Browse through all publications from the Institute of Global Health Innovation, which our Patient Safety Research Collaboration is part of. This feed includes reports and research papers from our Centre.
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Journal articleReka H, van Kessel R, Mossialos E, et al., 2026,
Private health insurance in Gulf Cooperation Council countries: A scoping review
, Health Policy Open, Vol: 10Private Health Insurance (PHI) in Gulf Cooperation Council (GCC) countries has experienced rapid growth over the past two decades, driven by demographic and economic changes. Although various analyses at the country level have been reported, no study has reviewed PHI systems in the GCC through a methodological approach. We provide a conceptual framework to review, describe and document the development of PHI in the GCC, based on literature from the scoping review. As of December 2023, all GCC countries have laws in place or have promulgated laws establishing mandatory PHI schemes. Most of these schemes are designed for expatriate populations residing in these countries, but there is a trend to extend them to nationals working in the private sector. The health system context plays a role in how PHI emerged and is designed in terms of role, eligibility, and coverage. PHI markets in the region are concentrated and dominated by local companies with performance levels that could be further improved. These markets are maturing and subject to more robust technical and prudential regulations as governments seek to enhance competition. Governments in the region must ensure the sustainable growth of these schemes and a more strategic alignment with health system objectives. Lessons learned from more mature markets are critical for future developments.
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Journal articleKovacevic L, Forbes L, Ashrafian H, et al., 2026,
The impact of primary care networks on emergency hospitalisations in the English NHS: An interrupted time series analysis
, HEALTH POLICY, Vol: 165, ISSN: 0168-8510 -
Journal articleXu C, Roddan A, Kakaletri I, et al., 2026,
Interpretable classification of endomicroscopic brain data via saliency consistent contrastive learning.
, Med Image Anal, Vol: 109In neurosurgery, accurate brain tissue characterization via probe-based Confocal Laser Endomicroscopy (pCLE) has become popular for guiding surgical decisions and ensuring safe tumour resections. In order to enable surgeons to trust a tissue classification model, interpretability of the result is required. However, state-of-the-art (SOTA) deep learning models for pCLE data classification exhibit limited interpretability. This paper introduces a novel image classification framework for interpretable brain tissue characterisation using pCLE data. Firstly, instead of the commonly employed cross-entropy based classification loss, we propose Label Contrastive Learning (LCL) loss to learn intra-category similarities and inter-category contrasts. We are then able to generate highly representative data embeddings, which not only improve classification performance but also distinguish characteristics from different tissue classes. Secondly, we design a Saliency Consistency (SC) module to enable the trained model to generate clinically relevant saliency maps of the input data. To further refine the saliency maps, a novel Top-K Maximum and Minimum Pooling (TK-MMP) layer is introduced to our SC module, to increase the contrast of saliency values between non-clinically relevant and clinically relevant areas. For the first time, the Exponential Moving Average (EMA) is used in a novel fashion to update global embeddings of the different tissue categories rather than the weights of the model. In addition, we propose a Global Embedding Inference (GEI) layer to replace learnable classification layers to achieve more robust classification by estimating the cosine similarity between the input data embeddings and global embeddings. Performance evaluation on ex-vivo and in-vivo pCLE brain data verifies that our proposed approach outperforms SOTA classification models in terms of accuracy, robustness and interpretability. Our source codes are released at: https://github.com/XC9292/LCL-SC.
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Journal articleCurcin V, Delaney B, Alkhatib A, et al., 2026,
Learning Health Systems provide a glide path to safe landing for AI in health.
, Artif Intell Med, Vol: 173Artificial Intelligence (AI) holds significant promise for healthcare but often struggles to transition from development to clinical integration. This paper argues that Learning Health Systems (LHS)-socio-technical ecosystems designed for continuous data-driven improvement-provide a potential "glide path" for safe, sustainable AI deployment. Just as modern aviation depends on instrument landing systems, the safe and effective integration of AI into healthcare requires the socio-technical infrastructure of LHSs, that enable iterative development and monitoring of AI tools, integrating clinical, technical, and ethical considerations through stakeholder collaboration. They address key challenges in AI implementation, including model generalizability, workflow integration, and transparency, by embedding co-creation, real-world evaluation, and continuous learning into care processes. Unlike static deployments, LHSs support the dynamic evolution of AI systems, incorporating feedback and recalibration to mitigate performance drift and bias. Moreover, they embed governance and regulatory functions-clarifying accountability, supporting data and model provenance, and upholding FAIR (Findable, Accessible, Interoperable, Reusable) principles. LHSs also promote "human-in-the-loop" safety through structured studies of human-AI interaction and shared decision-making. The paper outlines practical steps to align AI with LHS frameworks, including investment in data infrastructure, continuous model monitoring, and fostering a learning culture. Embedding AI in LHSs transforms implementation from a one-time event into a sustained, evidence-based learning process that aligns innovation with clinical realities, ultimately advancing patient care, health equity, and system resilience. The arguments build on insights from an international workshop hosted in 2025, offering a strategic vision for the future of AI in healthcare.
