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 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 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 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, ISSN: 2234-943XThe 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.
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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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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 articleTay T, Grailey K, Chen F, et al., 2026,
The impact of digitally-enabled interventions on frailty and other age related outcomes – systematic review and meta-analysis
, Digital Health, ISSN: 2055-2076IntroductionFrailty is defined as a clinically recognised state of increased vulnerability, reflecting a decline in an individual’s psychological and physical reserves. Digitally-enabled interventions are increasingly utilised to monitor and support the health of older adults. Evidence on the effectiveness of digitally-enabled interventions in reducing frailty is limited. This systematic review aimed to investigate the types of digitally-enabled interventions tested, with what goals with respect to frailty, and the resulting outcomes.MethodMedline, CINAHL, Scopus, PsychInfo and Embase were searched from time of origin until July 2024. Peer-reviewed RCTs assessing the impact of digitally-enabled interventions on older adults were included. Outcome measures explored were frailty, cognitive status, mental health, quality of life, adherence and usability. Data was extracted independently by two people using Covidence platform. Narrative synthesis was performed for all studies and meta-analysis was performed for outcomes reported in four or more studies.ResultsFrom 4476 titles and abstracts screened, 17 studies were included following full text review. Overall, 12 studies included exercises as a component or the sole form of intervention. The mean duration of intervention was 4.04(SD2.56) months. Mean adherence to the intervention was 59% which was lower in exercise-based intervention. The most and least reported frailty-specific outcome was walking speed(n=8) and self- reported exhaustion level(n=2). Meta-analysis showed non-exercise-based interventions showed significant improvements in SPPB. There was no statistically significant change in Timed-up and Go and handgrip strength. Narrative synthesis indicates there was insufficient evidence to evaluate the impact of digital interventions on frailty, frailty-specific outcomes, mental health, activities of daily living, health- related quality of life, sleep and cognition.ConclusionThe findings suggest low technolog
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Journal articlePower-Hays A, McElhinney KE, Williams TN, et al., 2026,
Hydroxyurea pharmacokinetics in children with sickle cell anemia across different global populations.
, Blood Adv, Vol: 10, Pages: 418-427Hydroxyurea provides effective disease-modifying treatment for people with sickle cell anemia (SCA), especially when escalated to maximum tolerated dose (MTD), which has wide interpatient dosing variability due to pharmacokinetic (PK) differences. Whether hydroxyurea PK parameters differ among children with SCA in different global regions is unknown. We compared hydroxyurea PK parameters among children with SCA from 5 clinical trials: HUSTLE (United States), TREAT (United States), NOHARM (Uganda), REACH (Uganda and Kenya), and EXTEND (Jamaica). Key hydroxyurea PK parameters were determined using HdxSim, a validated hydroxyurea PK software program. The results were compared across regions by analysis of variance. PK profiles from 451 children with SCA (146 from the United States, 265 from Africa, and 40 from the Caribbean) were included. Children from Africa had slightly lower volumes of distribution, but absorption rate and clearance were similar across regions. The PK-recommended doses to achieve MTD were statistically different but clinically similar across the United States (26.6 ± 5.9 mg/kg per day), Africa (27.6 ± 6.5 mg/kg per day), and the Caribbean (25.2 ± 4.7 mg/kg per day) (P = .04). In multivariable regression, younger age and increased reticulocyte counts were associated with higher PK-recommended doses. Hydroxyurea PK parameters in children with SCA differ minimally across global populations, predicting clinically similar doses to achieve MTD. Individualized hydroxyurea dosing based on a PK-population model derived from US children with SCA can be used broadly to maximize the benefits of this critical medication in other global populations. These trials were registered at www.ClinicalTrials.gov as #NCT00305175 (HUSTLE), #NCT02286154 (TREAT), #NCT01976416 (NOHARM), #NCT01966731 (REACH), and #NCT02556099 (EXTEND).
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Journal articleMacharia AW, Uyoga S, Kariuki SN, et al., 2026,
The effect of heterozygous β-thalassaemia on childhood health and survival in Kilifi, Kenya
, Wellcome Open Research, Vol: 11, Pages: 82-82<ns3:p>Introduction Heterozygous β-thalassaemia occurs at low frequency in coastal Kenya, but its clinical significance is poorly understood. While some evidence suggests protection against malaria, its influence on childhood health and survival in African children remains unknown. Methods We conducted the prospective analysis of a cohort of 15,077 children recruited at age 3–12 months of age (72 β-thalassaemia heterozygotes and 15,005 controls) and followed passively for disease-specific hospital admission and survival until their fifth birthday. Results β-thalassaemia heterozygotes were more frequently admitted than controls with severe (Hb <5g/dl) [adjusted Incidence Rate Ratio 5.1 (95% CI 1.3-20.0; P=0.02)] and moderate (Hb <10g/dl) anaemia [aIRR 2.3 (95% CI 1.3-3.9; P=0.004)]. No other significant differences were found. Conclusion Heterozygous β-thalassaemia increased the risk of anaemia-related hospital admissions within this cohort, highlighting the need to investigate the underlying triggers of anaemia in such children.</ns3:p>
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Journal articleAshrafian H, 2026,
Possible earliest depiction of tuberous sclerosis complex in Bernardo de' Rossi (1468-1527).
, J Neurol, Vol: 273
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