Journal of the Royal Society of Medicine最新文献

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Non-training grades in the NHS workforce: the lost tribe? NHS员工队伍中的非培训等级：失落的部落？

IF 7.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Royal Society of Medicine

Pub Date : 2025-12-01 Epub Date: 2025-11-24 DOI: 10.1177/01410768251389450

Thinkwell Jamera, Martin Deahl

引用次数: 0

Patterns of long COVID symptoms among healthcare workers in the UK and variations by sociodemographic, clinical and occupational factors: a cross-sectional analysis of a nationwide study (UK-REACH). 英国医护人员长期COVID症状的模式以及社会人口统计学、临床和职业因素的变化：一项全国性研究的横断面分析（UK- reach）。

IF 7.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Royal Society of Medicine

Pub Date : 2025-12-01 Epub Date: 2025-12-08 DOI: 10.1177/01410768251389692

Amani Al-Oraibi, Christopher A Martin, Katherine Woolf, Laura B Nellums, Carolyn Tarrant, Manish Pareek

Objectives: This study aimed to examine symptom patterns between healthcare workers (HCWs) with and without long COVID, identify the most common long COVID symptom groups and investigate how these symptom profiles vary across different ethnic groups, demographic characteristics, clinical factors and occupational roles in UK HCWS.Design: We conducted a cross-sectional study using data from the United Kingdom Research study into Ethnicity and COVID-19 outcomes in Healthcare workers (UK-REACH) cohort study. Data were collected electronically between October 2021 and October 2022.Setting: United Kingdom.Participants: Individuals aged 16 years or older, residing in the UK, working as HCWs or ancillary workers in a healthcare setting and/or registered with one of seven major UK healthcare professional regulators.Main outcome measures: Long COVID was defined as symptoms persisting for ⩾12 weeks following SARS-CoV-2 infection. Our primary outcome was the presence or absence of particular groups of long COVID symptoms. We collapsed 28 symptoms into seven groups: cardiopulmonary, gastrointestinal, musculoskeletal, neurocognitive/neurologic, upper respiratory tract, psychological/social and systemic.Results: Among 4033 HCWs with a history of COVID-19, those with long COVID (26.5%; 1067/4033) reported a higher prevalence of systemic, neurological and psychological symptoms compared with those without long COVID. Among those with long COVID, the most commonly reported symptom groups were neurocognitive/neurologic (63.4%), cardiopulmonary (40.0%) - highest among Asian HCWs at 45.6% - and systemic (54.6%), which particularly affected Black and Mixed ethnicities at 64.0% and 63.9%, respectively. In multivariable analyses, Asian HCWs had higher odds of experiencing cardiopulmonary symptoms (adjusted odds ratio (aOR): 1.62, 95% CI 1.04-2.51, p = 0.032), while female HCWs were more likely to experience gastrointestinal (aOR: 3.78, 95% CI 1.14-12.45, p = 0.029) and neurocognitive symptoms (aOR: 1.58, 95% CI 1.10-2.28, p = 0.014). Compared with those in medical roles, musculoskeletal symptoms were more commonly reported by those in nursing (aOR: 2.50, 95% CI 1.32-4.72, p = 0.005), allied health professional (aOR: 1.82, 95% CI 1.01-3.30, p = 0.048) and dental roles (aOR: 3.07, 95% CI 1.31-7.17, p = 0.010). Vaccination with two or three doses was protective against several symptom groups, including cardiopulmonary, musculoskeletal and neurocognitive symptoms.Conclusions: Our findings are the first to reveal distinct patterns in long COVID symptoms among HCWs with significant variations by ethnicity, sex and occupational role. These findings emphasise the need for targeted support strategies and workplace adjustments that consider both occupation-specific risks and in

