JRSM Open最新文献

{"title":"A National Health Service in 'Serious Trouble': What do multiple long-term conditions tell us about deterioration in health among people accessing hospital care in the North East of England? - An analysis of electronic health records.","authors":"Rachel Cooper, Marzieh Shahmandi, Jonathan G Bunn, Peta Leroux, Chris Plummer, Tom P Marshall, James Ms Wason, Miles D Witham, Avan A Sayer","doi":"10.1177/20542704261465142","DOIUrl":"https://doi.org/10.1177/20542704261465142","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate the prevalence of multiple long-term conditions (MLTC) among people accessing hospital care in North East England, and to assess associations with age, sex, ethnicity and neighbourhood deprivation.</p><p><strong>Design: </strong>Analysis of electronic health records.</p><p><strong>Setting: </strong>Secondary care.</p><p><strong>Participants: </strong>All adults, 18 years and above, with  ≥ 1 admission to Newcastle upon Tyne Hospitals NHS Foundation Trust (NuTH) between July 2018 and June 2019 (N = 88,117, 51% women) or between July 2021 and June 2022 (N = 83,036, 51% women).</p><p><strong>Main outcome measures: </strong>MLTC; ≥2 long-term conditions.</p><p><strong>Results: </strong>Between July 2018 and June 2019, overall prevalence of MLTC was 49.6%, and between July 2021 and June 2022 it was 61.0%. Older age and living in a more deprived neighbourhood were consistently associated with increased risk of MLTC, whereby people living in the most deprived neighbourhoods had a prevalence of MLTC equivalent to people from the least deprived neighbourhoods a decade older. Associations between neighbourhood deprivation and increased MLTC risk were stronger in younger adults; relative risk of MLTC was 1.74 (95% confidence interval: 1.49-2.02) when comparing people aged 30-39 living in the most and least deprived neighbourhoods.</p><p><strong>Conclusions: </strong>Among adults accessing inpatient hospital care in North East England, the prevalence of MLTC is high in all age groups, has increased since the COVID-19 pandemic and has a greater impact on younger adults from more deprived neighbourhoods. This highlights the sheer scale of the challenge that MLTC present in hospitals and the value of harnessing information at a local level as we look to redesign hospital care fit for the future.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"17 8","pages":"20542704261465142"},"PeriodicalIF":0.7,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-racism in postgraduate medical curricula: A review of curricula.","authors":"Hadjer Nacer, Chetna Sharma, Aaron Koay, Martin McKee, Delan Devakumar","doi":"10.1177/20542704261462649","DOIUrl":"10.1177/20542704261462649","url":null,"abstract":"<p><strong>Objectives: </strong>To assess how UK postgraduate medical organisations have responded to calls for action on structural racism, and to examine the extent to which anti-racism is embedded in postgraduate medical curricula and learning outcomes.</p><p><strong>Design: </strong>We conducted a review of publicly available statements and commitments from organisations responsible for postgraduate medical education, and a content analysis of all General Medical Council (GMC)-approved postgraduate curricula. Search terms related to racism, ethnicity, religion and discrimination were used, with double-coding of extracted data and inductive thematic analysis of relevant learning outcomes.</p><p><strong>Settings: </strong>United Kingdom.</p><p><strong>Participants: </strong>Twenty-one organisations responsible for postgraduate medical training and all 102 GMC-approved postgraduate medical curricula.</p><p><strong>Main outcome measures: </strong>Presence of explicit anti-racism commitments, inclusion of education-related actions and accountability mechanisms, and representation of racism and its impacts on health within assessed curricular competencies.</p><p><strong>Results: </strong>Sixteen organisations (76%) had public commitments addressing racism or related issues, with ten (48%) including education-related measures and five (24%) specifying accountability mechanisms. Across 102 curricula, only 11 (11%) mentioned racism, and just 10 included it in learning outcomes, largely confined to three specialities. Mentions of race, ethnicity and religion were more common but often lacked reference to structural drivers of health inequalities. No curricula addressed xenophobia, Islamophobia, antisemitism or decolonisation.</p><p><strong>Conclusions: </strong>Despite widespread institutional commitments, anti-racism is minimally represented in UK postgraduate medical curricula. There is an urgent need to integrate explicit anti-racism competencies into training to equip doctors with the knowledge and skills required to address structural determinants of health and reduce inequalities.