{"title":"Target to fix unsafe NHS hospitals slips but overall programme is on firmer footing, report finds.","authors":"Adrian O'Dowd","doi":"10.1136/bmj.s108","DOIUrl":"https://doi.org/10.1136/bmj.s108","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"58 1","pages":"s108"},"PeriodicalIF":0.0,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"PLAB exams: International medical graduates face exploitation and unemployment.","authors":"Gaurav Gupta","doi":"10.1136/bmj.s72","DOIUrl":"https://doi.org/10.1136/bmj.s72","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"56 1","pages":"s72"},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pulse oximetry in people with darker skin tones.","authors":"Thomas S Valley,Andrew W Fogarty","doi":"10.1136/bmj.s37","DOIUrl":"https://doi.org/10.1136/bmj.s37","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"41 1","pages":"s37"},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel S Martin,James C Doidge,Doug Gould,Tasnin Shahid,Alex Cowden,Walton N Charles,Amelia Francis Johnson,Roger Garrett,Catherine Mbema,Olusegun Olusanya,Eugene Healy,Kathryn Rowan,Paul Mouncey,David A Harrison,
OBJECTIVESTo assess the impact of skin tone on the measurement and diagnostic accuracy of five fingertip pulse oximeters used by patients in the NHS (National Health Service) England COVID Oximetry @home scheme.DESIGNMeasurement and diagnostic accuracy study (exploring pulse oximeter accuracy across skin tones-EXAKT).SETTINGTwenty four intensive care units in England between June 2022 and August 2024.PARTICIPANTS903 critically ill adults admitted to intensive care units screened for or enrolled into a trial evaluating different approaches to oxygen therapy.INTERVENTIONSPulse oximetry derived peripheral oxygen saturation (SpO2) measurements were compared with paired arterial oxygen saturation (SaO2) measurements from arterial blood analysed by co-oximetry (gold standard). Skin tone (individual typology angle) was objectively measured using a handheld spectrophotometer.MAIN OUTCOME MEASURESPulse oximeter measurement accuracy was assessed for bias, precision, and overall accuracy. Diagnostic accuracy for identifying SaO2 ≤92% was assessed by false negative and false positive rates for SpO2 using thresholds of ≤92% and ≤94%, and the area under the receiver operating characteristic curve, and by the presence of occult hypoxaemia (SaO2 <88% with SpO2 >92%).RESULTS11 018 paired SpO2-SaO2 measurements were analysed. All tested pulse oximeters overestimated at lower values and underestimated at higher values of SaO2. On average, SpO2 readings were 0.6-1.5 percentage points higher for patients with darker skin tone (individual typology angle -44°) than for those with lighter skin tone (46°). At both SpO2 thresholds assessed, false negative rates increased with darker skin tones; the proportion of SpO2 measurements >94% despite a paired SaO2 ≤92% ranged from 5.3 to 35.3 percentage points higher for patients with darker skin tones than for those with lighter skin tones (7.6-62.2% v 1.2-26.9%, rate ratio 2.3-7.1). By contrast, false positive rates decreased with darker skin tones.CONCLUSIONSFive pulse oximeters provided by the NHS England COVID Oximetry @home scheme yielded higher SpO2 measurements for patients with darker skin tones compared with those with lighter skin tones, which could translate into potentially clinically important differences in false negative and false positive rates for detecting hypoxaemia.TRIAL REGISTRATIONClinicalTrials.gov NCT05481515.
