Journal of the Royal Society of Medicine最新文献

{"title":"Access is clinical care: the front door of primary care as a public health intervention.","authors":"Waseem Jerjes, Austen El-Osta, Azeem Majeed","doi":"10.1177/01410768261480469","DOIUrl":"10.1177/01410768261480469","url":null,"abstract":"","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":" ","pages":"1410768261480469"},"PeriodicalIF":5.9,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The historical development of sample size estimation: from Huygens and Bernoulli to the present.","authors":"Kristian Thorlund, Christian Gluud","doi":"10.1177/01410768261479691","DOIUrl":"10.1177/01410768261479691","url":null,"abstract":"","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":" ","pages":"1410768261479691"},"PeriodicalIF":5.9,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical academic careers need structural integration, not individual endurance.","authors":"Agnieszka Jakubowska, Jungmin Choi, Yeun Joon Kim","doi":"10.1177/01410768261480477","DOIUrl":"https://doi.org/10.1177/01410768261480477","url":null,"abstract":"","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":" ","pages":"1410768261480477"},"PeriodicalIF":5.9,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seven lessons for financial incentivisation schemes in healthcare: a qualitative study of NHS Resolution's Maternity Incentive Scheme.","authors":"Graham Paul Martin, Gizdem Akdur, Jane O'Hara, Mary Dixon-Woods","doi":"10.1177/01410768261476118","DOIUrl":"10.1177/01410768261476118","url":null,"abstract":"<p><strong>Objectives: </strong>Avoidable harm and variations in quality have remained persistent features of health systems, but the track record of financial incentives in driving improvement is mixed. Based on an evaluation of NHS Resolution's Maternity Incentive Scheme (MIS), which focuses on safety of maternity care in English NHS trusts, we identify generalisable principles to inform design of financial incentive schemes in healthcare.</p><p><strong>Design: </strong>Qualitative process evaluation based on interviews with those involved in the design and delivery of MIS.</p><p><strong>Setting: </strong>Organisations involved in running MIS and organisations participating in the scheme.</p><p><strong>Participants: </strong>Thirty-five individuals were interviewed, including 17 involved in the national-level administration of MIS and 18 with experience of MIS at local level.</p><p><strong>Main outcome measures: </strong>Not applicable.</p><p><strong>Results: </strong>We identified strengths, weaknesses and unintended consequences of the Scheme from the perspective of participants. MIS was seen by national-level stakeholders as having succeeded in elevating maternity safety in organisations' priorities and consolidating disparate safety requirements into a unified framework. They saw MIS as a clinically credible and system-owned mechanism for prioritisation. However, local-level participants reported significant administrative burdens, opportunity costs and challenges in interpreting and implementing its requirements. The Scheme's all-or-nothing reimbursement model, while reinforcing parity across the areas it covered, sometimes led to disproportionate focus on marginal issues and created perverse incentives when full compliance seemed unattainable. We identify seven key lessons for the design of incentive systems that might optimise their impact from the findings.</p><p><strong>Conclusions: </strong>Careful design of incentive schemes is vital to minimise unintended consequences. Lessons from MIS are relevant to broader healthcare system reform efforts and initiatives aiming to harness financial levers for quality improvement, such as those in the 10-Year Health Plan for England.</p>","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":" ","pages":"1410768261476118"},"PeriodicalIF":5.9,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alfred the Great: a diagnosis.","authors":"Nicholas Summerton","doi":"10.1177/01410768261479846","DOIUrl":"10.1177/01410768261479846","url":null,"abstract":"","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":" ","pages":"1410768261479846"},"PeriodicalIF":5.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accountability for AI harms? Lessons from valproate.","authors":"Alain Braillon","doi":"10.1177/01410768261479496","DOIUrl":"10.1177/01410768261479496","url":null,"abstract":"","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":" ","pages":"1410768261479496"},"PeriodicalIF":5.9,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13498672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"After harm involving AI: reconstructing human-AI clinical system performance.","authors":"Bryan D Johnston, Scott J Adams, Jay Kalra","doi":"10.1177/01410768261479489","DOIUrl":"10.1177/01410768261479489","url":null,"abstract":"","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":" ","pages":"1410768261479489"},"PeriodicalIF":5.9,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13498688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Henry VIII Gate of St Bartholomew's Hospital: Roman Baroque influence and English identity in early 18th century London.","authors":"Paolo Pozzilli, Richard David Leslie, Christopher Rowland Payne, Claudio De Dominicis","doi":"10.1177/01410768261475044","DOIUrl":"https://doi.org/10.1177/01410768261475044","url":null,"abstract":"","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":" ","pages":"1410768261475044"},"PeriodicalIF":5.9,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence must not worsen maternal health inequalities.","authors":"Moiz Ahmad, Karthik Prabhu, Pippa Oakeshott, Rucchi Ryan, Mohammad S Razai","doi":"10.1177/01410768261474986","DOIUrl":"https://doi.org/10.1177/01410768261474986","url":null,"abstract":"","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":" ","pages":"1410768261474986"},"PeriodicalIF":5.9,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Competition and equity in NHS specialty training, 2021-2024: longitudinal cohort analysis of protected-characteristic outcomes.","authors":"Dinesh Aggarwal, Meera Roy-Chowdhury, Nicola Xiang, Sharon J Peacock","doi":"10.1177/01410768261475034","DOIUrl":"10.1177/01410768261475034","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate recruitment equity for NHS specialty training posts between 2021-2024, characterising demographics, quantifying appointment disparities by protected characteristics and assessing temporal trends.</p><p><strong>Design: </strong>Longitudinal cohort study using national recruitment data via annual Freedom of Information requests.</p><p><strong>Setting: </strong>National Health Service, UK.</p><p><strong>Participants: </strong>All medical and surgical specialty training applications to NHS England (2021-2024).</p><p><strong>Main outcome measures: </strong>Application success by protected characteristics.</p><p><strong>Results: </strong>Of 214,893 applications, 52,998 (24.7%) were appointed. Annual success rates fell from 12,419/37,971 (32.7%) in 2021 to 13,929/81,189 (17.2%) in 2024. Competitiveness increased but non-UK graduate applications did not reduce successful UK graduate numbers. Gender segregation persisted: surgical specialties had the highest proportion of male applicants, whereas for females this was observed in obstetrics and gynaecology. Female applicants had higher success rates than males (27.5% vs 22.2%; Δ5.3%, 95% CI 4.95-5.70, <i>p</i> < 0.001). Pregnant/maternity-leave candidates had lower success (21.3% vs 25.8%, Δ4.5%, 95% CI 3.15-5.82, <i>p</i> < 0.001), most markedly in paediatrics (Δ14.8%, 95% CI 8.95-20.58, <i>p</i> < 0.001) and surgery (Δ13.7%, 95% CI 7.60-19.82, <i>p</i> = 0.008). UK graduates outperformed non-UK graduates (40.7% vs 15.5%; Δ25.2%, 95% CI 24.8-25.6, <i>p</i> < 0.001). Adjusted for country of graduation, 15/15 minority ethnic groups had lower odds of success versus White-British, with steepest declines among Black Caribbean and Bangladeshi graduates.</p><p><strong>Conclusions: </strong>Inequities persist in NHS specialty recruitment. Gender segregation remains and disparities disadvantage pregnant/maternity-leave applicants. Disparities impacting minority ethnic UK graduates have widened. While data constraints preclude adjusting for confounders, these consistent trends require continuous monitoring and targeted interventions to ensure equitable access.</p>","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":" ","pages":"1410768261475034"},"PeriodicalIF":5.9,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}