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"17 7","pages":"20542704261462649"},"PeriodicalIF":0.7,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13438363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptom burden in multiple long-term conditions: An AI-supported, mixed-methods concept elicitation study.","authors":"Sarah E Hughes, Benjamin M A Hughes, Shamil Haroon, Eleanor Hathaway, Nicola Anderson, Christel McMullan, Michael Newnham, Clare Taylor, Alastair Denniston, Steven Backhouse, Andrew Filer, Karim Raza, Julia Scarisbrick, Clare Anderson, Matthew Lee, Lee Watts, Victoria Hodgetts Morton, Sarah Hillman, Faraz Mughal, Ed Day, Tariq Sami, Aliza Jesani, Thomas Jackson, Philip Collis, John Devin Peipert, Melanie Calvert","doi":"10.1177/20542704261459717","DOIUrl":"10.1177/20542704261459717","url":null,"abstract":"<p><strong>Objective: </strong>To develop the conceptual framework for an MLTC-specific patient-reported outcome measure (PROM), the Symptom Burden Questionnaire™ for MLTC (SBQ™-MLTC).</p><p><strong>Design: </strong>Mixed-methods study: (1) symptom list generation; (2) assessment of list face validity; and (3) construction of a conceptual framework.</p><p><strong>Setting: </strong>Concept elicitation and conceptual framework development using existing PROMs identified through the Mapi Research Trust PROQOLID eCOA database and AI-generated symptom lists.</p><p><strong>Participants: </strong>Fifty-one condition-specific PROMs with evidence of patient involvement during concept elicitation were included for symptom extraction. ChatGPT-4 generated symptom lists for 24 conditions prevalent in MLTC. Seventeen healthcare practitioners reviewed symptom relevance and contributed to refinement of the conceptual framework.</p><p><strong>Main outcome measures: </strong>Identification, refinement, and organisation of relevant MLTC symptoms into body system and functional domains, and development of the SBQ™-MLTC's conceptual framework.</p><p><strong>Results: </strong>ePROVIDE searches in July and August 2023 identified 51 condition-specific PROMs for 24 conditions prevalent in MLTC. ChatGPT-4 was prompted to generate a list of 75 symptoms for each condition. A merged list of 2202 symptoms was iteratively reduced to 190 symptoms for healthcare practitioner review. The final conceptual framework included 151 symptoms spanning 18 body system and functional domains.</p><p><strong>Conclusions: </strong>This study represents the first phase in the development of an MLTC-specific PROM of symptom burden. Generative AI output triangulated with content from existing PROMs and healthcare practitioner review proved a feasible approach to concept elicitation. Planned cognitive debriefing will confirm content validity of the SBQ™-MLTC for people with lived experience. In the future, the SBQ™-MLTC could support integrated, symptom-led approaches for clinical management of MLTC.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"17 7","pages":"20542704261459717"},"PeriodicalIF":0.7,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of menopausal hormone therapy on cardiovascular disease, cancer, cognition and depression in younger women: A systematic review.","authors":"Patricia A Bencivenga, Natalie Fort, Adriane Fugh-Berman, Anthony R Scialli","doi":"10.1177/20542704261455970","DOIUrl":"10.1177/20542704261455970","url":null,"abstract":"<p><strong>Objective: </strong>The Women's Health Initiative (WHI), a randomized controlled trial, found no overall health benefit of menopausal hormone therapy. Our objective was to evaluate the hypothesis that initiating hormonal therapy prior to age 60 or within a few years after the last menstrual period provides health benefits in menopausal women.</p><p><strong>Design: </strong>A search was conducted in MEDLINE, Scopus, and ClinicalTrials.gov from inception until August 26, 2025. Randomized controlled trials in which at least one arm was a pharmaceutical oestrogen and one arm was a placebo were included. We required studies to present clinical health outcomes.</p><p><strong>Setting: </strong>Systematic review.</p><p><strong>Participants: </strong>Menopausal women age 60 or younger or within a short time of the last menstrual period, as defined by individual study authors.</p><p><strong>Main outcome measures: </strong>Studies were categorized based on primary endpoints, namely cardiovascular disease, cancer, depression, and cognition. Risk of bias was assessed using a standard tool. The reliability of conclusions was assessed using the core GRADE method.</p><p><strong>Results: </strong>Thirty-one papers, reporting on seventeen randomized controlled trials, met eligibility criteria. Menopausal hormone therapy in young menopausal women was not shown to have beneficial effects on cardiovascular disease, cancer, depression, or cognition with the exception of some cardiovascular endpoints in women on oestrogen alone in the WHI, a finding not confirmed in other randomized controlled trials and not confirmed in women with vasomotor symptoms.