Author: Azeem Majeed

I am Professor of Primary Care and Public Health, and Head of the Department of Primary Care & Public Health at Imperial College London. I am also involved in postgraduate education and training in both general practice and public health, and I am the Course Director of the Imperial College Master of Public Health (MPH) programme.

Congratulations to the 2016-17 MPH prize winners

Each year, we award a number of prizes to our Master of Public Health (MPH) students. The award winners in 2016-17 were:

MPH (General Stream) Faculty of Medicine Dean’s Scholarship
Alette Ellms

MPH (Global Stream) Faculty of Medicine Dean’s Scholarship
Maya Malarski

MPH (General Stream) Dissertation Award
Meghan Cupp

MPH (Global Stream) Dissertation Award
Maya Malarski

Wellcome Trust Centre MPH-Global Health Dissertation Award
Micol Tedeschi Samaia

Wellcome Trust Centre MPH Global Health Student Award
Debra Ten Brink

Flu vaccine may reduce the risk of death and hospital admission in people with type 2 diabetes

The flu vaccine may reduce the likelihood of being hospitalised with stroke and heart failure in people with type 2 diabetes, according to new research. The study from Imperial College London also found the patients who received the influenza vaccination had a 24 per cent lower death rate in the flu season compared to patients who weren’t vaccinated.

The team, who published their findings in CMAJ (Canadian Medical Association Journal) studied 123,503 UK adults with type 2 diabetes between 2003 and 2010. Around 65 per cent of these patients received the flu vaccine. We found that, compared to patients who had not been vaccinated, those who received the jab had a 30 per cent reduction in hospital admissions for stroke, 22 per cent reduction in heart failure admissions and 15 per cent reduction in admissions for pneumonia or influenza. Furthermore, people who were vaccinated had a 24 per cent lower death rate than patients who were not vaccinated.

We also found a 19 per cent reduction in hospital admissions for heart attack among vaccinated type 2 diabetes patients during the flu season, but this finding was not statistically significant.

Dr Eszter Vamos, lead author of the study from the School of Public Health at Imperial, said: “Most flu deaths every year occur in people with pre-existing health conditions such as type 2 diabetes. This study suggests the vaccine may have substantial benefits for patients with long-term conditions. Not only might it help reduce serious illness such as stroke – and possibly heart attack – in high-risk individuals, but it may also reduce the risk of death in the flu season. Currently more than one-third of people with diabetes do not receive their flu vaccine year-by-year in England. By increasing the number of people receiving influenza vaccine annually, we could further reduce the risk of severe illness not addressed by other measures.”

Type 2 diabetes results in a person being unable to control their blood sugar properly and affects around 2.7 million people in UK. People with the condition are at high risk of cardiovascular disease, which includes heart disease and stroke, possibly due to high blood sugar levels damaging blood vessels. Furthermore, flu infection has been found to increase the risk of heart attack or stroke in patients with cardiovascular disease, although scientists are unsure why.

In the UK the NHS offers the annual flu vaccine to children and adults with underlying health conditions such as type 2 diabetes, as well as to all over-65s and pregnant women.

Professor Azeem Majeed, co-senior author from the School of Public Health at Imperial added: “There are few studies looking at the effectiveness of the influenza vaccine in people with diabetes. Although there have been questions surrounding the effectiveness of the flu vaccine in recent years, this research demonstrates a clear advantage for people with diabetes. The findings of the study illustrate the importance of flu vaccine in reducing the risk of ill-health and death in people with long-term conditions. The flu vaccine is available free to these patients from GPs and pharmacists, and patients with diabetes should ensure they receive the vaccine every year.”

In the study, we looked at a representative sample of patients with type 2 diabetes in England. We then tracked these patients over a seven year period, and monitored the number of hospital admissions in this patient group for heart attack, stroke, heart failure, pneumonia, influenza. We also looked at the number of deaths. We then adjusted their figures for demographic and social factors, as well as existing health conditions.

The research was supported by the National Institute of Health Research North West London Collaboration for Leadership in Applied Health Research and Care Scheme and the NIHR Imperial Biomedical Research Centre.

