Azeem Majeed’s research while affiliated with Imperial College London and other places

Introduction: Diagnostic accuracy is essential for good-quality medical practice, and yet diagnostic errors remain widespread, influencing patient outcomes, healthcare costs, and clinician confidence. “Misdiagnosis Tracker” aims to instil error analysis into medical education and shift the focus toward the learning of lessons from errors in diagnosis. This study investigates how systematic review of diagnostic errors enhances medical students’ competence in diagnostic reasoning, identification of cognitive bias, and identification of atypical presentations. Methods: A cohort of 65 final-year medical students participated in a structured three-phase educational intervention comprising preparation, case study analysis, and reflection. Students examined 20 diagnostic error case studies to identify contributory factors, such as cognitive biases, atypical presentations, and systemic barriers. Quantitative data were obtained from pre- and post-study surveys assessing confidence and knowledge, while qualitative insights were gathered through group reports, reflective journals, and debriefing sessions. Results: The results indicated significant improvements in confidence in diagnostic reasoning (3.0 to 4.4, p < 0.01), awareness of cognitive bias (2.9 to 4.5, p < 0.01), and recognition of atypical presentations (3.1 to 4.6, p < 0.01). Qualitative results highlighted increased insight into red flags, systemic issues, and reflective development. Actionable recommendations made by the students were systematic diagnostic frameworks, better interprofessional communication, and focused education on cognitive bias. Conclusion: This study illustrates how the “Misdiagnosis Tracker” greatly enhances medical students’ reflective and diagnostic reasoning skills and better prepares them for clinical practice. By fostering an environment of learning from diagnostic mistakes, this approach could ultimately result in fewer diagnostic errors and improved patient outcomes. Longitudinal studies are essential to determine the long-term effect of this model on clinical competence and its application in different education settings.

Background Workplace settings are linked to staff health and wellbeing, affecting sickness absence, presenteeism and productivity. With the growing prevalence of health issues among employees in the UK, including stress and long-term conditions, effective workplace health and wellbeing support by local government can play a crucial role in keeping people economically active and well. Objective Identify and characterise workplace health and wellbeing programmes offered by local authorities within the United Kingdom. Methods A scoping review involved a comprehensive search of Local Authority Districts (LADs) and county councils' websites followed by direct communications between 1 January 2024 and 30 April 2024. Initiatives were included if they were designed to enhance workplace health and wellbeing, actively ongoing and offered at no cost to workplaces. Data were extracted on the initiative name, provider, deprivation level, health focus, workplace eligibility and accreditation processes. Results The review identified 61 active local government workplace health programmes across the UK in March 2024, reflecting a 21% provision among local authorities. These initiatives were homogenous in focus, scope of coverage and implementation methods, with all focusing on general health. Geographical mapping highlighted regional disparities in the provision of workplace health and wellbeing initiatives that are free at the point of access (WHISPAs). England had a higher number (Central, Southern, and Southeastern regions specifically) while the rest of England, Wales, Scotland and North Ireland had a lower number or no WHISPAs. Conclusion There is a need for more coordinated efforts to increase the visibility and accessibility of local government workplace health initiatives that are free at the point of access. National workplace health accreditation could further encourage employers to adopt health and wellbeing programmes.

Introduction Early detection of cardiovascular disease in primary care is a public health priority, for which the clinical and cost-effectiveness of an artificial intelligence-enabled stethoscope that detects left ventricular systolic dysfunction, atrial fibrillation and cardiac murmurs is unproven but potentially transformative. Methods and analysis TRICORDER is a pragmatic, two-arm, multi-centre (decentralised), cluster-randomised controlled trial and implementation study. Up to 200 primary care practices in urban North West London and rural North Wales, UK, will be randomised to usual care or to have artificial intelligence-enabled stethoscopes available for use. Primary care clinicians will use the artificial intelligence-enabled stethoscopes at their own discretion, without patient-level inclusion or exclusion criteria. They will be supported to do so by a clinical guideline developed and approved by the regional health system executive board. Patient and outcome data will be captured from pooled primary and secondary care records, supplemented by qualitative and quantitative clinician surveys. The coprimary endpoints are (i) difference in the coded incidence (detection) of heart failure and (ii) difference in the ratio of coded incidence of heart failure via hospital admission versus community-based diagnostic pathways. Secondary endpoints include difference in the incidence of atrial fibrillation and valvular heart disease, cost-consequence differential, and prescription of guideline-directed medical therapy. Ethics and dissemination This trial has ethical approval from the UK Health Research Authority (23/LO/0051). Findings from this trial will be disseminated through publication of peer-reviewed manuscripts, presentations at scientific meetings and conferences with local and national stakeholders. Trial registration number NCT05987670

