Future healthcare journal最新文献

Recent laboratory advances have allowed re-conceptualising fibromyalgia syndrome, a common, severe chronic widespread pain condition, as an immune-mediated disease. This article summarises key findings and their implications for preventative strategies and future healthcare advances and their costs.

Diagnostic labels in functional disorders are explored with particular reference to functional neurological disorder (FND). Use of the term 'functional' is discussed, and is compared with alternative terminology. Relevant considerations including avoidance of inaccurate nomenclature and dualist labels, and the impact of diagnostic label choice on individual patient experience and broader service provision are considered.

This short paper illustrates the lived experience of individuals with severe enduring symptoms: chronic, often debilitating conditions for which no clear medical explanation currently exists. Drawing on qualitative interviews, the paper highlights the profound suffering, isolation, and lack of medical support experienced by this underserved population. It examines the systemic barriers to care, including stigma, the absence of follow-up services, and the traumatising nature of some healthcare encounters, which can lead to healthcare avoidance even in the face of potentially life-threatening symptoms. It concludes with a call for improved training for clinicians, increased capacity within NHS services, and ring-fenced funding for biomedical research.

Persistent physical symptoms (PPS) account for around 45% of all primary care consultations, and are associated with significant disability and costs. While not always the case, co-existent mental health difficulties can often present alongside PPS. Individuals suffering from PPS may present with psychological symptoms such as rumination and catastrophising, as well as early adverse childhood events. Research has shown that adequately understanding and managing psychological factors associated with PPS can prevent symptoms from being more chronic and disabling. Adequate education therefore is vital for medical students and doctors, particularly GPs, such that they are able to manage PPS in a professional, knowledgeable and patient-centred manner. At present there exist several barriers to such education - including curriculum overload and a lack of alignment with the current structure of medical school, whereby physical and mental health are often taught in separate blocks. We suggest several ways in which barriers can be broken, such that GPs feel more empowered to manage patients with PPS. These include a greater emphasis on the psychological dimensions of illness from an early stage in medical school, an improved framework for taking a history from patients with PPS, more exposure to case studies and real-life patient experiences of PPS, narrowing the gap between theoretical teaching and the realities of the workplace, including importantly highlighting multidisciplinary working and improved education around communicating effectively with patients with PPS. We hope that by breaking these barriers, doctors can feel more able to enquire about, understand and manage PPS, ultimately leading to better outcomes for patients.

Rheumatology has undergone unprecedented transformation over the past quarter century, evolving from broad-spectrum immunosuppression to precision therapeutics targeting specific immune pathways. As the clinical, biological and economic landscape continues to evolve, understanding emerging trends is crucial for shaping the future of the specialty. In this narrative review, we will examine contemporary themes that will define rheumatology by 2050, spanning key areas of rheumatological practice, including precision medicine, genomic discoveries, disease prevention, cellular therapies and healthcare economics. Multiple transformative trends are currently reshaping rheumatology. Precision medicine is advancing beyond single-pathway targeting towards molecular stratification integrating serology, genomics and synovial pathotyping. Whole-exome sequencing has revealed new disease entities such as vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome, while disease interception strategies show promise for preventing established autoimmunity, with trials demonstrating potential relative risk reduction in rheumatoid arthritis development using abatacept in at-risk individuals. Chimeric antigen receptor T-cell therapy has achieved complete clinical remission in severe systemic lupus erythematosus, while immune checkpoint inhibitor-induced rheumatic diseases present new diagnostic challenges. Environmental pressures, including air pollution and occupational exposures, are increasingly recognised as disease drivers. In the UK, national audit data show disparities in access to advanced therapies even within a universal healthcare system. Artificial intelligence integration promises enhanced diagnostics and monitoring, while economic pressures necessitate innovative funding models, with biosimilars demonstrating potential for expanding treatment access. By 2050, rheumatology will be characterised by molecularly stratified diseases, more affordable and accessible targeted therapies, curative cellular interventions and digital clinical ecosystems. Success will depend not only on technological advances but on ensuring equitable access, affordability, and preservation of patient-centred care.

The acute medical unit (AMU) is a specialist area, focused on delivering timely, effective acute care for adults with acute medical illness. AMUs were first established to provide timely physician review, risk stratification and multidisciplinary management in the first 72 h. They are designed to improve patient care, prevent unnecessary admissions and reduce morbidity and mortality. However, national benchmarking and local audit data showed that core acute medicine processes at Frimley Park Hospital's AMU had drifted from these standards. A structured quality improvement programme was therefore implemented to restore AMU function and align operational processes and workforce to national guidance and national Getting it Right First Time (GIRFT) principles. Real-time oversight, standardised multidisciplinary team board rounds and rota alignment to peak demand, halved AMU length of stay, doubled daily discharges and increased emergency department-to-AMU transfers. These improvements were associated with enhanced hospital-wide throughput and more effective early acute care.