目的：本研究旨在研究患有和不患有长COVID的医护人员（HCWs）之间的症状模式，确定最常见的长COVID症状组，并调查这些症状概况在英国HCWs中不同种族、人口统计学特征、临床因素和职业角色之间的差异。设计：我们使用来自英国研究的数据进行了一项横断面研究，该研究涉及医疗工作者的种族和COVID-19结果（UK-REACH）队列研究。数据在2021年10月至2022年10月期间以电子方式收集。背景：英国。参与者：居住在英国的16岁或以上的个人，在医疗保健机构担任卫生保健员或辅助工作者和/或在英国七个主要医疗保健专业监管机构之一注册。主要结局指标：长COVID被定义为在SARS-CoV-2感染后症状持续小于12周。我们的主要结局是是否存在特定的长冠状病毒症状组。我们将28种症状分为7组：心肺、胃肠、肌肉骨骼、神经认知/神经、上呼吸道、心理/社会和全身。结果：4033名有COVID-19病史的医护人员中，长冠者（26.5%;1067/4033）出现全身、神经和心理症状的比例高于无长冠者。在长冠状病毒感染者中，最常报告的症状组是神经认知/神经系统（63.4%）、心肺（40.0%）——在亚洲HCWs中最高，为45.6%——和全身性（54.6%），黑人和混血儿的感染率分别为64.0%和63.9%。在多变量分析中，亚洲医护人员出现心肺症状的几率更高（调整比值比（aOR）： 1.62, 95% CI 1.04-2.51, p = 0.032），而女性医护人员更有可能出现胃肠道症状（aOR: 3.78, 95% CI 1.14-12.45, p = 0.029）和神经认知症状（aOR: 1.58, 95% CI 1.10-2.28, p = 0.014）。与医务人员相比，肌肉骨骼症状更常出现在护理人员（aOR: 2.50, 95% CI 1.32-4.72, p = 0.005）、专职卫生人员（aOR: 1.82, 95% CI 1.01-3.30, p = 0.048）和牙科人员（aOR: 3.07, 95% CI 1.31-7.17, p = 0.010）中。接种两剂或三剂疫苗对几种症状组有保护作用，包括心肺、肌肉骨骼和神经认知症状。结论：我们的研究结果首次揭示了不同种族、性别和职业角色的医护人员长COVID症状的不同模式。这些发现强调需要有针对性的支持策略和工作场所调整，考虑职业特定风险和个人社会人口因素。

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引用次数: 0

Medical education at the crossroads. Part I: undergraduate education and the erosion of professional identity. 医学教育处于十字路口。第一部分：本科教育与职业认同的侵蚀。

IF 7.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Royal Society of Medicine

Pub Date : 2025-11-25 DOI: 10.1177/01410768251395407

Louella Vaughan, Martin McKee

引用次数: 0

SGLT2 inhibitors for primary prevention of macrovascular and major microvascular complications in type 2 diabetes: an island-wide cohort study. SGLT2抑制剂用于2型糖尿病大血管和主要微血管并发症的一级预防：一项全岛队列研究

IF 7.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Royal Society of Medicine

Pub Date : 2025-11-01 Epub Date: 2025-11-03 DOI: 10.1177/01410768251375906

Wan-Yin Cheng, Fu-Shun Yen, Yao-Min Hung, James Cheng-Chung Wei, Heng-Jun Lin, Yu-Han Huang, Chih-Cheng Hsu, Chii-Min Hwu

Objective: This study aimed to evaluate the different risks of developing cardiovascular disease and major microvascular complications between sodium-glucose cotransporter-2 inhibitors (SGLT2i) and non-SGLT2i users in patients with type 2 diabetes (T2D) who do not have existing macrovascular or microvascular diseases.

Design: This study employed a retrospective, population-based cohort study design.

Setting: Data were obtained from Taiwan's National Health Insurance Research Database, covering the period from January 1, 2008, to December 31, 2021. Propensity score matching was used to identify 91,327 matched pairs of SGLT2 inhibitor and dipeptidyl peptidase-4 (DPP-4) inhibitor users, 91,673 pairs of SGLT2 inhibitor and sulfonylurea users, and 20,857 pairs of SGLT2 inhibitor and glucagon-like peptide-1 receptor agonist (GLP-1 RA) users.

Participants: The study included 1,145,035 patients diagnosed with T2D from the NHIRD.

Main outcome measures: Cox proportional hazard models were used to assess the risk of outcomes.

Results: SGLT2i users showed a lower risk of coronary artery disease (0.80 (0.73-0.87), 0.78 (0.72-0.85) and 0.74 (0.64-0.86)), heart failure (0.44 (0.38-0.49), 0.56 (0.50-0.62) and 0.66 (0.55-0.78)), cardiovascular death (0.47 (0.40-0.56), 0.47 (0.40-0.55) and 0.68 (0.53-0.87)), dialysis (0.03 (0.02-0.05), 0.13 (0.10-0.17) and 0.16 (0.11-0.23)), vision-threatening retinopathy (0.58 (0.51-0.67), 0.59 (0.51-0.67) and 0.78 (0.62-0.98)), amputation (0.29 (0.20-0.41), 0.28 (0.21-0.38) and 0.61 (0.46-0.89)) and all-cause mortality (0.42 (0.39-0.445), 0.39 (0.37-0.42) and 0.68 (0.61-0.76]))when compared to DPP-4 inhibitors, sulfonylureas, and GLP-1 RA users, respectively.

