Akbari ME, Akinyemiju T, Akseer N, Al-Aly Z, Al-Eyadhy A, Al-Mekhlafi HM, Alandab F, Alam K, Alam S, Alam T, Alashi A, Alavian SM, Alene KA, Ali K, Ali SM, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Alsharif U, Altirkawi K, Alvis-Guzman N, Amare AT, Ammar W, Anber NH, Anderson JA, Andrei CL, Androudi S, Animut MD, Anjomshoa M, Ansha MG, Anto JM, Antonio CAT, Anwari P, Appiah LT, Appiah SCY, Arabloo J, Aremu O, Amlov J, Artaman A, Aryal KK, Asayesh H, Ataro Z, Ausloos M, Avokpaho EFGA, Awasthi A, Quintanilla BPA, Ayer R, Ayuk TB, Azzopardi PS, Babazadeff A, Badali H, Badawi A, Balakrishnan K, Bali AG, Ball K, Bellew SH, Banach M, Banoub JAM, Barac A, Barker-Collo SL, Bamighausen TW, Barrero LH, Basu S, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Bejoy Y, Bekele BB, Bekru FT, Belay E, Belay YA, Bell ML, Bello AK, Bennett DA, Bensenor IM, Bergeron G, Berhane A, Bemabe E, Bemstein RS, Beuran M, Beyranvand T, Bhala N, Bhalla A, Bhattarai S, Bhutta ZA, Biadgo B, Bijani A, Bikbov B, Bilano V, Bililign N, Bin Sayeed MS, Bisanzio D, Biswas T, Bjorge T, Blacker BF, Bleyer A, Borschmann R, Bou-Orm IR, Boufous S, Bourne R, Brady OJ, Brauer M, Brazinova A, Breitborde NJK, Brenner H, Briko AN, Britton G, Brugha T, Buchbindet R, Burnett RT, Busse R, Butt ZA, Cahill LE, Cahuana-Hurtado L, Campos-Nonato IR, Cardenas R, Carreras G, Carrero JJ, Carvalho F, Castaneda-Orjuela CA Ret al., 2018, Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017, LANCET, Vol: 392, Pages: 1923-1994, ISSN: 0140-6736

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JOURNAL ARTICLE

Elmontsri M, Banarsee R, Majeed A, 2018, Improving patient safety in developing countries - moving towards an integrated approach., JRSM Open, Vol: 9, ISSN: 2054-2704

Patient safety is a major public health issue. It has also been recognised as an area for improvement. The purpose of this article is to discuss the need for developing an integrated approach to patient safety improvement in developing countries. Relevant literature to identify the common themes and patterns associated with patient safety improvement was conducted through a search of the online databases (MEDLINE, EMBASE, PUBMED and Google Scholar) for the years 2000 to 2017. Lessons and interventions from developed countries have been taken into consideration to identify the themes needed for patient safety improvement in developing countries. This review provides an integrated approach based on best practice which can be used to guide the development of a national strategy for improving patient safety. Policy makers need to focus on developing a holistic and comprehensive approach to patient safety improvement that takes into account the themes discussed in this article.

JOURNAL ARTICLE

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