Journal of the Royal Society of Medicine最新文献

{"title":"Industrial action and emergency department attendances in England, 2022-2024: a retrospective multicentre causal mediation analysis.","authors":"Steven Wyatt, Mohammed A Mohammed, Jonathan Clarke, Marta Garcia-Fiñana, Iain Buchan","doi":"10.1177/01410768261461989","DOIUrl":"10.1177/01410768261461989","url":null,"abstract":"<p><strong>Objectives: </strong>Between December 2022 and July 2024, the English National Health Service (NHS) experienced 27 periods of industrial action spanning 78 days, involving hospital and ambulance staff. We examined the direct and indirect impacts of these strikes on emergency department (ED) performanceDesign:A retrospective causal mediation analysis. Effects were estimated using mixed effects accelerated failure time, linear and generalised linear regression models with patient- and hospital-level covariates within a causal mediation framework.</p><p><strong>Setting: </strong>20 major (Type 1) EDs in England with high-quality linkage across ED, inpatient, and imaging data.</p><p><strong>Participants: </strong>Patients attending these EDs between August 2022 and July 2024.</p><p><strong>Main outcome measures: </strong>A patient's time in ED analysed in relation to strike activity at the mid-point of attendance by one or more staff groups: (1) resident/junior doctors, (2) consultants, (3) both resident and consultant doctors, (4) paramedics and (5) nurses.</p><p><strong>Results: </strong>Average duration of ED attendances reduced on days affected by residents' strikes (-12.6%, 95% CI -10.4% to -14.8%), consultant strikes (-5.6%, 95% CI -2.7% to -8.4%), paramedic strikes (-4.5%, 95% CI -2.0% to -6.8%), but increased when residents and consultants were on strike simultaneously (+7.2%, 95% CI 3.8%-10.7%). There were no significant changes to ED durations during nurse strikes (-1.7%, 95% CI -1.5% to 4.7%). Changes in emergency inpatient occupancy explained a proportion of the change in average ED durations (resident doctor 10.4%, consultants 53.3%, combined doctors 5.4% and paramedics 14.3%). The impact of strikes on ED attendance volumes was mixed. The net effect of these changes explained 1.5%, 16.8% and 28.8% of the change in average ED durations observed during residents, combined doctor and paramedic strikes, respectively. During the residents' strikes, patients were more likely to receive treatments in ED (adjusted incident risk ratio 1.013, 95% CI 1.008-1.018), but less likely to be admitted (adjusted odds ratio 0.963, 95% CI 0.946-0.980). Efforts to meet the 4-h target intensified during the resident, consultant and combined doctors strike, but reduced during the nurse and paramedic strikes. This explained 2.7% and 17.1% of the changes in average ED durations observed during the resident and consultant strikes, respectively. There were substantial reductions in many forms of planned hospital care during the resident, consultant and combined doctor strikes, but these did not contribute to the observed reductions in ED durations.</p><p><strong>Conclusion: </strong>Industrial action - particularly by resident and consultant doctors - was associated with shorter ED stays, partly mediated by greater emergency bed availability, lower demand and intensified throughput efforts. However, much of the reduction during resident strikes remained ","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":" ","pages":"190-204"},"PeriodicalIF":5.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701678","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 mixed Impact of industrial action on emergency department stays.","authors":"Kamran Abbasi","doi":"10.1177/01410768261481148","DOIUrl":"10.1177/01410768261481148","url":null,"abstract":"","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":"119 7","pages":"183"},"PeriodicalIF":5.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13558950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912684","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":"Patient-centred care: is it enough?","authors":"Waseem Jerjes, Azeem Majeed","doi":"10.1177/01410768261461964","DOIUrl":"10.1177/01410768261461964","url":null,"abstract":"","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":" ","pages":"1410768261461964"},"PeriodicalIF":5.9,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13309346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148330563","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":"Ethnic differences in specialty destinations in UK medicine: a repeated cross-sectional analysis of secondary data.","authors":"Celia Brown, Nariell Morrison, Karen Aus, Anna Coulson, Amir H Sam","doi":"10.1177/01410768261455488","DOIUrl":"10.1177/01410768261455488","url":null,"abstract":"<p><strong>Objectives: </strong>To examine time-trends in ethnic differences in UK medical specialty destinations at two key career points: entry into specialty training (CT/ST1) and awarding Certificate of Completion of Training (CCT).