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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Conference paperDaly C, Russo S, Ekanayake J, et al., 2027, , Pages: 95-105, ISSN: 0302-9743
Markerless intraoperative tracking of spinal anatomy via RGB-D sensors is a promising alternative to invasive bone-anchored fiducials, yet no existing clinical dataset provides independent subsurface ground truth for validating these methods. We address this gap with a clinically viable pipeline that derives per-vertebra 6-DoF pose from routine intraoperative C-arm fluoroscopy, co-registered to the RGB-D camera frame through a multimodal fiducial array detectable in both imaging modalities. Critically, the pipeline requires no invasive instrumentation contacting the patient, no additional radiation, or deviation from standard surgical workflows, relying solely on the fluoroscopic images already acquired during routine level checks. A calibrated transform chain links the vertebral pose recovered via multi-view 2D–3D CT-to-fluoroscopy registration to the RGB-D coordinate frame, enabling direct comparison of any markerless registration estimate against a subsurface reference. Ex vivo validation against optically tracked ovine vertebrae confirms end-to-end accuracy of 2.06 ± 0.29 mm and 3.35 ± 0.93<sup>∘</sup>, sufficient to serve as independent ground truth for methods with substantially larger errors. We demonstrate the pipeline’s utility by evaluating two markerless registration strategies on clinical data spanning 11 vertebrae across 1,500 frames from three surgical sequences: the first such evaluation against an independent subsurface reference in a clinical setting. The proposed framework provides reusable infrastructure for benchmarking emerging markerless tracking methods on real surgical data.
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Journal articleBracey S, Ainsworth B, Alderman J, et al., 2026, , BMC Medical Informatics and Decision Making, Vol: 26, ISSN: 1472-6947
BackgroundThe implementation of Artificial Intelligence assisted Clinical Decision Support Systems (AI-CDSS) shows significant potential to improve healthcare. However, implementing AI-CDSS has many associated challenges. This article introduces the ‘Hippocratic Oath’ for AI which promotes safe and effective AI-CDSS development and implementation.MethodsThis paper summarises discussions which took place during the Turing-Roche Clinical AI Interest Group Joint Workshop. The workshop began with scoping lectures from AI experts, leading into focus group discussions of key themes surrounding AI-CDSS implementation. These include the ethics, trust, evaluation, regulation, human factors and challenges involved with implementing AI-CDSS into healthcare settings. Focus group outcomes, alongside insight from lectures, were used to formulate the arguments in this paper.ResultsThis article presents a consensus definition of AI-CDSS and outlines a comprehensive table of implementation challenges alongside mitigation measures. It introduces the ‘Hippocratic Oath for AI’ and discusses its potential to promote safe and effective AI-CDSS implementation through addressing human factors and explainability.ConclusionsThe ‘Hippocratic Oath for AI’, can be used by AI-CDSS implementers and developers as a framework to mitigate challenges involved with implementing AI-CDSS into healthcare settings. This framework is likely to promote safe and effective implementation and maximise HCP uptake of the AI-CDSS. Through facilitating AI-CDSS use, this oath can transform health care practice via reducing medical errors, healthcare costs and improving patient outcomes.
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Journal articleLampridou S, Saghdaoui LB, Boobier C, et al., 2026, , BMC Health Services Research, Vol: 26, ISSN: 1472-6963
BackgroundPeripheral arterial disease (PAD), presenting as intermittent claudication (IC), affects 20% of adults over 60 years of age in the UK. Claudication reduces patients’ mobility, quality of life, and increases their risk of cardiovascular mortality. National guidelines recommend a holistic, multidisciplinary approach including supervised exercise therapy (SET), pharmacotherapy, and lifestyle modifications. However, clinicians raise concerns about inconsistent service provision across NHS England. Freedom of information requests (FOIR) have become an important tool for researchers to access government information and examine practices. This study aimed to explore the availability and structure of services for the management of patients with IC in England.MethodsA FOIR was distributed to NHS Trusts in England in January 2025. The request included questions about IC clinics, SET availability, staffing, access to lifestyle and psychological support, and the referral process to IC services. The questionnaire was piloted with vascular specialists and was refined before dissemination. The data were analysed using descriptive statistics in SPSS (v29).ResultsOf the 138 Trusts contacted, 124 (89.9%) responded, with 82 (66.2%) providing vascular services. Fewer than half (46.3%) offered dedicated claudication clinics, and only 29.3% provided structured SET programmes. Yet of these SET programmes, only 12.5% of were delivered in line with national guidelines. Most clinics were nurse-led, whereas most SET programmes were physiotherapy-led. Lifestyle support was limited: only 22% provided smoking cessation services internally, 25.6% offered dietetic support within the Trust, and just one Trust reported access to psychological services for PAD patients. Most Trusts (94%) used an electronic referral form, whereas only 34% had a specific vascular proforma.ConclusionThis FOIR highlights substantial regional variation and gaps in claudication service provision across Engl
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Journal articlevan Kessel R, Carter AW, Nasir K, et al., 2026, , Npj Digital Medicine, Vol: 9
Artificial Intelligence (AI) technologies are increasingly prevalent in healthcare, yet without adaptive governance, even well-designed systems risk exacerbating health inequalities. This perspective examines five interconnected governance domains: legal frameworks, evidence generation, regulation and market access, workforce readiness, and public trust. We argue these form a cyclical governance chain in which weaknesses cascade across domains, and identify critical gaps and system-level reforms to ensure AI reduces rather than amplifies disparities.