目的评估肤色对英国国民健康服务体系（NHS）患者使用的五种指尖脉搏血氧仪测量和诊断准确性的影响。设计测量和诊断准确性研究（探索跨肤色脉搏血氧仪准确性- exakt）。在2022年6月至2024年8月期间，英格兰有24个重症监护病房。903名重症监护病房的危重成人患者接受了筛查或参加了一项评估不同氧疗方法的试验。干预措施：将脉搏血氧仪衍生的外周血氧饱和度（SpO2）测量值与共氧仪（金标准）分析的动脉血氧饱和度（SaO2）测量值进行比较。用手持式分光光度计客观测量肤色（个体类型角）。主要观察指标：对血氧仪测量的准确度进行偏倚、精密度和总体准确度评估。通过SpO2假阴性和假阳性率（阈值分别为≤92%和≤94%）、受试者工作特征曲线下面积以及是否存在隐匿性低氧血症（SaO2 92%）来评估SaO2≤92%的诊断准确性。结果分析了11018对SpO2-SaO2测定结果。所有测试的脉搏血氧计在SaO2值较低时高估，在SaO2值较高时低估。平均而言，肤色较深的患者（个体类型角度为-44°）的SpO2读数比肤色较浅的患者（46°）高0.6-1.5个百分点。在两个SpO2阈值评估中，肤色越深，假阴性率越高；尽管配对的SaO2≤92%，但肤色较深的患者SpO2测量比例为bb0 94%，比肤色较浅的患者高5.3至35.3个百分点（7.6-62.2% v 1.2-26.9%，比率比2.3-7.1）。相比之下，肤色越深，假阳性率越低。结论NHS England COVID血氧计@home方案提供的5台脉搏血氧计，与肤色较浅的患者相比，肤色较深的患者的SpO2测量值更高，这可能转化为检测低氧血症的假阴性和假阳性率的潜在临床重要差异。临床试验注册网站NCT05481515。
{"title":"The impact of skin tone on performance of pulse oximeters used by NHS England COVID Oximetry @home scheme: measurement and diagnostic accuracy study.","authors":"Daniel S Martin,James C Doidge,Doug Gould,Tasnin Shahid,Alex Cowden,Walton N Charles,Amelia Francis Johnson,Roger Garrett,Catherine Mbema,Olusegun Olusanya,Eugene Healy,Kathryn Rowan,Paul Mouncey,David A Harrison, ","doi":"10.1136/bmj-2025-085535","DOIUrl":"https://doi.org/10.1136/bmj-2025-085535","url":null,"abstract":"OBJECTIVESTo assess the impact of skin tone on the measurement and diagnostic accuracy of five fingertip pulse oximeters used by patients in the NHS (National Health Service) England COVID Oximetry @home scheme.DESIGNMeasurement and diagnostic accuracy study (exploring pulse oximeter accuracy across skin tones-EXAKT).SETTINGTwenty four intensive care units in England between June 2022 and August 2024.PARTICIPANTS903 critically ill adults admitted to intensive care units screened for or enrolled into a trial evaluating different approaches to oxygen therapy.INTERVENTIONSPulse oximetry derived peripheral oxygen saturation (SpO2) measurements were compared with paired arterial oxygen saturation (SaO2) measurements from arterial blood analysed by co-oximetry (gold standard). Skin tone (individual typology angle) was objectively measured using a handheld spectrophotometer.MAIN OUTCOME MEASURESPulse oximeter measurement accuracy was assessed for bias, precision, and overall accuracy. Diagnostic accuracy for identifying SaO2 ≤92% was assessed by false negative and false positive rates for SpO2 using thresholds of ≤92% and ≤94%, and the area under the receiver operating characteristic curve, and by the presence of occult hypoxaemia (SaO2 <88% with SpO2 >92%).RESULTS11 018 paired SpO2-SaO2 measurements were analysed. All tested pulse oximeters overestimated at lower values and underestimated at higher values of SaO2. On average, SpO2 readings were 0.6-1.5 percentage points higher for patients with darker skin tone (individual typology angle -44°) than for those with lighter skin tone (46°). At both SpO2 thresholds assessed, false negative rates increased with darker skin tones; the proportion of SpO2 measurements >94% despite a paired SaO2 ≤92% ranged from 5.3 to 35.3 percentage points higher for patients with darker skin tones than for those with lighter skin tones (7.6-62.2% v 1.2-26.9%, rate ratio 2.3-7.1). By contrast, false positive rates decreased with darker skin tones.CONCLUSIONSFive pulse oximeters provided by the NHS England COVID Oximetry @home scheme yielded higher SpO2 measurements for patients with darker skin tones compared with those with lighter skin tones, which could translate into potentially clinically important differences in false negative and false positive rates for detecting hypoxaemia.TRIAL REGISTRATIONClinicalTrials.gov NCT05481515.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"390 1","pages":"e085535"},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Concept of de-diagnosing autism and ADHD raises pressing questions.","authors":"Nour Al Tarsha","doi":"10.1136/bmj.s51","DOIUrl":"https://doi.org/10.1136/bmj.s51","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"9 1","pages":"s51"},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Medical training posts bill: UK graduates will be prioritised, but critics flag lack of clarity on IMGs.","authors":"Gareth Iacobucci","doi":"10.1136/bmj.s78","DOIUrl":"https://doi.org/10.1136/bmj.s78","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"56 1","pages":"s78"},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tero Kortekangas,Ristomatti Lehtola,Hannu-Ville Leskelä,Simo Taimela,Pasi Ohtonen,Olli Savola,Teppo L N Järvinen,Harri Pakarinen
OBJECTIVETo compare cast immobilisation with surgery using open reduction and internal plate fixation for unimalleolar Weber B ankle fractures with a congruent mortise on initial radiography but deemed unstable by external rotation stress testing.DESIGNRandomised, pragmatic, non-inferiority, clinical trial.SETTINGOne specialist university hospital trauma centre in Finland, 16 January 2013 to 7 July 2021.PARTICIPANTS840 skeletally mature patients (age ≥16 years) with an isolated Weber B fibula fracture on static radiographs. Fracture instability was assessed by standard external rotation stress test under fluoroscopy. 