Media Coverage
http://www.foxnews.com/health/2016/07/25/flu-vaccine-may-help-keep-diabetics-out-hospital.html

http://www.eurekalert.org/pub_releases/2016-07/cmaj-fvr072016.php

http://medicalxpress.com/news/2016-07-flu-vaccine-death-diabetes-patients.html

http://healthmedicinet.com/news/flu-vaccine-may-reduce-risk-of-death-for-type-2-diabetes-patients/

http://healthmedicinet.com/i/flu-vaccine-may-reduce-risk-of-death-for-type-2-diabetes-patients/

http://goo.gl/fTQPVI

http://www.reuters.com/article/us-health-diabetes-flu-shot-idUSKCN1051W7

http://www.bmj.com/content/354/bmj.i4130

http://www.doctorslounge.com/index.php/news/hd/65293

http://health.usnews.com/health-care/articles/2016-07-26/flu-shot-tied-to-fewer-hospitalizations-deaths-in-type-2-diabetes-patients

http://www.diabetes.co.uk/news/2016/jul/flu-jab-could-reduce-stroke-and-heart-failure-risks-in-type-2-diabetes-94994360.html

https://consumer.healthday.com/diabetes-information-10/type-ii-diabetes-news-183/flu-vaccine-tied-to-lower-deaths-hospitalizations-in-type-2-diabetes-patients-713085.html

http://www.asianage.com/life-and-style/flu-vaccine-may-help-keep-diabetics-out-hospital-619

http://timesofindia.indiatimes.com/life-style/health-fitness/health-news/Flu-vaccine-may-help-keep-diabetics-out-of-the-hospital/articleshow/53397756.cms

http://www.techtimes.com/articles/171345/20160726/flu-vaccine-lowers-heart-failure-and-stroke-related-hospitalization-rates-in-patients-with-type-2-diabetes.htm

http://gulftoday.ae/portal/3b35d484-2da8-43e2-95f6-b31481926376.aspx

How to monitor patient safety in primary care: Healthcare professionals’ views

A study from my research group published in JRSM Open aimed to identify ideas for patient safety monitoring strategies that could be used in primary care. People who took part in the survey offered 188 suggestions for monitoring patient safety in primary care. The content analysis revealed that these could be condensed into 24 different future monitoring strategies with varying levels of support. Most commonly, respondents supported the suggestion that patient safety can only be monitored effectively in primary care with greater levels of staffing or with additional resources. About one-third of all responses were recommendations for strategies which addressed monitoring of the individual in the clinical practice environment (e.g. GP, practice nurse) to improve safety. There was a clear need for more staff and resource to encourage better safety monitoring. Respondents recommended the dissemination of specific information for monitoring patient safety such as distributing the lessons of significant event audits amongst GP practices to enable shared learning.

Dr Demis Hassabis, Co-Founder and CEO of DeepMind, Speaks about AI in Healthcare

OnOn 28 September 2017, I attended the Annual Institute of Global Health Innovation Lecture: Artificial General Intelligence and Healthcare, delivered by Dr Demis Hassabis, co-founder and CEO of Google DeepMind. Artificial intelligence is the science of making machines smart argued Dr Hassabis, so how can we make it improve the healthcare sector? Dr Hassabis then went on to describe the work that DeepMind was carrying out in healthcare in areas such as organising information, deep learning to support the reporting of medical images (such as scans and pathology slides), and biomedical science. Dr Hassabis also discussed the challenges of applying techniques such as reinforcement learning in healthcare. He concluded that artificial intelligence has great scope for improving healthcare; for example, by prioritising the tasks that clinicians had to carry out and by providing decision support aids for both patients and doctors.

Why do some children not attend their hospital outpatient appointments?

A  study from my research group published in JRSM Open examined why some children do not attend their hospital outpatient appointments. The study found that the commonest reason for non-attendance is unawareness of the appointment due to incorrect contact details being held by the hospital. Potential strategies for reducing non-attendance at paediatric clinics include developing a confirmation or reminder system and improved communication with parents.

