Clinical Medicine最新文献

Thromboelastography for Rapid Diagnosis of Heparin-Like Anticoagulant Release During Anaphylaxis-Induced Coagulopathy in Systemic Mastocytosis: A Case Report. 血栓弹力图用于快速诊断全身性肥大细胞增多症过敏性休克诱发凝血病期间肝素样抗凝剂的释放：病例报告。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-11-16 DOI: 10.1016/j.clinme.2024.100267

Rajkumar Rajendram, Abdul Hadi Al-Qahtani, Farrukh Sheikh

{"title":"Thromboelastography for Rapid Diagnosis of Heparin-Like Anticoagulant Release During Anaphylaxis-Induced Coagulopathy in Systemic Mastocytosis: A Case Report.","authors":"Rajkumar Rajendram, Abdul Hadi Al-Qahtani, Farrukh Sheikh","doi":"10.1016/j.clinme.2024.100267","DOIUrl":"10.1016/j.clinme.2024.100267","url":null,"abstract":"Anaphylaxis can induce life-threatening coagulopathy by releasing various mediators from activated mast cells. These mediators directly affect coagulation and fibrinolytic pathways increasing the bleeding risk. Diagnosis and management of anaphylaxis-induced coagulopathy remain challenging. We report a unique case of a 44-year-old man with undiagnosed systemic mastocytosis who developed peanut-induced anaphylactic shock, resulting in cardiac arrest. Laboratory tests revealed elevated serum tryptase and severe coagulopathy. Thromboelastography, a point-of-care viscoelastic monitoring (VEM) test rapidly identified the presence of heparin-like anticoagulants within minutes. Bone marrow examination subsequently confirmed isolated mastocytosis. This case highlights the potential of VEM for rapid diagnosis and management of coagulopathy in patients with anaphylaxis, potentially aiding in the identification of mast cell degranulation in undifferentiated shock. We suggest that VEM should be considered in the investigation of patients with suspected anaphylaxis-induced coagulopathy.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100267"},"PeriodicalIF":3.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The feasibility of a novel national Quality Improvement programme for Tobacco Dependency Treatment Pathways in acute UK hospitals. 英国急症医院烟草依赖治疗路径的新型国家质量改进计划的可行性。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-11-12 DOI: 10.1016/j.clinme.2024.100263

Dr Robyn Fletcher, Dr Alexander Hammant, Christina Moll, Miguel Souto, Professor Sanjay Agrawal

{"title":"The feasibility of a novel national Quality Improvement programme for Tobacco Dependency Treatment Pathways in acute UK hospitals.","authors":"Dr Robyn Fletcher, Dr Alexander Hammant, Christina Moll, Miguel Souto, Professor Sanjay Agrawal","doi":"10.1016/j.clinme.2024.100263","DOIUrl":"10.1016/j.clinme.2024.100263","url":null,"abstract":"The prevalence of smoking remains stubbornly high in the UK despite comprehensive tobacco control measures. A national quality improvement (QI) approach to enhance the treatment of an estimated one million annual hospital admissions of tobacco smokers, could provide a new opportunity to improve population health and reduce healthcare demand. Barriers to QI include knowledge, costs and competing demands. This study aimed to evaluate the feasibility and effectiveness of a national QI programme hosted by the British Thoracic Society, focused on improving NHS tobacco dependency treatment in acute hospitals. The programme utilised the Model for Improvement as its QI framework and was delivered over a six month period. 25 teams from across the UK were upskilled through a series of webinars and coaching sessions and undertook QI projects focused on specific areas of their local tobacco dependency treatment pathways. Results of the programme demonstrated improvements across the treatment pathway including screening for smoking status, rapid provision of nicotine replacement therapy to prevent nicotine withdrawal, referrals to inpatient tobacco dependency treatment teams and transfers of care to community services. Other programme outcomes included increases in QI knowledge, confidence, and attitudes along with enhanced project management skills. This novel, national, online QI programme supported participating multidisciplinary teams in acute trusts across the UK to deliver tobacco dependency treatment pathway improvements using QI tools and methodology. This programme demonstrated the feasibility and effectiveness of delivering a national QI programme, at low cost using a microsystems approach applied to an important area of clinical medicine.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100263"},"PeriodicalIF":3.6,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

KEY CONCEPTS IN DIAGNOSING INFECTION- WHEN TO TREAT AND WHEN NOT TO. 诊断感染的关键概念--何时治疗，何时不治疗。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-11-09 DOI: 10.1016/j.clinme.2024.100264

Dr Emma Hayton, Dr Nimal Wickramasinghe

引用次数: 0

Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Syndrome in Patients with Cancer: A Multicenter Study. 癌症患者的糖尿病酮症酸中毒和高血糖高渗综合征：一项多中心研究。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-11-08 DOI: 10.1016/j.clinme.2024.100262