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Journal articleKoye A, Erridge S, Clarke E, et al., 2026, , Neuropsychopharmacol Rep, Vol: 46
BACKGROUND: Insomnia disorder affects approximately 10% of people. The persistence of insomnia, despite treatment, remains high. Cannabis-based medicinal products (CBMPs) have been proposed as a potential treatment for insomnia. This study aims to use data from the UK Medical Cannabis Registry to analyze changes in self-reported sleep quality in patients prescribed CBMPs for insomnia. METHODS: A prospective cohort study of patients treated with CBMPs for insomnia was completed. The primary outcome was the Single-Item Sleep Quality Scale (SQS). This was assessed at baseline and at 1, 3, 6, 12, 18, and 24 months from baseline. Secondary outcomes included change in anxiety and general health-related quality of life. p-values < 0.050 were considered statistically significant. RESULTS: Two hundred and eleven participants met the inclusion criteria. Over half (n = 126; 59.72%) were users of cannabis at baseline. At the primary endpoint of 24 months, mean SQS improved from 2.46 ± 2.10 (mean ± standard deviation (SD)) at baseline to 5.14 ± 2.75 (mean difference +2.68; 95% confidence interval (CI) 2.23-3.14; p < 0.001), with improvements observed at all timepoints. SQS values of 0 (odds ratio (OR) 15.49; 95% CI 3.87-65.19; p < 0.001) and 1-3 (OR 4.90; 95% CI 1.87-13.80; p = 0.002) at baseline and prescription of dried flower CBMPs (OR 4.99; 95% CI 1.27-21.39; p = 0.025) were associated with clinically significant improvements in sleep quality at 24 months. Seventeen participants (8.06%) reported adverse events. Participants aged over 60 were more likely to report an adverse event (OR 19.08; 95% CI 1.52-535.75; p = 0.036). CONCLUSION: Initiation of CBMPs was associated with improvements in self-reported sleep quality across 2 years, with the largest associations observed in those with the
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Journal articleDanielli S, Archer S, Ashrafian H, et al., 2026,
Developing the 5C Mayoral framework for action on health (5C-MFAH): a qualitative study of the London mayoralty
, BMJ Public Health, ISSN: 2753-4294Introduction: Cities increasingly shape population health through transport, planning, housing, economic development and other wider determinants. Mayors play a key city leadership role, but their formal health and healthcare powers vary significantly between nations. London is a useful case example because the Mayor has no direct responsibility for healthcare services but can have a significant influence over health through statutory strategies. This study aimed to develop a London derived framework for how Mayors could use formal or informal powers to improve health and healthcare.Methods: Qualitative semi-structured interviews were conducted with 35 senior leaders all of whom had worked with or closely observed the London Mayor over the last 25 years. We used an abbreviated constructivist grounded theory-informed analysis using constant comparison, memoing and category development to develop the framework.Results: Findings from the data gave rise to five key dynamic modes of Mayoral action to improve urban health and healthcare: convene, champion, collaborate, challenge and command. Collectively, they constitute the ‘5C Mayoral Framework for Action on Health’ (5C-MFAH).Conclusion: The ‘5C-MFAH’ offers a provisional, London derived framework for understanding and guiding Mayoral action to improve health and healthcare. The framework would benefit from testing in cities with different governance and statutory powers to assess its wider applicability.