MPH students study tour to international organisations in Geneva

This popular study tour for Imperial MPH students is organised annually in collaboration with WHO Geneva. As part of the tour participants were introduced to the work of Médecins Sans Frontières, The UN High Commission for Refugees, the Red Cross, The UN, and WHO and its regional offices. MPH students have had the opportunity to meet with large numbers of senior colleagues in these key international organisations and learn about the nature of their work. The 3 day study tour was very busy, full of learning experience and fun.

2017 Annual GP Teachers Conference

The Annual Teachers’ Conference took place on Friday 9 June 2017 Celebrating the Student and Teacher Partnership. About 100 delegates joined together to network, offer peer support and learn through conversation, lectures and a series of workshops. A brief overview of the key themes and reflections from the day follows.

A story
Dr Sonia Kumar, Director of Undergraduate Primary Care Education, opened by sharing a story of coming across an old man with a bike puncture while out with her husband. While her husband repaired the puncture they got to know a little of his life; how his wife had died and he now lived in sheltered accommodation with cycling being an important way for him to get out and about. Later that day Sonia was reflecting on how hearing his story had made her feel sad and sorry for his changed circumstances, whereas Dev, Sonia’s husband, had taken away a different impression – a wonderful life where he continued to be cared for, maintaining his independence and a lifelong hobby in the form of his bike. And so with teaching, sometimes the student – teacher agenda and perspective to a situation can be different and recognising this is key to a successful teaching partnership.

A Vision for the Future
Professor Val Wass spoke to the subject “Doctors Without Borders”, drawing on her life experience as a GP, medical school dean, RCGP International lead and recent publication on By choice – not by chance: supporting medical students to careers in general practice for NHS Health Education England. She highlighted four important barriers (Generation Gap, Societal Borders, Specialty Borders and Self-Knowledge) we need to recognise in how we deliver education to support students to flourish in their future.

Reflecting with students
The student prizes showcased a huge amount of creativity with videos, paintings, interviews allowing us all to reflect on how healthcare delivery and our own attitudes shape the patient experience. One sensed a huge injection of energy and inspiration into the room, affirming to the audience members their inner calling of ‘this is why I want to teach’, and lots of reflections for teachers of their own practice – a true teacher-student partnership. This creative animation by a pair of students who got to know a patient over a number of months as she navigated the NHS and her own identity is highly recommended.

WHO Europe Primary Health Care Advisory Group

Professor Salman Rawaf was appointed by WHO Europe as a member of the newly formed Advisory Group on Primary Health Care. The first meeting of all Members was attended by the Regional Director Dr Zsuzanna Jakab and Kazakhstan’s Minister of Health, Dr Alexey Tsoy. Professor Rawaf gave a presentation on integration of public health and primary care services and highlighted the role of Healthy Living Centres in the UK. He also described some possible models for the integration using the experience of countries around the globe. The WHO European Centre for Primary Health is leading the work across the 53 member states of WHO Europe.

Introduction to Leadership and Communication in Medicine, Dubrovnik

This course was developed and run jointly between the Zagreb Institute of Culture of Health and the WHO Collaborating Centre, at the Centre for Advanced Academic Studies in Dubrovnik. More than 40 health professionals from across Croatia took part in this intensive course over 5 days. The modular format of the course allowed participants to choose the sessions which are relevant to their needs. The course was organised and led by Professor Rawaf from Imperial College London, and Professor Marijana Bras and Professor Velijko Dordevic of University of Zagreb. We plan to run the course annually at the Centre for Advanced Academic Studies.

Advanced Leadership and Management for Healthcare Course

This summer, the WHO Collaborating Centre delivered the well-established Advanced Leadership and Health Management course in London for delegations from China and the Gulf Region. The participants came from various health professional background with responsibilities to lead in their health systems.

Colleagues from China are mainly from hospital management, some from hospitals with over 4000 beds. The WHO Collaborating Centre Advanced Leadership and Management for healthcare course is a one-week intensive training addressed to health professionals. The content of the course is built around the WHO framework and aims to help participants become more successful leaders in complex knowledge-based health systems around the world.