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Journal articleChen F, Tay T, Thould H, et al., 2026,
The Impact of Social Media Videos on Quantitative Health Outcomes: Systematic Review.
, JMIR Infodemiology, Vol: 6BACKGROUND: Social media has transformed the landscape of health communication. Video content can optimally activate our cognitive systems, enhance learning, and deliver accessible information. Evidence has suggested the positive impact of videos on health knowledge and health-related behaviors, yet the impact of social media videos on quantitative health outcomes is underresearched. Evaluating such outcomes poses unique challenges in measuring exposure and outcomes within internet-based populations. OBJECTIVE: We aimed to evaluate the impact of social media videos on quantitative health outcomes, examine methodologies used to measure these effects, and describe the characteristics of video interventions and their delivery. METHODS: In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, MEDLINE, Embase, Web of Science, CINAHL, and Google Scholar were searched. Studies were eligible if they were original research evaluating long-form social media video interventions addressing any health-related condition, delivered via social media platforms, and reported quantitative health outcomes. The primary outcome was the effect of social media videos on quantitative health outcomes. Additional outcomes included participant characteristics, video features, delivery methods, and the use of theoretical frameworks. A narrative synthesis was conducted. A subgroup meta-analysis was performed to synthesize health outcomes mentioned in 2 or more studies with sufficient homogeneity. Risk of bias assessment was conducted using Cochrane Risk of Bias 2, ROBINS-I, or National Institutes of Health Quality Assessment Tool, depending on the study design. One reviewer screened titles and abstracts. Two reviewers independently conducted full-text screening, data extraction, and risk of bias assessment. RESULTS: A systematic search was conducted on October 25, 2023, and was updated on June 12, 2025, yielding a total of 41,172 records after du
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Journal articleNiknam Maleki A, Runciman M, Murray J, et al., 2026,
Hydraulic endorectal actuator for prostate radiotherapy reduces variations in motion in a silicone rectal phantom
, Frontiers in Oncology, Vol: 16, ISSN: 2234-943XBackground: The accuracy and morbidity of prostate cancer radiotherapy are influenced by unpredictable variations in rectal filling and patient motion. We developed a soft robotic hydraulic endorectal actuator that aims to reduce rectal motion and retract the rectum to restore the anorectal angle, improve target accuracy, and reduce toxicity during prostate cancer radiotherapy. The ability of the endorectal actuator to stabilize the rectum and improve prostate radiotherapy outcomes has not yet been assessed. This study evaluates the actuator’s performance in a simulated rectal phantom.Methods: We fabricated a rectal phantom using silicone and motor-controlled elastic ribbons to simulate muscle tone and control the phantom diameter. The rectal compliance of the phantom was validated using a barostat balloon and was deliberately set low to simulate a high resistance to distension to challenge the actuator’s capabilities. We assessed the actuator’s ability to (1) resist dynamic peristaltic forces and (2) reproduce the rectal position and anorectal angle from varying initial displacements. The anterior–posterior rectal diameter and anterior rectal wall (ARW) displacements were measured using video tracker software.Results: The phantom demonstrated a rectal compliance of 4.19 ml/mmHg within the 40 ml–60 ml volume range, meeting the low-compliance target. During dynamic compression, the endorectal actuator reduced the change in the anterior–posterior diameter and ARW displacement from 25 mm and 15 mm, respectively, to less than 5 mm in both. The actuator reduced the increase in rectal volume from 132.3 cm3 (control) to 59.7 cm3 (actuator). When the phantom was translated anteriorly, the actuator reduced the anorectal angle deviation from +12° to +2° and anterior displacement of the ARW from 13 mm to 4 mm.Conclusion: Within this rectal phantom, the endorectal actuator reduced the variations in rectal motion. These findings sugges
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Journal articleOmar N, Elgharably N, Lam K, 2026,
Assessment of the Quality and Reliability of Social Media Videos for Patient Information on Common General Surgical Procedures.