</p><p><strong>Conclusions: </strong>Menopausal hormone therapy in young menopausal women has not been shown in randomized controlled trials to have beneficial effects on cardiovascular disease, cancer, depression, or cognition.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"17 6","pages":"20542704261455970"},"PeriodicalIF":0.7,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13315305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of COVID-19 NHS breast screening pause on breast cancer presentation and management: an insight into overdiagnosis.","authors":"Rachel Aquilina, Jajini Varghese, Jayant S Vaidya, Uma J Vaidya","doi":"10.1177/20542704261447649","DOIUrl":"10.1177/20542704261447649","url":null,"abstract":"<p><strong>Objective: </strong>To ascertain the impact of a 3-month pause in the NHS Breast Screening Programme (NHSBSP) during COVID-19 on numbers, characteristics and outcomes of breast cancer patients.</p><p><strong>Design: </strong>We compared numbers, referral sources (NHSBSP/GP), tumour characteristics, treatments, and survival before and during COVID-19 using chi-square tests and Kaplan-Meier estimates. Patients were grouped into: (a) all cases from 2019 to 2021 (<i>n</i> = 3353) and (b) six selected months in 2019 and 2020 (<i>n</i> = 325).</p><p><strong>Setting: </strong>The study was conducted with the breast units of two large London NHS hospitals as a local audit to understand the impact of COVID-19 on breast cancer management.</p><p><strong>Participants: </strong>Patients diagnosed with breast cancer from 2019 to 2021 were analysed.</p><p><strong>Main outcome measures: </strong>Temporal variation in the number of breast cancer cases by referral source and the impact of the pause in screening mammography due to the COVID-19 pandemic on changes in tumour characteristics, treatments and survival.</p><p><strong>Results: </strong>Overall, there were 31% fewer patients in 2020 vs. 2019 (886 vs. 1281, <i>p</i> = .002), due to fewer screen-detected (851 vs. 398) rather than symptomatic cases (432 vs. 459), <i>p</i> < .00001), with no corresponding increase in 2021 (<i>n</i> = 1186) In the detailed analysis, there were significantly fewer grade 1 cancers (11/120 vs. 37/204, <i>p</i> = .028) in 2020 vs. 2019, but there was no stage shift from smaller or less advanced (node-negative) tumours to larger or more advanced tumours, and no difference in extent of surgery, i.e., ratios of breast conservation to mastectomy, or sentinel node biopsy to axillary clearance. There was no difference in time from referral to diagnosis between the two time periods. The median follow-up was 3.8 years; K-M survival curves overlapped, with no difference in 3-year survival (90.5% vs. 91.7%, HR=1.09, <i>p</i> = .83).</p><p><strong>Conclusions: </strong>During the COVID-19-induced NHSBSP pause, good-prognosis (grade 1) cancers reduced without an increase in larger, or node-positive cancers, or more extensive surgery, and 3-year survival remained unchanged, suggesting that pausing NHSBSP may have avoided overdiagnosis without causing harm.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"17 4","pages":"20542704261447649"},"PeriodicalIF":0.7,"publicationDate":"2026-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147973550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative hormone replacement therapy (HRT) and venous thromboembolism risk: a scoping review of available evidence and guidance.","authors":"Omar Helmy, Celine Iswarya Partha Sarathi, Diwakar Sarma","doi":"10.1177/20542704261435338","DOIUrl":"10.1177/20542704261435338","url":null,"abstract":"<p><strong>Objective: </strong>Hormone replacement therapy (HRT) is used to manage menopausal symptoms, but its perioperative use raises concerns about increased venous thromboembolism (VTE) risk. Clinical guidelines vary, with some advising temporary discontinuation before surgery. This scoping review aims to synthesise evidence and guidance on whether perioperative cessation of HRT influences postoperative VTE risk.</p><p><strong>Design: </strong>A systematic search of PubMed and the Cochrane Library identified studies evaluating pre-operative HRT and VTE outcomes. Search terms included Hormone Replacement Therapy, HRT, Venous Thromboembolism, Venous Thrombosis, Pulmonary Embolism, Perioperative Care and Surgical Procedures, Operative.</p><p><strong>Participants: </strong>Studies included adult women on HRT undergoing surgery and assessed discontinuation and VTE risk. Data were synthesised narratively.