Clinical MedicinePub Date : 2026-10-18DOI: 10.1016/j.clinme.2026.100658
Sam Houston, Devon Ward
{"title":"Letter to the Editor: 'Don't work more than 3 days straight': Working conditions as learning conditions in general practice.","authors":"Sam Houston, Devon Ward","doi":"10.1016/j.clinme.2026.100658","DOIUrl":"https://doi.org/10.1016/j.clinme.2026.100658","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100658"},"PeriodicalIF":3.9,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219827","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}
Clinical MedicinePub Date : 2026-10-18DOI: 10.1016/j.clinme.2026.100657
Ranya V Kumar, Caleb Cole, Jacob Vincent, Prakrit R Kumar, Nicholas R Evans
{"title":"Investigating Barriers to Clinical Academic Careers Amongst Undergraduate Medical Students.","authors":"Ranya V Kumar, Caleb Cole, Jacob Vincent, Prakrit R Kumar, Nicholas R Evans","doi":"10.1016/j.clinme.2026.100657","DOIUrl":"https://doi.org/10.1016/j.clinme.2026.100657","url":null,"abstract":"<p><strong>Introduction: </strong>There is a critical shortage of academic clinicians in the UK, particularly amongst minority ethnic groups. This study aimed to identify students' perceived barriers to engagement in research, and evaluate whether demographic characteristics influenced these perceptions, in order to identify opportunities to improve training and promote clinical academic careers.</p><p><strong>Methods: </strong>A 59-item structured survey was distributed between November 2023-January 2024 to medical students at the University of Cambridge. It incorporated 45 questions using a five-point Likert scale to measure knowledge of research types, confidence with research skills, and understanding of academic careers, producing a total (global) score of 45-225.</p><p><strong>Results: </strong>One hundred and twenty-six students responded. One in four students reported a poor understanding of the clinical academic career pathway. Few students felt confident performing core research steps, such as designing a study (n=23, 18.3%), analysing data (n=27, 21.4%), and writing it as a full research manuscript (n=16, 12.7%). On multivariable analysis, Caucasian ethnicity and year of study were independently associated with increased global scores (betas of 26.4 and 12.5 respectively, both p<0.05), but not sex (beta -0.92, p=0.88). Consequently, students from non-Caucasian backgrounds reported 11.8% less confidence in their understanding of research and clinical academic careers.</p><p><strong>Conclusion: </strong>Students perceive that insufficient understanding, skills and opportunities inhibit their engagement in research. These feelings are heightened in those at early stages of their training and those of non-Caucasian ethnicity. Thus, there is a need for dedicated training delivered early in medical training to increase representation and inclusivity in clinical academia.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100657"},"PeriodicalIF":3.9,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219833","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}
Clinical MedicinePub Date : 2026-10-17DOI: 10.1016/j.clinme.2026.100659
Leonard Grant
{"title":"Response to Letter to the Editor: 'Don't work more than 3 days straight': Working conditions as learning conditions in general practice.","authors":"Leonard Grant","doi":"10.1016/j.clinme.2026.100659","DOIUrl":"https://doi.org/10.1016/j.clinme.2026.100659","url":null,"abstract":"<p><p>I am grateful to the authors of this Letter to the Editor for the productive and thoughtful ways in which they extend my argument. I agree with their proposition to include education on how to identify and challenge the structures than underpin working conditions.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100659"},"PeriodicalIF":3.9,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215095","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}
Clinical MedicinePub Date : 2026-10-15DOI: 10.1016/j.clinme.2026.100660
Sang Heon Suh, Hong Sang Choi, Chang Seong Kim, Eun Hui Bae, Seong Kwon Ma, Kook-Hwan Oh, Soo Wan Kim
{"title":"Response to Letter to the Editor: Prognostic value of left atrial diameter in chronic kidney disease: The KNOW-CKD study.","authors":"Sang Heon Suh, Hong Sang Choi, Chang Seong Kim, Eun Hui Bae, Seong Kwon Ma, Kook-Hwan Oh, Soo Wan Kim","doi":"10.1016/j.clinme.2026.100660","DOIUrl":"https://doi.org/10.1016/j.clinme.2026.100660","url":null,"abstract":"<p><p>none.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100660"},"PeriodicalIF":3.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191864","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}
