Clinical Medicine最新文献

{"title":"A multi-centre quality improvement project to assess the impact of a standardised NIV care bundle on mortality outcomes in patients with acute type 2 respiratory failure.","authors":"Christopher J Michie, Kirsty R Ward, Peter W Creber, Susie Beresford, Mark C Juniper, Rebecca Helen Mason","doi":"10.1016/j.clinme.2026.100574","DOIUrl":"10.1016/j.clinme.2026.100574","url":null,"abstract":"<p><p>The evidence for non-invasive ventilation (NIV) is clear; however, real-world outcomes fall short of those demonstrated by clinical trials. We developed a five-step care bundle in line with BTS quality standards to standardise management and guide clinicians through the first few hours of NIV care. This was combined with staff training initiatives. The project aimed to reduce acute NIV mortality to 10%. Although this target was not met, the project delivered a 7% reduction in mortality from 28% to 21%, equating to 143 fewer deaths in 2023 compared to 2022. The project also delivered increased staff confidence. Through this project we have demonstrated that early, effective NIV, in appropriate patients, delivered in a standardised way by confident and competent staff, improves outcomes.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100574"},"PeriodicalIF":3.9,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644404","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}

{"title":"The Global Burden of Rheumatic Heart Disease: 1990-2021.","authors":"Saeid Safiri, Reza Aletaha, Fatemeh Amiri, Mark J M Sullman, Mohammad Rahmanian, Kuljit Singh, Ali-Asghar Kolahi","doi":"10.1016/j.clinme.2026.100593","DOIUrl":"https://doi.org/10.1016/j.clinme.2026.100593","url":null,"abstract":"<p><strong>Introduction: </strong>Rheumatic heart disease (RHD) arises from acute rheumatic fever (ARF) following group A streptococcal infection. While its prevalence has declined in high-income regions, it remains a major health burden in low-resource settings.</p><p><strong>Objective: </strong>This research investigated the burden of RHD from 1990 to 2021, utilizing data from the Global Burden of Disease (GBD) 2021 study.</p><p><strong>Methods: </strong>Publicly available data were analysed to determine absolute counts, age-standardised rates, and percentage changes in prevalence, disability-adjusted life years (DALYs), and deaths from 1990 to 2021.</p><p><strong>Results: </strong>In 2021, global RHD cases numbered 54,785,119, with an age-standardised prevalence rate of 684.2 per 100,000, reflecting a 12.6% increase since 1990. Deaths totalled 373,345, with an age-standardised rate of 4.5 per 100,000, marking a 56.2% decline over the period. In 2021, Eritrea (1,865.4) had the highest prevalence rate and Finland (17.4) the lowest. In 2021, Micronesia reported the highest death rate (9.6 per 100,000), and Guatemala the lowest (0.2). Females exhibited higher prevalence rates across all ages, peaking in the 25-29 age range. Although prevalence declined with age, it remained higher in females than among males. The relationship between the Sociodemographic Index (SDI) and RHD burden was non-linear, peaking at an SDI of 0.42, before declining sharply.</p><p><strong>Conclusion: </strong>RHD remains a major public health challenge, characterised by rising prevalence and significant health and economic impacts. Despite reductions in mortality and DALY rates, the increasing prevalence underscores the urgent need for improved prevention and management strategies.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100593"},"PeriodicalIF":3.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834634","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}