Rabia K Shahid, Qasem Haider, Sunil Yadav, Duc Le, Shahid Ahmed

{"title":"Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Syndrome in Patients with Cancer: A Multicenter Study.","authors":"Rabia K Shahid, Qasem Haider, Sunil Yadav, Duc Le, Shahid Ahmed","doi":"10.1016/j.clinme.2024.100262","DOIUrl":"https://doi.org/10.1016/j.clinme.2024.100262","url":null,"abstract":"Background: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS) are life-threatening complications of diabetes mellitus. However, limited data about DKA and HHS is available in patients with cancer. The current study aimed to determine characteristics and outcomes of patients with cancer who were admitted with DKA/HHS in a mid-size Canadian city.Methods: Consecutive adult patients with an active cancer who were admitted with DKA or HHS from January 2008 to December 2020 in the city of Saskatoon, Saskatchewan, Canada were retrospectively evaluated. A univariate logistic regression analysis was performed to examine the correlation of various clinical variables with hospital mortality.Results: During the study period 6,555 patients with diabetes and cancer were admitted in one of the three tertiary care hospitals. Among them 33 (0.5%) eligible patients with DKA or HHS with a median age of 60 years (range 36-94 years) were identified. In 36% of patients, DKA or HHS was the presenting manifestation of newly diagnosed diabetes. Of all patients, 66% developed DKA and 73% had an advanced cancer. Overall, 52% patients received a systemic cancer therapy prior to the admission, and 41% received steroids. Ten (42%) of 24 patients with an advanced cancer died compared to none of the 9 patients with an early-stage cancer (p=0.032). No clinical factors significantly correlated with hospital mortality.Conclusions: Although DKA or HHS is uncommon in patients with diabetes and cancer, it is the manifestation of undiagnosed diabetes in about one-third of patients with cancer. It has been associated with a high hospital mortality rate in patients with advanced cancer.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100262"},"PeriodicalIF":3.6,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Staphylococcus aureus bacteraemia for the general physician: A narrative review of a metastatic infection with malignant complications. 全科医生的金黄色葡萄球菌菌血症：对伴有恶性并发症的转移性感染的叙述性回顾。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-11-07 DOI: 10.1016/j.clinme.2024.100265

Ronak J Shah, Ioannis Baltas

引用次数: 0

Prescribing for change - safer antimicrobial use in hospitals. 以处方促变革--在医院中更安全地使用抗菌药物。

IF 4.3 4区医学

Clinical Medicine Pub Date : 2024-10-29 DOI: 10.1016/j.clinme.2024.100261

Sean O'Gorman, Arthur Jackson, Karen Fitzmaurice

引用次数: 0

Hospital at home - developing a simulation induction programme for junior doctors. 家庭医院--为初级医生制定新颖的模拟上岗培训计划。

IF 4.3 4区医学

Clinical Medicine Pub Date : 2024-10-28 DOI: 10.1016/j.clinme.2024.100259

Gareth Watson, Amelia Paveley, Katherine Chin, Alexandra Lindsay-Perez, Rebekah Schiff

{"title":"Hospital at home - developing a simulation induction programme for junior doctors.","authors":"Gareth Watson, Amelia Paveley, Katherine Chin, Alexandra Lindsay-Perez, Rebekah Schiff","doi":"10.1016/j.clinme.2024.100259","DOIUrl":"10.1016/j.clinme.2024.100259","url":null,"abstract":"Hospital at Home (HaH) provides hospital-level care within patients' homes. With services expanding, a London HaH service embedded new junior doctor posts. Currently, gaps exist in the under- and postgraduate curriculum to develop clinical skills required to deliver care in this context. HaH simulation (HaH-SIM) was developed, through a multi-cycle QIP, to improve early-career doctors' confidence in providing care in this unfamiliar environment. Surveys before and after HaH-SIM assessed confidence in practical, clinical and communication skills; ranked concerns; rated sessions and gained qualitative feedback. 41 doctors participated over 2 years. It currently includes six low-fidelity stations and three high-fidelity stations. Confidence improved, particularly in managing end of life, decision-making around hospital admission and administering intravenous medications/fluids. High-fidelity scenarios, practical skills and prescribing stations were most highly rated. As HaH services expand, HaH-SIM is a feasible, effective and transferable way of improving early-career doctors' confidence and skills to provide care in patients' homes.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100259"},"PeriodicalIF":4.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

It all started with a sore throat: Polymicrobial septicaemia, cavitating lung lesions and severe thrombocytopenia. 一切始于喉咙痛：多菌性败血症、肺部空洞病变和严重血小板减少。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-10-26 DOI: 10.1016/j.clinme.2024.100260

Edmund Hugh Larkin, Ana Garcia-Mingo, Roopal Patel, Andrew Badacsonyi

引用次数: 0

Malaria: Past, present and future. 疟疾：过去、现在和未来。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-10-25 DOI: 10.1016/j.clinme.2024.100258

Jo Salkeld, Andrew Duncan, Angela M Minassian

引用次数: 0

Implementation of ultrasound-guided cannulation training for foundation doctors. 为基础医生实施超声引导插管培训。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-10-22 DOI: 10.1016/j.clinme.2024.100256

Mia Pham, Robert Aldous, Stephan Brincat

引用次数: 0