</p><p><strong>Design: </strong>Repeated cross-sectional analysis using General Medical Council (GMC) secondary data; CT/ST1: 12 specialties, 2012-2022; CCT: 11 specialties, 2007-2021.</p><p><strong>Setting: </strong>Postgraduate specialty training groups within the UK National Health Service.</p><p><strong>Participants: </strong>Doctors with a UK Primary Medical Qualification (CT/ST1: 64,995; CCT: 62,380), categorised as White, Asian and other ethnic groups using GMC data.</p><p><strong>Main outcome measures: </strong>The ethnic distribution across specialties was examined using chi-squared tests. The temporal trend was evaluated with ordinary least squares regression of the effect size. Trends in over- and under-representation of ethnic groups within specialties were identified using Kendall's tau-b correlations.</p><p><strong>Results: </strong>White doctors comprised the majority proportion (67.1% CT/ST1; 70.3% CCT), followed by Asian (23.4% CT/ST1; 22.6% CCT) and other ethnicities (9.5% CT/ST1; 7.1% CCT). Ethnic differences were statistically significant for all years except CCT in 2007, with larger effect sizes at CT/ST1. Effect sizes increased over time at both levels (CT/ST1 <i>p</i> = 0.041; CCT <i>p</i> = 0.024). Asian doctors were over-represented in Ophthalmology at both levels and Radiology at CT/ST1, and White doctors over-represented in Acute Care at CT/ST1 and Emergency Medicine at CCT.</p><p><strong>Conclusions: </strong>Persistent ethnic differences exist in UK medical specialty destinations. Systemic factors may therefore influence specialty choice, selection processes and progression to CCT. Future research should explore the underlying causes of ethnic differences between specialties to assess if biases affect career progression.</p>","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":" ","pages":"163-172"},"PeriodicalIF":5.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308788","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 delayed morbidity of war.","authors":"Afsaneh Shirani, Farzaneh Shirani","doi":"10.1177/01410768261465248","DOIUrl":"10.1177/01410768261465248","url":null,"abstract":"","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":" ","pages":"177-178"},"PeriodicalIF":5.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391350","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 placebo effect and long history of the habit of belief. How a medieval image reveals the power of the invisible.","authors":"Racha Kirakosian, Philip Liston-Kraft, Ted J Kaptchuk, Karin Jensen","doi":"10.1177/01410768261460426","DOIUrl":"10.1177/01410768261460426","url":null,"abstract":"","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":" ","pages":"173-176"},"PeriodicalIF":5.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13314658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345780","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":"For more events and to book online, please visit //www.rsm.ac.uk/events.","authors":"","doi":"10.1177/01410768261479723","DOIUrl":"https://doi.org/10.1177/01410768261479723","url":null,"abstract":"","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":"119 6","pages":"180"},"PeriodicalIF":5.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794560","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":"Tacking discrimination to improve population health.","authors":"Kamran Abbasi","doi":"10.1177/01410768261479126","DOIUrl":"https://doi.org/10.1177/01410768261479126","url":null,"abstract":"","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":"119 6","pages":"159"},"PeriodicalIF":5.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794572","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":"From testimonies to action: embedding ethnic minority participation in health research after the COVID-19 Inquiry.","authors":"Richard A Powell, Natasha M Dsouza, Keivan Armani, Kanika I Dharmayat, Keitumetse-Kabelo Murray, Mala Rao, Ganesh Sathyamoorthy","doi":"10.1177/01410768261461984","DOIUrl":"10.1177/01410768261461984","url":null,"abstract":"","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":" ","pages":"161-162"},"PeriodicalIF":5.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447818","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":"Beyond headcounts: South Korea's medical school expansion and physician distribution.","authors":"Sukhyun Ryu, Creuza Rachel Vicente, Kyujin Chang","doi":"10.1177/01410768261434773","DOIUrl":"10.1177/01410768261434773","url":null,"abstract":"","PeriodicalId":17271,"journal":{"name":"Journal of the Royal Society of Medicine","volume":" ","pages":"160"},"PeriodicalIF":5.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13033033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147530087","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}