{"title":"Parvovirus B19-associated fat embolism syndrome in sickle cell disease: a report of two cases.","authors":"Anna Corby, Jessica Lubel, Sara Stuart-Smith, Arne de Kreuk, Rachel Kesse-Adu, Temi Lampejo","doi":"10.1016/j.clinme.2026.100587","DOIUrl":"https://doi.org/10.1016/j.clinme.2026.100587","url":null,"abstract":"<p><p>Fat embolism syndrome (FES) is a rare but likely underdiagnosed complication of sickle cell disease (SCD) characterised by multi- or single- organ involvement secondary to embolism of fat and/or necrotic bone marrow. It is one of the most devastating acute complications of SCD and historically the diagnosis has often been made on the basis of post-mortem findings. Literature on FES in SCD is scarce although most reported cases are individuals with non-HbSS genotypes for reasons which have not yet been fully elucidated. Even fewer data exist regarding the potential association with parvovirus B19 (B19V) and the mechanisms by which B19V infection could trigger FES in SCD. Management is largely supportive with early intensive care team involvement for close monitoring and potential organ support. Emerging evidence, albeit limited, suggests that early exchange transfusion has an important role in improving clinical outcomes. We describe two life-threatening cases of FES in SCD of differing genotypes who required intensive care unit admission but who both recovered with supportive management and early exchange transfusion.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100587"},"PeriodicalIF":3.9,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811774","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}

{"title":"QUALITY IN POSTGRADUATE MEDICAL EDUCATION: A CONTESTED IDEA.","authors":"Janet Grant","doi":"10.1016/j.clinme.2026.100590","DOIUrl":"https://doi.org/10.1016/j.clinme.2026.100590","url":null,"abstract":"<p><p>The idea of 'quality' in education and training, forms the basis of both regulation and teaching and learning. 'Quality' therefore directly affects how residents and their teachers and supervisors spend their time. However, the derivation of these ideas remains largely unexamined. There is almost no robust evidence to suggest what the characteristics of good quality postgraduate medical education might be. Ideas change over time, following dominant social values and political imperatives, as an examination of the history, definition, uses, limitations and effects of 'quality' in PGME show. Ideas of quality inform interventions which are used differently by different interested parties, ranging through quality improvement, quality management, quality control, quality assurance, controls assurance, accreditation and regulation. Whichever level is involved, the idea of 'quality' is inherently political. But despite regulatory power being removed from the profession, responsibility for quality remains squarely in its corner.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100590"},"PeriodicalIF":3.9,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811725","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}

{"title":"AI and Clinicians growing together: A Cross-Sectional Survey of Clinicians' Attitudes Toward AI-CDSS with Comparison to 2020 Data.","authors":"Simona Curiello, Adriane Chapman, Jeremy C Wyatt","doi":"10.1016/j.clinme.2026.100589","DOIUrl":"https://doi.org/10.1016/j.clinme.2026.100589","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Clinical Decision Support Systems (CDSS) - software programs that provide patient-specific recommendations to assist in clinical decision-making - have evolved considerably since 2020, with increasing integration of Artificial Intelligence (AI) and machine-learning features. Modern AI-powered CDSS (AI-CDSS) no longer rely on static algorithms but instead create adaptive, data-driven insights to be used for diagnostics, prognosis, and  ‍ ‌‍ ‍‌therapy. Exposure in the clinical setting and attention from regulators have increased, yet uncertainty persists about how clinicians view the risks, benefits, and integration of such systems within their everyday practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Our objective in this research was to assess AI‑CDSS perception in 2025 and to explore cross-temporal patterns relative to earlier reports. Specifically, we sought to: (1) examine cross-temporal trends in perceived benefits and harms; (2) describe clinician subgroups by adoption intentions; and (3) examine professional and regulatory concerns following real-world experience with AI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional online survey was administered to UK and Italian clinicians (N=215). The instrument maintained thematic continuity with a 2020 survey while incorporating AI-specific constructs. The questions spanned five themes: perceived advantages, hazards, regulation, clinical utility, and ethical concerns. Cluster analysis (Ward's method, z-scored items) was used to identify attitudinal clusters. Comparison through time with 2020 data prioritized thematic concordance and relative frequencies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;AI‑CDSS are now more commonly used for diagnostic support (32.6%) compared to primarily administrative purposes in 2020. Greater endorsement was found for AI benefits such as improved diagnostics (63.3%) and medicine management (62.8%). Concerns moved from technological performance to professional issues, such as de-skilling of trainees (59.5%) and automation bias (67%). Regulatory concerns moved from device-focused agencies to evidence synthesis organizations (e.g.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;, nice: &lt;/strong&gt;31.2%). Hierarchical cluster analysis identified three distinct attitudinal profiles: The Optimists (n = 113), who reported high perceived benefits and low risk; The Balanced Sceptics (n = 83), with moderate scores across dimensions; and The Concerned (n = 19), who reported low perceived benefits and elevated risk perception.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Clinicians tend to display more nuanced, context-specific views of AI‑CDSS following real-world exposure. Clinicians in 2025 reported moderate to high trust in AI-based tools; however, as trust was measured in 2025 only, no direct cross-temporal trust comparison can be made. Persistent concerns regarding ethics, explainability, and professional education remain. Specialized regulatory frameworks and training models are needed to optimize sa","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100589"},"PeriodicalIF":3.9,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764711","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}