</p><p><strong>Results: </strong>The search identified 246 records, four of which met the inclusion criteria: three primary studies and one systematic review. Only one study compared perioperative continuation versus cessation of HRT and found no significant increase in postoperative VTE with continued use. Other studies examined HRT among multiple VTE risk factors, with inconsistent findings. Clinical guidelines recognise oral oestrogen as a VTE risk factor and distinguish between higher-risk oral and lower-risk transdermal formulations; however, few provide explicit perioperative recommendations.</p><p><strong>Conclusion: </strong>Evidence is limited and insufficient to support routine perioperative HRT cessation. The only comparative study found no significant increase in VTE with continuation, though limitations restrict interpretation. Overall, the literature reflects uncertainty. Given limited and heterogeneous data, perioperative HRT management should be individualised. Further prospective research is needed to determine whether temporary withdrawal, particularly of oral oestrogen, reduces postoperative VTE risk.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"17 3","pages":"20542704261435338"},"PeriodicalIF":0.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147941866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to \"Scrotal Masson's tumour masquerading as dysplastic polyorchidism - a case report\".","authors":"","doi":"10.1177/20542704261442225","DOIUrl":"10.1177/20542704261442225","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1177/20542704221095371.].</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"17 5","pages":"20542704261442225"},"PeriodicalIF":0.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13158471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147930862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Rashōmon Effect and COVID-19 vaccine decision-making: A qualitative study.","authors":"Poonam Madar, Raj S Chandok, Azeem Majeed","doi":"10.1177/20542704251408587","DOIUrl":"10.1177/20542704251408587","url":null,"abstract":"<p><strong>Objectives: </strong>This qualitative study captured the perspectives of patients and healthcare professionals to better understand COVID-19 vaccine decision-making among South Asians in London.</p><p><strong>Design: </strong>In-depth semi-structured telephone and virtual interviews were conducted using convenience and purposive sampling to explore narratives about COVID-19 decision-making processes, pandemic experiences, and perceptions of living through a period of unprecedented uncertainty and turbulence.</p><p><strong>Setting: </strong>UK.</p><p><strong>Participants: </strong>12 London-based individuals including patients, clinicians, and a medical receptionist.</p><p><strong>Main outcome measures: </strong>Respondents were categorised as either COVID-19 vaccine compliant or non-compliant based on their vaccination status.</p><p><strong>Results: </strong>The variation and dynamic nature of the vaccination trajectories described in this study suggest that the decision to vaccinate or not against COVID-19 comprises a fluid, continually evolving process shaped by personal experiences and ongoing risk assessments. This study examines the possibility that some individuals form an 'epistemic community of uncertainty,' influenced by the pervasive 'infodemic' surrounding COVID-19 vaccines, which has created substantial ambiguity about truth and trust, reminiscent of the Rashōmon effect. Developing a nuanced understanding of this effect in the context of the COVID-19 era is a critical step towards addressing such ambiguity and fostering deeper critical thinking about vaccine decision-making.</p><p><strong>Conclusions: </strong>This research highlights the need for more flexible and innovative strategies to navigate the complex factors influencing decision-making. Furthermore, the study advocates for a more refined and discerning personalised approach to engagement, which is vital for improving scientific and health literacy within society and overcoming common barriers to making informed and autonomous choices.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"17 1","pages":"20542704251408587"},"PeriodicalIF":0.7,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12921138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the evidence on the role and impact of plastics in the context of health products and their packaging: A scoping review.","authors":"Navisha Weerasinghe, Dana Hart, Andrea Bowra, Marilia D'Souza, Shugri Nour, Nicholas Chartres, Gillian Parker, Kelly Holloway, Fiona A Miller, Mina Tadrous, Deirdre Dimancesco, Quinn Grundy","doi":"10.1177/20542704251409014","DOIUrl":"10.1177/20542704251409014","url":null,"abstract":"<p><strong>Objective: </strong>To map the global research on the impact of plastic-based health products and their packaging across the product lifecycle in order to inform equitable, sustainable governance for the role of plastics in health products.