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Journal articleKagenaar E, Lugo-Palacios DG, Aggarwal A, et al., 2026, , Journal of Clinical Oncology, ISSN: 0732-183X
<jats:sec> <jats:title>Purpose</jats:title> <jats:p>Stereotactic ablative radiotherapy (SABR) is standard of care for inoperable early-stage non–small cell lung cancer (NSCLC), but there is little evidence to support SABR as an alternative to surgical resection. Randomized controlled trials (RCTs) have failed to recruit, and ongoing RCTs apply strict inclusion criteria. To our knowledge, this is the first emulated target trial comparing the effectiveness of SABR versus surgery in individuals with early-stage NSCLC eligible for either treatment.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>We used England's National Cancer Registry data to identify individuals diagnosed with T1-2N0M0 NSCLC during 2015-2020, age 18-79 years with Zubrod performance status 0-2, or age 80+ years with performance status 0-1, who underwent SABR or surgical resection within 6 months of diagnosis. Treatment receipt was identified via linkage to Hospital Episode Statistics and the National Radiotherapy Data Set. The primary outcome was 3-year all-cause mortality; secondary outcomes included lung cancer–specific mortality and recurrence. An instrumental variable analysis reduced the risk of confounding by indication.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p> A total of 12,546 met the eligibility criteria (2,299 SABR; 10,247 surgery). After adjustment, 3-year all-cause mortality estimates were 30.3% (SABR) and 21.6% (surgery; mean absolute risk difference 8.8 percentage points [pp], [95% CI, 1.4 to 16.2]; <jats:italic toggle="yes">P</jats:italic> = .02). Lung c
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Journal articleAnderson M, O'Neill E, Ljungqvist G, et al., 2026, , Lancet Regional Health Europe, Vol: 70
Background: Pull incentives aim to improve the commercial viability of antibacterials, but the criteria determining which products and companies qualify have not been compared across countries. We compared product and company eligibility and evaluation criteria across these incentives. Methods: We conducted an umbrella review of MEDLINE and Embase for English-language reviews of pull incentives targeting antibacterial innovation and access (2014 to 14 October 2024), supplemented by grey literature searches and the Global AMR R&D Hub dashboard (December 2025). Two reviewers independently extracted criteria from official documentation, using a framework of six product domains (high-priority medical need, relative effectiveness, unmet clinical need, innovative characteristics, health-system impact, and other) and five company domains (antibacterial sustainability, patient access, environmental health, economic criteria, and other). Findings: We identified 28 pull incentives: 20 implemented (UK, Sweden, Germany, France, Italy, US, Japan, and EU) and 8 proposed or in development (US, Japan, Canada, Australia, Switzerland, and EU). As mechanisms overlapped within countries, the 20 implemented incentives were analysed as nine groups. All nine targeted high-priority medical need and seven (78%) included unmet clinical need. Relative effectiveness featured in six (67%), economic criteria in five (56%), and innovative characteristics, health-system impact, patient access, and antibacterial sustainability in four each (44%); environmental health in two (22%). The UK Subscription Model applied all 11 domains and Sweden's Annual Revenue Guarantee eight (73%). Priority pathogen lists were widely referenced but varied in breadth. Interpretation: Eligibility and evaluation criteria vary substantially across countries in scope and specificity. Company-level obligations on stewardship, access, and environmental safeguards are applied inconsistently, and most comprehensive in the
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Journal articleDattani R, Pierce B, Muktadir G, et al., 2026,
Under-recognition of metabolic syndrome in North West London (2000–2023): a 23-year retrospective analysis
, BMJ Public Health, ISSN: 2753-4294Introduction:Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors associated with increased morbidity and mortality. Despite the rising prevalence of obesity, hypertension, dyslipidaemia and glucose dysregulation, MetS remains inconsistently recognised and coded within electronic health records (EHRs). We aimed to determine the extent of under-recognition of MetS within North West London (NWL) over a 23-year period.Methods:The Discover-NOW London Secure Data Environment dataset was retrospectively analysed between 1 January 2000 and 31 July 2023. Adults aged ≥18 years were identified as having MetS if coded within EHRs or if they met ≥3 of 5 American Heart Association/ (AHA) 2005 diagnostic criteria. An Extended AHA definition incorporating BMI and HbA1c was also applied to reflect routine clinical practice.Results:Among 2,096,480 adults registered in NWL during the study period, 975 individuals (0.04%) had a clinician-coded diagnosis of MetS. In contrast, 594,325 individuals (21.2%) met AHA-defined criteria and 875,993 (31.3%) met Extended AHA-defined criteria. Women, individuals of Black or Black British ethnicity, and those from more deprived areas were under-represented in the coded cohort relative to algorithm-defined cohorts.Conclusion:Metabolic syndrome is substantially under-recorded within routine clinical coding in NWL. Recognition of the true prevalence of MetS within healthcare datasets may support improved risk stratification, enable population level surveillance, and facilitate evaluation of MetS related morbidity and healthcare utilisation.
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Journal articleFruet D, Bombieri M, Ordali E, et al., 2026, , IEEE Trans Med Robot Bionics
A multidisciplinary workshop, 'Toward Cognitive Digital Twins in Surgery,' was held during the Hamlyn Symposium in London, UK on Friday, June 27, 2025. This work summarizes the main insights that emerged from the discussion, including the potential benefits and limitations of Cognitive Digital Twins (CogDT) in surgery. The CogDT framework is designed to capture the entire clinical system, including patients and healthcare providers. We introduce the novel concept of the Surgical Cognitive Digital Twin (S-CogDT), highlighting its potential for advancement in surgical care. Participants conceptualized S-CogDTs as potential tools for creating dynamic, individualized profiles for personalized provider training, serving as real-time early-warning indicators to mitigate cognitive overload, and optimizing organizational workflows within the surgical environment. However, the effective adoption of this technology faces significant challenges. These include the difficulty of measuring and validating dynamic cognitive states, the considerable hurdles in achieving user acceptance and trust, and critical questions surrounding data governance, privacy, and regulatory pathways. These results inform future research in this novel, multidisciplinary field by clearly showing the potential of S-CogDTs and mapping the potential challenges required for their successful implementation.
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