714 participants were excluded (569 with stable fracture, mortise incongruency, or fracture dislocation) and the remaining 126 patients with a congruent but unstable ankle mortise were randomised.INTERVENTIONSParticipants were randomly allocated to receive either conventional cast immobilisation for six weeks (n=62) or surgical treatment with open reduction and internal plate fixation followed by cast immobilisation for six weeks (n=64).MAIN OUTCOME MEASURESThe primary, non-inferiority outcome was the Olerud-Molander Ankle Score (OMAS; range 0-100 points; higher scores indicating better outcomes and fewer symptoms) at two years. The predefined non-inferiority margin for the primary outcome was set at -8 points. Secondary outcomes were ankle function, pain, health related quality of life, ankle range of motion, and radiographic outcome. Treatment related adverse events were also recorded.RESULTS121 out of 126 randomised participants (96%) completed the study. In the primary intention-to-treat analysis of 121 participants completing two year follow-up, the mean OMAS was 89 in the cast immobilisation group and 87 in the surgery group (between group mean difference 1.3 points, 95% confidence interval -4.8 to 7.3). No statistically significant between group differences were observed in any secondary outcomes. One participant in each group had radiographic evidence of non-union. In the surgery group, one participant had a superficial wound infection, one had delayed wound healing, and nine underwent procedures to remove hardware, two of whom developed postoperative infections (one deep and one superficial).CONCLUSIONSCast immobilisation proved non-inferior to surgery for the treatment of unimalleolar Weber B ankle fractures with a congruent mortise on initial radiography but deemed unstable by external rotation stress testing. Overall, fewer treatment related harms occurred with cast immobilisation compared with surgery.TRIAL REGISTRATIONClinicalTrials.gov NCT01758796.
{"title":"Cast immobilisation versus surgery for unstable lateral malleolus fractures (SUPER-FIN): randomised non-inferiority clinical trial.","authors":"Tero Kortekangas,Ristomatti Lehtola,Hannu-Ville Leskelä,Simo Taimela,Pasi Ohtonen,Olli Savola,Teppo L N Järvinen,Harri Pakarinen","doi":"10.1136/bmj-2025-085295","DOIUrl":"https://doi.org/10.1136/bmj-2025-085295","url":null,"abstract":"OBJECTIVETo compare cast immobilisation with surgery using open reduction and internal plate fixation for unimalleolar Weber B ankle fractures with a congruent mortise on initial radiography but deemed unstable by external rotation stress testing.DESIGNRandomised, pragmatic, non-inferiority, clinical trial.SETTINGOne specialist university hospital trauma centre in Finland, 16 January 2013 to 7 July 2021.PARTICIPANTS840 skeletally mature patients (age ≥16 years) with an isolated Weber B fibula fracture on static radiographs. Fracture instability was assessed by standard external rotation stress test under fluoroscopy. 714 participants were excluded (569 with stable fracture, mortise incongruency, or fracture dislocation) and the remaining 126 patients with a congruent but unstable ankle mortise were randomised.INTERVENTIONSParticipants were randomly allocated to receive either conventional cast immobilisation for six weeks (n=62) or surgical treatment with open reduction and internal plate fixation followed by cast immobilisation for six weeks (n=64).MAIN OUTCOME MEASURESThe primary, non-inferiority outcome was the Olerud-Molander Ankle Score (OMAS; range 0-100 points; higher scores indicating better outcomes and fewer symptoms) at two years. The predefined non-inferiority margin for the primary outcome was set at -8 points. Secondary outcomes were ankle function, pain, health related quality of life, ankle range of motion, and radiographic outcome. Treatment related adverse events were also recorded.RESULTS121 out of 126 randomised participants (96%) completed the study. In the primary intention-to-treat analysis of 121 participants completing two year follow-up, the mean OMAS was 89 in the cast immobilisation group and 87 in the surgery group (between group mean difference 1.3 points, 95% confidence interval -4.8 to 7.3). No statistically significant between group differences were observed in any secondary outcomes. One participant in each group had radiographic evidence of non-union. In the surgery group, one participant had a superficial wound infection, one had delayed wound healing, and nine underwent procedures to remove hardware, two of whom developed postoperative infections (one deep and one superficial).CONCLUSIONSCast immobilisation proved non-inferior to surgery for the treatment of unimalleolar Weber B ankle fractures with a congruent mortise on initial radiography but deemed unstable by external rotation stress testing. Overall, fewer treatment related harms occurred with cast immobilisation compared with surgery.TRIAL REGISTRATIONClinicalTrials.gov NCT01758796.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"3 1","pages":"e085295"},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carol Sinnott,Akbar Ansari,Evleen Price,Katy Horder,Ahmed Alboksmaty,Janet Willars,Jake Beech,Hugh Alderwick,Mary Dixon-Woods