</p><p><strong>Design: </strong>A scoping review of primary research and systematic reviews examining plastic-related outcomes in the context of health products or packaging using a systematic search of the MEDLINE, EMBASE, SCOPUS, GEOBASE and Compendex databases November 2024 with no date or language restrictions.</p><p><strong>Setting: </strong>Studies spanning global and disciplinary contexts.</p><p><strong>Participants: </strong>Primary research or systematic reviews that examined plastic-related outcomes in the context of health products or packaging.</p><p><strong>Main outcome measures: </strong>We descriptively analyzed characteristics and outcomes of the included articles according to the product lifecycle stage.</p><p><strong>Results: </strong>We screened 14,695 articles and included 572 articles published between 1960-2024. Only 8% (45/572) of articles studied more than one lifecycle stage. The evidence is otherwise siloed by focus, setting, and discipline: articles focused on clinical use and storage outcomes (266/572, 46.5%), were conducted primarily in high income countries (230/266, 86.5%) and within biomedical disciplines (207/266, 86.5%); articles focused on end-of-life outcomes (n=257/572, 44.9%) were conducted more frequently in middle-income countries (158/257, 61.7%), and within engineering and environmental sciences (208/257, 80.9%). We documented a multi-decade interest in plasticizer leaching from plastic devices and packaging.</p><p><strong>Conclusions: </strong>A research agenda that is lifecycle oriented, prevention focused, and precautionary will produce robust, actionable evidence to support treaty decision-making and implementation. We conclude with recommendations for research priorities that include interventions to reduce the use of plastics in healthcare, to measure the health and environmental impacts of the chemicals in plastics, and identification and assessment of safe, toxics-free, sustainable alternatives.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"17 1","pages":"20542704251409014"},"PeriodicalIF":0.7,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12921195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How should services for high-intensity users be organised? A scoping review of published literature with recommendations for future research and delivery of care.","authors":"Peter Greengross, Ismail Ismail, Callum Parr, Rebecca Wright, Sophie Hunter","doi":"10.1177/20542704251413949","DOIUrl":"10.1177/20542704251413949","url":null,"abstract":"<p><strong>Objective: </strong>High Intensity Users (HIUs) of Urgent and Emergency Care (UEC) services account for disproportionately high numbers of Emergency Department (ED) attendances, ambulance journeys and non-elective admissions. This review aimed to assess the quality and completeness of evidence for understanding the characteristics of HIUs, how best to identify and differentiate them, the effectiveness of services to support them, and to identify areas for further research.</p><p><strong>Design: </strong>Scoping review of UK-based peer-reviewed literature.</p><p><strong>Setting: </strong>Four databases (January 2010 to October 2025) - additional grey literature identified through hand searching and Google searches.</p><p><strong>Participants: </strong>Twenty-eight published articles (19 peer-reviewed papers, 9 grey literature).</p><p><strong>Main outcome measures: </strong>HIU definitions, descriptions, effectiveness of care, characteristics of successful programmes and interventions.</p><p><strong>Results: </strong>HIUs are generally defined by the frequency of UEC use rather than diagnosis or need, despite being highly heterogeneous. The national model of care adopted in England relies largely on individual Case Managers supporting small numbers of HIUs. Although most published evaluations report reductions in ED attendances and admissions, and positive impacts on individual well-being, they are generally small, uncontrolled, and short-term with poorly defined interventions and minimal evidence that they reduce overall demand on UEC services.</p><p><strong>Conclusions: </strong>Further research is needed to better characterise HIUs, drivers of their behaviour and risk factors to determine which HIUs benefit from which interventions. Services need to operate at scale using near-real time data, be integrated with health as well as social care services, and use standardised, granular definitions of HIUs to guide appropriate interventions.</p>","PeriodicalId":17674,"journal":{"name":"JRSM Open","volume":"17 2","pages":"20542704251413949"},"PeriodicalIF":0.7,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12921198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147271587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}