{"title":"Management of hypertension in chronic kidney disease.","authors":"Tim Doulton, Pauline A Swift, Swapnil Hiremath","doi":"10.1016/j.clinme.2026.100583","DOIUrl":"https://doi.org/10.1016/j.clinme.2026.100583","url":null,"abstract":"<p><p>Hypertension is a major risk factor for cardiovascular (CV) disease and progression in chronic kidney disease (CKD). Blood pressure (BP) measurement should be standardized and supplemented by ambulatory and home BP monitoring. BP goals are generally <140/90 and <130/80mmHg for those at higher risk of CV disease or CKD progression. Lifestyle modification includes restricting salt intake to <5 grams/day. Most people with hypertension and CKD, especially those with a urine albumin:creatinine ratio ≥3mg/mmol should be treated with a renin-angiotensin system inhibitor to which, in selected individuals, a sodium-glucose co-transporter inhibitors type 2 and non-steroidal mineralocorticoid receptor antagonist may be added, followed by additional anti-hypertensives to achieve goal BP. Strategies to manage hyperkalaemia (e.g. low potassium dietary advice and oral potassium binders) should be employed to avoid stopping prognostically beneficial medications. A range of emerging therapeutics, including aldosterone synthase and endothelin antagonists, and renal denervation are briefly discussed.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100583"},"PeriodicalIF":3.9,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764731","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}

{"title":"When a smartphone-free childhood is not a choice: Recognising smartphones as essential medical devices.","authors":"Alice M Gregory, Partha Kar","doi":"10.1016/j.clinme.2026.100591","DOIUrl":"https://doi.org/10.1016/j.clinme.2026.100591","url":null,"abstract":"<p><p>Recently there have been initiatives to ban or reduce the use of smartphones in children and young people. Whilst exemptions are typically made for those for whom smartphones constitute an essential medical device, these groups have not been sufficiently considered in discussions to date. These people include children living with type 1 diabetes, young carers as well as some with heart conditions and epilepsy. Research urgently needs to examine the consequences of smartphone use and restriction in children in general, but this is particularly urgent when smartphones constitute an essential medical device. While restricting use and negative messaging surrounding campaigns could cause harm to these children, the negative impacts of devices (e.g. providing opportunities for bullying or distraction) may also be amplified in these populations. Four clinical and research recommendations on this topic are proposed.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100591"},"PeriodicalIF":3.9,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764715","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}