, Surg InnovIntroductionSocial media is a significant platform for health information. However, the quality and reliability of patient facing surgical content is uncertain. We evaluated the quality and reliability of TikTok and Instagram videos about three common general surgical procedures: laparoscopic appendicectomy; laparoscopic cholecystectomy; and inguinal hernia repair, and compared performance by platform, procedure, and creator type.MethodsWe conducted a cross-sectional study of the top fifty results per procedure per platform. Videos were classified as useful, misleading, personal experience, or irrelevant and quality and reliability assessed with the Global Quality Score (GQS) and modified DISCERN (mDISCERN) score respectively.Results300 videos, accruing 592,975 likes and 11,489 comments, were analysed. Videos were low in both quality and reliability across both platforms although higher on Instagram (GQS 1.95; mDISCERN 1.65) than TikTok (GQS 1.27; mDISCERN 0.33; both P < .0001). 53/300 (17.7%) videos were judged to be misleading. Useful content was less frequent on TikTok than Instagram (14/150, 9.3% vs 82/150, 54.7%; P < .0001). Professional content was deemed more useful than that of non professionals (54/117, 46.2% vs 42/183, 23.0%; P < .0001) with higher quality and reliability scores (GQS 1.80 vs 1.49; mDISCERN 1.36 vs 0.76; both P < .0001).ConclusionsSurgical educational videos across popular social media platforms are low in quality and reliability. Patients should be wary of the risk of possible health misinformation. Clinicians and professional bodies should be aware of the growing popularity of social media and consider the production of evidence-based content on these platforms to disseminate credible information and counter misinformation.
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Journal articleLawrance EL, 2026,
Why climate action is an opportunity multiplier for mental health
, World Psychiatry, Vol: 25, Pages: 54-55, ISSN: 1723-8617 -
Journal articleClarke J, Jha S, Prociuk D, et al., 2026,
Exploring the intensity and continuity of hospital care for patients with long covid: evidence from an English urban healthcare system
, Health Expectations, Vol: 29, ISSN: 1369-6513BackgroundLong Covid (LC) is a multisystem condition leading to a wide range of symptoms and often requiring treatment by several different clinical specialties. Patients with LC have reported difficulties in accessing care and a lack of coordination of their care, particularly in a hospital setting.ObjectiveTo determine the extent to which the intensity and continuity of hospital care changes for patients after they receive an LC diagnosis.DesignRetrospective observational cohort study using a linked primary and secondary care dataset.Setting and ParticipantsRoutine healthcare data from North West London Integrated Care System of patients with a recorded diagnosis of LC who had attended a secondary care hospital Trust from 1 January 2019 to 30 September 2023.Main Variables StudiedThe intensity of utilisation of secondary care was calculated, and the continuity of care with respect to hospitals and specialties was computed using the sequential continuity score (SeCon) before the Covid-19 pandemic, before and after an LC diagnosis.Results5611 out of 6270 (90.1%) patients diagnosed with LC had a recorded secondary care interaction in the study period. Intensity of secondary care utilisation increased markedly in outpatient, inpatient and Emergency Department pathways after a diagnosis of LC but peaked in the week of diagnosis. Average hospital SeCon fell significantly after an LC diagnosis from 1.00 to 0.83, while specialty SeCon remained unchanged from after diagnosis (0.40) and before the pandemic (0.44). A notable shift in specialty activity was observed with a focus on respiratory medicine as a major hub in a densely connected patient-sharing network with cardiology and other medical and surgical specialties.DiscussionA recorded LC diagnosis was associated with increases in the intensity of hospital activity and a reduction in hospital-level care continuity, but no change in specialty continuity, which remains low.ConclusionCollectively, this indicates a significa
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Journal articleNúñez-Elvira A, Feng Y, Kristensen SR, et al., 2026,
Does pay for performance affect socioeconomic inequalities in access? Evidence from hospital specialised care in England
, Health Policy, Vol: 164, ISSN: 0168-8510Pay for performance aims to improve quality and efficiency in the health sector but may widen inequalities. We investigate how pay for performance for specialised hospital care in England affected socioeconomic inequalities in access. We focus on two clinical areas: trauma care aimed at reducing delayed discharges from adult critical care; and internal medicine aimed at reducing in-hospital waiting time and length of stay for patients requiring urgent coronary bypass grafting. Both were part of the Prescribed Specialised Services Commissioning for Quality and Innovation. Using patient-level administrative data from Hospital Episodes Statistics in 2012/13–2016/17, we employ difference-in-difference models to estimate the impact of these schemes across socioeconomic status. Our treatment group comprises hospitals that adopted the scheme, and our control group the remaining eligible hospitals. For trauma care, we measure the impact of the scheme on discharge delays and the probability of an overnight discharge. For urgent coronary bypass, we measure pre-surgery inpatient waiting time, length of stay, 30-day and one-year mortality, and hospital-acquired infections. For trauma care we find the scheme widened inequalities by reducing delays that favoured more patients in the least income-deprived quintile (by 2.4 h or 30.4 % at the sample mean) than in the most income-deprived quintile (by 1.3 h). We find no effect or socioeconomic differences across outcomes for patients requiring an urgent coronary bypass.
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