Clinical MedicinePub Date : 2026-10-15DOI: 10.1016/j.clinme.2026.100661
Muhammad Nauman Hashmi, Pankaj Garg
{"title":"Left Atrial Enlargement in Chronic Kidney Disease: A Marker of Risk or a Target for Intervention?","authors":"Muhammad Nauman Hashmi, Pankaj Garg","doi":"10.1016/j.clinme.2026.100661","DOIUrl":"https://doi.org/10.1016/j.clinme.2026.100661","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100661"},"PeriodicalIF":3.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191829","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}
Clinical MedicinePub Date : 2026-10-15DOI: 10.1016/j.clinme.2026.100656
Shivam Patel, Soma Sengupta, Wuwei Feng, Dylan Ryan
{"title":"Pathophysiology, Workup and Treatment of Cancer-Related Ischaemic Stroke.","authors":"Shivam Patel, Soma Sengupta, Wuwei Feng, Dylan Ryan","doi":"10.1016/j.clinme.2026.100656","DOIUrl":"https://doi.org/10.1016/j.clinme.2026.100656","url":null,"abstract":"<p><p>Cancer and acute ischemic stroke are two leading causes of mortality worldwide. The association between these two diseases is being increasingly recognized, and with improvements in cancer mortality, the co-prevalence is increasing. Evidence suggested that cancer-related ischemic stroke is a unique subtype of stroke, including a newly proposed schematic to define this subgroup of patients. Cancer-related ischemic stroke encompasses a heterogeneous group of mechanisms that requires individualized diagnostic evaluation and multidisciplinary collaboration. In this narrative review, we describe the pathophysiology, workup, and management considerations in patients with cancer and ischemic stroke.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100656"},"PeriodicalIF":3.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191834","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}
Clinical MedicinePub Date : 2026-10-12DOI: 10.1016/j.clinme.2026.100655
Neelia Abadi, Alissa Thomas, Oluwatosin Akintola
{"title":"The Current Landscape of Neuro-Oncology Clinical Trials.","authors":"Neelia Abadi, Alissa Thomas, Oluwatosin Akintola","doi":"10.1016/j.clinme.2026.100655","DOIUrl":"https://doi.org/10.1016/j.clinme.2026.100655","url":null,"abstract":"<p><p>CNS malignancies, particularly gliomas, are aggressive and often terminal brain tumors in adults. While advances have been made in the understanding of the glioma microenvironment and the molecular genetic pathways that drive gliomagenesis, translation into effective clinical therapies remains challenging. Barriers to therapeutic advancement include intrinsic factors such as the poorly understood blood-brain barrier, glioma heterogeneity, and the immunologically privileged environment of the brain. This review provides an exploration of therapeutic developments in neuro-oncology, namely - immunotherapies, targeted therapies, surgical trials and radiation therapy trials. We address the difficulty of glioma clinical trials designs and lessons from ineffective interventions. We discuss future strategies in improving breakthrough therapies for gliomas such as streamlining clinical trial design, integrating biomarkers and molecular targeting into studies, enhancing the validity and reproducibility of glioma trials.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100655"},"PeriodicalIF":3.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164620","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}
Clinical MedicinePub Date : 2026-10-07DOI: 10.1016/j.clinme.2026.100654
Shopeitha Ravithas, Samantha Jane Meredith, Abolanle Lawal, Sarah Wallace, Stephen Lim
{"title":"Barriers and facilitators to engagement in fall interventions among older adults from ethnic backgrounds: A systematic review.","authors":"Shopeitha Ravithas, Samantha Jane Meredith, Abolanle Lawal, Sarah Wallace, Stephen Lim","doi":"10.1016/j.clinme.2026.100654","DOIUrl":"10.1016/j.clinme.2026.100654","url":null,"abstract":"<p><strong>Background: </strong>Falls prevention interventions among older adults can reduce falls risk but low engagement and adherence, especially amongst ethnic minority groups, remains a challenge.</p><p><strong>Aims: </strong>To identify the facilitators and barriers influencing uptake of fall prevention programmes among older adults from ethnic minority backgrounds.