OBJECTIVETo report experiences and views of patients, carers, and staff on access to general practice in England in the context of major government plans to reform NHS services.DESIGNQualitative interview study.SETTINGPatients and carers in Devon, Medway, Blackpool, Luton, and Lancashire, and NHS general practices in the east of England.PARTICIPANTS70 interviews with 41 patients and carers and 29 general practice staff, including general practitioners (GPs), nurses and allied health professionals, practice managers, and administrators. Analysis was based on the constant comparative method, with themes mapped to the three shifts-to digital, to community, and to prevention-proposed in the 10 year plan for England.RESULTSPatient participants represented 12 ethnic groups and diverse personal and medical characteristics. The three shifts offered some benefits to participants but also introduced new risks and disadvantages. The shift to greater digitisation in general practice (mainly in the form of online appointment booking systems and access to medical information) offered more convenience for some patients and improved efficiencies. The shift did little to resolve the fundamental scarcity of appointments with a GP, however, and it introduced new forms of disadvantage and exclusion while failing to address what patients were often seeking: human connection and empathy with a GP they knew. The shift from hospital to community based services, with GPs working over greater geographical scale in new neighbourhood based models, was perceived by participants to offer greater capacity for appointments but faced constraints including practical challenges to coordination and organisation. New services encompassing larger areas risked patients feeling unrecognised and unknown at their practice and undermining the long term relationships with GPs that patients valued. Prevention efforts, while accepted as important, were seen as challenged by their tendency to fragment care, oversimplified models focused on single diseases, and consuming capacity that could otherwise be used for contacts initiated by patients. Concern about increased workload for staff at general practices was consistently expressed.CONCLUSIONSAlthough improving access to general practice is a stated priority in government plans to reform NHS services, the three proposed shifts may not be what patients are seeking or what practices want in order to support their work. The proposals will require careful design, implementation, and evaluation in collaboration with key stakeholders, to ensure they do not undermine continuity of care nor fragment existing services.
{"title":"Experiences of access to general practice in England: qualitative study and implications for the NHS 10 year plan.","authors":"Carol Sinnott,Akbar Ansari,Evleen Price,Katy Horder,Ahmed Alboksmaty,Janet Willars,Jake Beech,Hugh Alderwick,Mary Dixon-Woods","doi":"10.1136/bmj-2025-087367","DOIUrl":"https://doi.org/10.1136/bmj-2025-087367","url":null,"abstract":"OBJECTIVETo report experiences and views of patients, carers, and staff on access to general practice in England in the context of major government plans to reform NHS services.DESIGNQualitative interview study.SETTINGPatients and carers in Devon, Medway, Blackpool, Luton, and Lancashire, and NHS general practices in the east of England.PARTICIPANTS70 interviews with 41 patients and carers and 29 general practice staff, including general practitioners (GPs), nurses and allied health professionals, practice managers, and administrators. Analysis was based on the constant comparative method, with themes mapped to the three shifts-to digital, to community, and to prevention-proposed in the 10 year plan for England.RESULTSPatient participants represented 12 ethnic groups and diverse personal and medical characteristics. The three shifts offered some benefits to participants but also introduced new risks and disadvantages. The shift to greater digitisation in general practice (mainly in the form of online appointment booking systems and access to medical information) offered more convenience for some patients and improved efficiencies. The shift did little to resolve the fundamental scarcity of appointments with a GP, however, and it introduced new forms of disadvantage and exclusion while failing to address what patients were often seeking: human connection and empathy with a GP they knew. The shift from hospital to community based services, with GPs working over greater geographical scale in new neighbourhood based models, was perceived by participants to offer greater capacity for appointments but faced constraints including practical challenges to coordination and organisation. New services encompassing larger areas risked patients feeling unrecognised and unknown at their practice and undermining the long term relationships with GPs that patients valued. Prevention efforts, while accepted as important, were seen as challenged by their tendency to fragment care, oversimplified models focused on single diseases, and consuming capacity that could otherwise be used for contacts initiated by patients. Concern about increased workload for staff at general practices was consistently expressed.CONCLUSIONSAlthough improving access to general practice is a stated priority in government plans to reform NHS services, the three proposed shifts may not be what patients are seeking or what practices want in order to support their work. The proposals will require careful design, implementation, and evaluation in collaboration with key stakeholders, to ensure they do not undermine continuity of care nor fragment existing services.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"39 1","pages":"e087367"},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The health impacts of being held hostage, even after being freed.","authors":"Rebecca L Root","doi":"10.1136/bmj.s35","DOIUrl":"https://doi.org/10.1136/bmj.s35","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"84 1","pages":"s35"},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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