Conclusions: This study showed that SGLT2i use was associated with a lower risk of incident cardiovascular diseases, major microvascular complications and mortality compared with the use of DPP-4 inhibitors, sulfonylureas and GLP-1 RA in patients with T2D, who did not have macrovascular and microvascular diseases.

目的：本研究旨在评估无大血管或微血管疾病的2型糖尿病（T2D）患者钠-葡萄糖共转运蛋白-2抑制剂（SGLT2i）和非SGLT2i使用者发生心血管疾病和主要微血管并发症的不同风险。设计：本研究采用回顾性、基于人群的队列研究设计。使用倾向评分匹配鉴定91,327对SGLT2抑制剂和二肽基肽酶-4 （DPP-4）抑制剂使用者，91,673对SGLT2抑制剂和磺脲类使用者，20,857对SGLT2抑制剂和胰高血糖素样肽-1受体激动剂（GLP-1 RA）使用者。主要结局指标：采用Cox比例风险模型评估结局风险。结果:sgltti使用者冠心病(0.80（0.73-0.87）、0.78（0.72-0.85）和0.74（0.64-0.86）、心力衰竭（0.44（0.38-0.49）、0.56（0.50-0.62）和0.66(0.55-0.78)）、心血管死亡（0.47（0.40-0.56）、0.47（0.40-0.55）和0.68(0.53-0.87)）、透析（0.03（0.02-0.05）、0.13（0.10-0.17）和0.16(0.11-0.23)）、视力威胁视网膜病变（0.58（0.51-0.67）、0.59（0.51-0.67）和0.78(0.62-0.98)）、截肢(0.29（0.20-0.41）、与DPP-4抑制剂、磺脲类药物和GLP-1 RA使用者相比，全因死亡率分别为0.28（0.21-0.38）和0.61(0.46-0.89)，分别为0.42（0.39-0.445）、0.39（0.37-0.42）和0.68（0.61-0.76）。结论：本研究表明，在没有大血管和微血管疾病的T2D患者中，与使用DPP-4抑制剂、磺脲类药物和GLP-1 RA相比，使用SGLT2i可降低心血管疾病、主要微血管并发症和死亡率的风险。

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引用次数: 0

The unsolved complexities inherent in informed patient choice. 未解决的复杂性内在的知情患者的选择。

IF 7.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Royal Society of Medicine

Pub Date : 2025-11-01 Epub Date: 2025-12-04 DOI: 10.1177/01410768251406499

Kamran Abbasi

引用次数: 0

Medical decision-making: sometimes variation is appropriate. 医疗决策：有时变化是适当的。

IF 7.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Royal Society of Medicine

Pub Date : 2025-11-01 Epub Date: 2025-07-27 DOI: 10.1177/01410768251363078

John Howat, Sarah Gardiner, Dieneke Hubbeling

引用次数: 0

Promoting informed health choices: the long and winding road. 促进知情健康选择：漫长而曲折的道路。

IF 7.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Royal Society of Medicine

Pub Date : 2025-11-01 Epub Date: 2025-11-04 DOI: 10.1177/01410768251384317

Andrew D Oxman, Iain Chalmers, Paul P Glasziou

引用次数: 0

The 10-year NHS plan needs a workforce equity foundation. 10年NHS计划需要一个劳动力公平的基础。

IF 7.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Royal Society of Medicine

Pub Date : 2025-11-01 Epub Date: 2025-11-25 DOI: 10.1177/01410768251389442

Richard Antony Powell, Vijay Nayar, Mo Al-Haddad, Partha Kar, Ganesh Sathyamoorthy, Mala Rao

引用次数: 0

Forgetting is the clinical skill that separates human doctors from AI. 遗忘是区分人类医生和人工智能的临床技能。

IF 7.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Royal Society of Medicine

Pub Date : 2025-11-01 Epub Date: 2025-12-04 DOI: 10.1177/01410768251394834

Waseem Jerjes, See Chai Carol Chan, Azeem Majeed

引用次数: 0

ReSPECT at the bedside - between design and reality. 尊重在床边-设计和现实之间。

IF 7.1 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the Royal Society of Medicine

Pub Date : 2025-10-01 Epub Date: 2025-07-30 DOI: 10.1177/01410768251362989

Christina Lok Ming Wong, Lucy-Anne Frank

引用次数: 0

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