JRSM Open最新文献

Objectives: Evaluating the outcomes of enhanced case management (ECM) for patients with tuberculosis (TB) in the North Central London TB Service (NCLTBS).

Design: Retrospective cohort study.

Setting: The NCLTBS provides care for persons diagnosed with TB across north and central London. Management involves both medical and psychosocial support, leading to the implementation ECM to provide additional non-clinical assistance to patients at risk of treatment non-completion. However, there has been limited evaluation of its outcomes.

Participants: All adults with TB notified to NCLTBS between January 2013 and June 2021.

Main outcome measures: Descriptive socio-economic and clinical characteristics grouped by binary ECM status (yes/no) and level (0-3). Clinical outcomes at 12 months (completed treatment, death, lost-to-follow-up, continuing on treatment) were compared using multivariable logistic regression.

Results: Totally, 2437 patients were included (57.2% male, 79.1% born outside the UK). Overall, 82.3% completed treatment and 4.1% died. Factors associated with mortality included older age (over 70 years odds ratio (OR) 3.3), inpatient diagnosis (OR 4.4), and mental health issues (OR 2.2). 52.8% received ECM, with the proportion increasing over time, and 76% of this group successfully competed treatment.

Conclusions: This comprehensive evaluation of ECM in a diverse London population indicates high treatment completion rates even among those with multiple social risk factors. However, ECM needs of patients has increased over time, with a particular rise in patients requiring the highest support level. Given the small difference between standard care and ECM categories 1 and 2, there may be scope to simplify the system.

Objectives: To assess how ethnicity, migration status and occupation are associated with healthcare workers (HCW) redeployment experiences during COVID-19 in a nationwide ethnically diverse sample.

Design: A cross-sectional analysis using data from the nationwide United Kingdom Research Study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) cohort study.

Setting: Healthcare settings.

Participants: Healthcare workers (HCW).

Main outcome measures: Outcome measures included redeployment, provision of training and supervision during redeployment, change in patient contact and interaction with COVID-19 patients.

Methods: We used logistic regression to examine associations of ethnicity, migration status, and occupation with redeployment experiences of HCWs.

Results: Of the 10,889 HCWs included, 20.4% reported being redeployed during the first UK national lockdown in March 2020. Those in nursing roles (Odds Ratio (OR) 1.22, 95% Confidence Interval (CI) 1.04-1.42, p = 0.009) (compared to medical roles) had higher likelihood of being redeployed as did migrants compared to those born in the UK (OR 1.26, 95% CI 1.06-1.49, p = 0.01) (in a subcohort of HCWs on the agenda for change (AfC) pay scales). Asian HCWs were less likely to report receiving training (OR 0.66, 95% CI 0.50-0.88, p = 0.005) and Black HCWs (OR 2.02, 95% CI 1.14-3.57, p = 0.02) were more likely to report receiving supervision, compared to White colleagues. Finally, redeployed Black (OR 1.33, 95% CI 1.07-1.66, p = 0.009) and Asian HCWs (OR 1.30, 95% CI 1.14-1.48, p < 0.001) were more likely to report face-to-face interaction with COVID-19 patients than White HCWs.

Conclusions: Our findings highlight disparities in HCWs' redeployment experiences by ethnicity, migration, and job role which are potentially related to structural inequalities in healthcare.

Post-stroke spasticity and contracture remain prevalent and pose significant challenges in stroke rehabilitation. While non-surgical management is the mainstay, surgical reconstruction offers a valuable adjunct when conservative measures are exhausted. This clinical review article provides an overview of surgical reconstruction for limb spasticity and contracture following adult stroke, encompassing the rationale and specifics of these interventions. It highlights the underutilization of surgical reconstruction in rehabilitation of adult stroke patients with spasticity and contracture, and the importance of multidisciplinary collaboration including surgeons in stroke rehabilitation to optimize functional outcomes.

Objectives: To investigate long COVID (LC) symptoms self-reported via a digital application. Explore associations between various demographic factors and intensity of LC symptoms.

Design: A retrospective case series study. We analysed self-reported symptoms from 1008 individuals with LC between November 30, 2020, and March 23, 2022.

Setting: England and Wales.

Participants: Individuals with LC using the healthcare application in 31 post-COVID-19 clinics and self-reporting LC symptoms.

Main outcome measures: Highest reported LC symptoms, associations with demographic factors and intensity of symptoms.

Results: 109 symptom categories were identified, with pain (26.5%), neuropsychological issues (18.4%), fatigue (14.3%) and dyspnoea (7.4%) the most prevalent. The intensity of reported symptoms increased by 3.3% per month since registration. Age groups 68-77 and 78-87 experienced higher symptom intensity (32.8% and 86% higher, respectively) compared to the 18-27 age group. Women reported 9.2% more intense symptoms than men, and non-white individuals with LC reported 23.5% more intense symptoms than white individuals with LC. Higher education levels (national vocational qualification (NVQ) 3 to NVQ 5) were associated with less symptom intensity (27.7%, 62.8% and 44.7% less, respectively) compared to the least educated (NVQ 1-2). People in less deprived areas had less intense symptoms than those in the most deprived area. No significant association was found between index of multiple deprivation (IMD) decile and number of symptoms.

Conclusion: Treatment plans must prioritise addressing prevalent LC symptoms; we recommend sustained support for LC clinics. Demographic factors significantly influence symptom severity, underlining the need for targeted interventions. These findings can inform healthcare policies to better manage LC.

Racial microaggressions are subtle and everyday actions that communicate derogatory messages or assumptions based on an individual's race. These seemingly minor acts, often unintended, can accumulate to undermine patient well-being and contribute to healthcare disparities. They are the unnoticed comments, gestures, or attitudes that carry significant impact. Through a systematic analysis of the literature, we highlight the insidious nature of racial microaggressions and their impact on healthcare outcomes. The objectives of this paper are to: • Present real-life instances from research to showcase the tangible effects of racial microaggressions. • Identify the everyday scenarios within healthcare interactions where racial microaggressions often occur. • Emphasise the need for recognition and understanding of these biases for fostering better patient-provider relationships. Also, by analysing the fundamental elements underpinning racial microaggressions such as systems, interactions, vulnerabilities and consequences, we explore the implications it has on healthcare policy and management. Most importantly, we address the importance of identifying and tackling racial microaggressions in order to create a more inclusive healthcare environment.

[This retracts the article DOI: 10.1177/20542704231182057.].

[This retracts the article DOI: 10.1177/20542704231153529.].

[This retracts the article DOI: 10.1177/20542704221086166.].

[This corrects the article DOI: 10.1177/20542704221124013.].

[This corrects the article DOI: 10.1177/20542704231188569.].