BACKGROUND Continuous glucose monitors (CGM) play an important role in type 2 diabetes management, offering benefits such as improved glucose awareness, behavioural adjustments, and reduced anxiety. While generally accepted by persons with T2D, challenges such as pain from sensor insertion and skin reactions to the adhesive may hinder their effectiveness. This qualitative study aims to examine how individuals with T2D perceive the clinical and personal benefits of CGM, as well as the challenges affecting its long-term use. By understanding patient experiences, this project seeks to inform clinical education, enhance patient support strategies, and promote CGM adoption and adherence. OBJECTIVE This qualitative study aims to explore T2D person’s perceived benefits and challenges associated with using CGM METHODS This study used an online questionnaire survey to explore the experiences of CGM of individuals with T2D in the UK. A total of 531 participants were recruited in October 2024. Thematic analysis identified key benefits and challenges associated with continuous glucose monitoring (CGM) use. RESULTS Participants identified several key benefits, which were categorised into five overarching themes, including (i) practicality, (ii) better understanding of lifestyle impacts on glucose levels, (iii) improved self-management, (iv) improved safety, and (v) enhanced data sharing with healthcare providers. The main challenges identified included (i) limited access, (ii) usability and technological issues, (iii) overreliance on passive monitoring, (iv) emotional burden, and (v) data-related issues. CONCLUSIONS Participants provided valuable insights into the experiences of individuals with T2D using CGM, particularly regarding its perceived benefits and challenges. Despite the benefits demonstrating that CGM is a valuable tool for T2D management, these findings emphasise the need for improved accessibility, user-friendly technology, and tailored education to enhance CGM adoption and long-term adherence.

This is the supplementary information for the paper "Characterising Acute and Chronic Care Needs: Insights from the Global Burden of Disease Study 2019" published in Nature Communications. The document provides complementary study results, presented as supplementary figures and tables. The list of contributors is also included.

Background Self-care interventions for sexual and reproductive health and rights (SRHR) are critical to advancing individual wellbeing and achieving universal health coverage. This study assesses how three countries (Kenya, Nigeria and Uganda) have adapted and implemented the World Health Organization (WHO) Guideline on Self-Care Interventions for SRHR within their national policy and practice landscapes. Objectives The primary objective was to develop and pilot a novel policy mapping and implementation analysis tool. Secondary aims included using a mixed-methods approach comprising policy document review, surveys and interviews to evaluate the contextualisation and uptake of WHO recommendations at the country level. Methods We designed a Policy Mapping and Implementation Matrix (PMIM) to assess alignment with 24 WHO SRHR self-care recommendations. Data were collected from 316 stakeholders through surveys and interviews, and 47 policy documents were reviewed. Findings were synthesised using a Red Amber Green (RAG) matrix to assess implementation across the guidelines five domains. Results Implementation varied by country and recommendation. Family planning and infertility services (Category 2) showed the strongest uptake, while areas such as unsafe abortion management and STI self-sampling (Categories 3 and 4) were less consistently addressed. Kenya demonstrated broad alignment through multiple policies, while Nigeria and Uganda showed promising progress, particularly with the development of dedicated national self-care guidelines. Key barriers included supply chain challenges, low health literacy and legal constraints. Critical enablers were provider training and task shifting. Conclusion This study introduces a novel, pragmatic framework for assessing national self-care policy and practice. It highlights the importance of contextual adaptation rather than mechanical adoption of global guidelines. While study limitations are acknowledged, the methodology offers a replicable approach for monitoring and strengthening self-care integration in diverse settings.

Chronic care manages long-term, progressive conditions, while acute care addresses short-term conditions. Chronic conditions increasingly strain health systems, which are often unprepared for these demands. This study examines the burden of conditions requiring acute versus chronic care, including sequelae. Conditions and sequelae from the Global Burden of Diseases Study 2019 were classified into acute or chronic care categories. Data were analysed by age, sex, and socio-demographic index, presenting total numbers and contributions to burden metrics such as Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLD), and Years of Life Lost (YLL). Approximately 68% of DALYs were attributed to chronic care, while 27% were due to acute care. Chronic care needs increased with age, representing 86% of YLDs and 71% of YLLs, and accounting for 93% of YLDs from sequelae. These findings highlight that chronic care needs far exceed acute care needs globally, necessitating health systems to adapt accordingly.