</p><p><strong>Methods: </strong>A literature search was conducted on three electronic databases included English language studies involving older adults aged ≥65 years from ethnic minority backgrounds. Study quality was assessed using the Joanna Briggs Institute's tool. Data were extracted and analysed using the Capability, Opportunity, Motivation (COM-B) model.</p><p><strong>Results: </strong>11 studies were included (eight qualitative, three mixed method). Study participants (n = 1176) included Hispanics, South Asians, Chinese and African American ethnic groups. Main themes included language barriers, cultural beliefs and inadequate support from healthcare professionals.</p><p><strong>Conclusion: </strong>Falls prevention interventions should incorporate culturally tailored, multi-lingual content and foster stronger partnership with healthcare professionals to enhance uptake among ethnic minority populations.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100654"},"PeriodicalIF":3.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126778","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}
Clinical MedicinePub Date : 2026-10-06DOI: 10.1016/j.clinme.2026.100653
Joshua A Kornbluth, Jessica Wallace, David Y Hwang
{"title":"Neuro-oncological emergencies requiring critical care intervention.","authors":"Joshua A Kornbluth, Jessica Wallace, David Y Hwang","doi":"10.1016/j.clinme.2026.100653","DOIUrl":"10.1016/j.clinme.2026.100653","url":null,"abstract":"<p><p>Patients with primary or metastatic brain tumours can deteriorate abruptly, and the acute physician is often the first to respond. This review covers the recognition and initial management of the neurological emergencies most likely to need critical care: raised intracranial pressure from peritumoural oedema and herniation; seizures and status epilepticus, including non-convulsive status epilepticus (NCSE); intracranial haemorrhage; acute hydrocephalus; and venous thromboembolism. It also covers two treatment-related emergencies that the general physician must now recognise: immune effector cell-associated neurotoxicity syndrome after chimeric antigen receptor (CAR) T-cell therapy, and immune checkpoint inhibitor encephalitis. Throughout, the text indicates whether recommendations rest on guidelines and where on observational data. The focus is on recognising time-critical treatment, timely escalation to neurosurgical and neurocritical care services, and the early, values-based discussion of goals of care.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100653"},"PeriodicalIF":3.9,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105172","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}
Clinical MedicinePub Date : 2026-10-04DOI: 10.1016/j.clinme.2026.100652
Melyda, Ahmad Ozair, Sean E H Lau, Irene S Guterman, Faisal Fa'ak, Manmeet S Ahluwalia, Laura Alder, Paul M Brennan, Mahua Dey, Samuel Emerson, Vinton W T Cheng
{"title":"Modern multidisciplinary management of brain metastasis.","authors":"Melyda, Ahmad Ozair, Sean E H Lau, Irene S Guterman, Faisal Fa'ak, Manmeet S Ahluwalia, Laura Alder, Paul M Brennan, Mahua Dey, Samuel Emerson, Vinton W T Cheng","doi":"10.1016/j.clinme.2026.100652","DOIUrl":"10.1016/j.clinme.2026.100652","url":null,"abstract":"<p><p>Brain metastases (BrM) are no longer considered to be a uniform end-stage complication of cancer, but as a biologically and clinically heterogeneous disease requiring coordinated management. This article synthesises the fundamentals of BrM diagnosis and treatment, relevant to primary and urgent care settings. Treatment sequencing should account for acuity of neurologic symptoms, anticipated intracranial response, extracranial disease tempo, steroid requirements, and risks of local therapy. Focal radiotherapy is now the dominant local modality for limited BrM. Surgery remains central for large, symptomatic, diagnostically uncertain, or mass-effect-producing lesions. Postoperative stereotactic radiosurgery is favoured over whole-brain radiotherapy. Novel CNS-active targeted agents and immune checkpoint inhibitors can permit deferral of radiotherapy in carefully selected asymptomatic patients with certain molecularly defined cancers. Follow-up, based on longitudinal MRI, requires multidisciplinary surveillance and decision-making. Optimal care combines integrated multidisciplinary management and risk-adapted sequencing to jointly achieve preservation of neurologic function while maintaining durable systemic control.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100652"},"PeriodicalIF":3.9,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105160","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}