{"title":"'Don't work more than three days straight': working conditions as learning conditions in general practice.","authors":"Leonard Grant","doi":"10.1016/j.clinme.2026.100588","DOIUrl":"https://doi.org/10.1016/j.clinme.2026.100588","url":null,"abstract":"<p><strong>Objective: </strong>To examine how GPs understand their working conditions and to consider what significance this holds for medical education.</p><p><strong>Design: </strong>Data were collected through online interviews with GPs, conducted between April and July 2023. These data were then subjected to thematic analysis.</p><p><strong>Participants: </strong>Fifteen GPs were interviewed, including two practice partners, seven salaried GPs, one locum GP and five GPs in training. Participants were recruited through professional networks using purposive sampling.</p><p><strong>Results: </strong>GPs described intense pressure from increasing demand, large administrative burden and erosion of professional autonomy. Practitioners viewed working full-time as unsustainable, with experienced GPs actively discouraging trainees from taking on such work. The primary coping mechanism GPs used was reducing their working days, which they considered necessary to continue in practice. The working conditions shape what is understood and transmitted about the profession: that general practice is a fundamentally unsustainable full-time career.</p><p><strong>Conclusion: </strong>GPs understand their working conditions as untenable and that they must be managed at a personal level. However, these conditions are products of specific political and economic arrangements rather than natural features of medical practice. Medical educators should actively consider what the workplace is teaching and what effects this might have on the future workforce.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100588"},"PeriodicalIF":3.9,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764655","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}

{"title":"Integrating MASLD detection into diabetes care in primary care settings in Mexico: a cascade analysis.","authors":"Rubén Silva-Tinoco, Erick Vladimir Martínez-de la Cruz, Ana Galíndez-Fuentes, Berenice Cabrera-Victoria, Erick Villa-Mejía, Ricardo Ulises Macías-Rodríguez, Alejandro Avalos-Bracho, María Fernanda Bernal-Ceballos","doi":"10.1016/j.clinme.2026.100585","DOIUrl":"https://doi.org/10.1016/j.clinme.2026.100585","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) remains underrecognized in diabetes care due to the lack of structured detection pathways in primary healthcare.</p><p><strong>Objective: </strong>To evaluate the feasibility and performance of a stepwise diagnostic pathway for identifying the full spectrum of MASLD in adults with type 2 diabetes in primary healthcare settings.</p><p><strong>Methods: </strong>A diagnostic pathway for early detection across the MASLD spectrum, including steatosis, metabolic-dysfunction associated steatohepatitis (MASH), liver fibrosis risk, and significant fibrosis, was integrated into a multicomponent diabetes care program within the public health system. A secondary exploratory analysis used multivariable logistic regression to identify factors independently associated with MASLD.</p><p><strong>Results: </strong>Among 454 adults with type 2 diabetes, MASLD was identified in 51.5%, and MASH in 22.2%. Through stepwise assessment, 22.7% showed intermediate-to-high fibrosis risk, and among those who underwent transient elastography, significant fibrosis was confirmed in 27.9% of individuals with increased risk, yielding an estimated prevalence of 10.6% in the MASLD group and 5.9% overall. In multivariable analysis, female sex, elevated liver enzymes, and higher body mass index were independently associated with MASLD, with a non-linear association across BMI categories.</p><p><strong>Conclusion: </strong>Implementing structured care pathways for the identification and management of MASLD is feasible and essential to mitigate the burden of diabetes and liver disease. Strengthening primary care capacity remains crucial for systematic integration of MASLD identification in routine care.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100585"},"PeriodicalIF":3.9,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728841","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}

{"title":"Hypertension and Heart Failure: Navigating Blood Pressure Targets and Medication Titration and Tolerance.","authors":"Irfan Helmy, Mohamad Karnib, Varun Sundaram","doi":"10.1016/j.clinme.2026.100584","DOIUrl":"https://doi.org/10.1016/j.clinme.2026.100584","url":null,"abstract":"<p><p>This article briefly reviews the latest hypertension guidelines and how they should be individualised in patients with HF, including the two specific phenotypes: HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). Key recent trials and guidelines show that HF medications remain beneficial and safe to use even in patients without overt hypertension, provided that they are tolerated. We also outline practical strategies for titration and selection of HF medications, most of which affect BP, in an outpatient setting. These strategies are applicable to both normotensive patients and those with pre-existing hypertension.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100584"},"PeriodicalIF":3.9,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147721861","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}