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Opioid analgesics: Managing the predictable. 阿片类镇痛药：管理可预测的。
IF 3.6 4区 医学
Clinical Medicine Pub Date : 2025-05-27 DOI: 10.1016/j.clinme.2025.100330
A Barnes, G Heppenstall-Harris, A Dickman
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引用次数: 0
Impact of chronic liver disease (CLD) on mortality, complications, and early readmission in patients with spontaneous intracranial hemorrhage (ICH): A National Readmission Database Analysis 2016-2020. 慢性肝病（CLD）对自发性颅内出血（ICH）患者死亡率、并发症和早期再入院的影响：2016-2020年全国再入院数据库分析
IF 3.6 4区 医学
Clinical Medicine Pub Date : 2025-05-26 DOI: 10.1016/j.clinme.2025.100332
Ping-Jui Tsai, Yu-Jen Kuo
{"title":"Impact of chronic liver disease (CLD) on mortality, complications, and early readmission in patients with spontaneous intracranial hemorrhage (ICH): A National Readmission Database Analysis 2016-2020.","authors":"Ping-Jui Tsai, Yu-Jen Kuo","doi":"10.1016/j.clinme.2025.100332","DOIUrl":"https://doi.org/10.1016/j.clinme.2025.100332","url":null,"abstract":"<p><strong>Background: </strong>Chronic liver disease (CLD) is associated with worse outcomes in many medical conditions, but its impact on patients with spontaneous intracranial hemorrhage (ICH) has not been fully explored. This study aims to evaluate the influence of CLD on in-hospital outcomes of patients with a spontaneous ICH.</p><p><strong>Methods: </strong>Data from the Nationwide Readmissions Database (NRD) between 2016 and 2020 were retrospectively reviewed. Patients ≥ 18 years old admitted for the first time with a spontaneous ICH were included. Study outcomes included in-hospital mortality, length of stay (LOS), major complications, and 90-day readmission rate. Patients with and without CLD were matched using 1:4 propensity score matching (PSM). Univariate and multivariable logistic and linear regression analyses were performed to determine the associations between CLD and outcomes of interest.</p><p><strong>Results: </strong>After applying PSM, 21,345 patients were included in the analysis of which 4,269 had CLD. After adjustment, compared to patients without CLD, those with CLD had significantly higher in-hospital mortality (adjusted odds ratio [aOR] = 1.23, 95% confidence interval [CI]: 1.13-1.34, p < 0.001), a longer LOS(aOR = 1.26, 95% CI: 1.12-1.39, p < 0.001), higher rates of major complications(aOR = 1.76, 95% CI: 1.62-1.91, p < 0.001), and increased 90-day readmission rates (aOR = 1.20, 95% CI: 1.09-1.31, p < 0.001)​.</p><p><strong>Conclusions: </strong>CLD is independently associated with higher mortality, more complications, longer LOS, and higher readmission rates in patients admitted for spontaneous ICH. These findings underscore the need for specialized care strategies for patients with an ICH and underlying CLD.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100332"},"PeriodicalIF":3.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173202","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
Gout on the acute medical take. 痛风的急症治疗。
IF 3.6 4区 医学
Clinical Medicine Pub Date : 2025-05-26 DOI: 10.1016/j.clinme.2025.100331
Abhishek Abhishek, Edoardo Cipolletta
{"title":"Gout on the acute medical take.","authors":"Abhishek Abhishek, Edoardo Cipolletta","doi":"10.1016/j.clinme.2025.100331","DOIUrl":"https://doi.org/10.1016/j.clinme.2025.100331","url":null,"abstract":"<p><p>Gout is the commonest form of inflammatory arthritis. Flares are the commonest presentation of gout. Typically, gout flares present as acute mono-arthritis, and most often affect the first metatarsophalangeal joint (\"podagra\"). Other joints in the lower limbs are affected more often than those in the upper limbs. Joint aspiration followed by examination of the synovial fluid using a polarized light microscope is the gold standard for a definite diagnosis of gout. Gout may be diagnosed without recourse to joint aspiration if there is podagra, elevated serum urate, and no suspicion of infection. Ultrasonography and dual energy computed tomography may be used to diagnose gout if joint aspiration is unsuccessful or not feasible. Oral colchicine, NSAIDs, and glucocorticoids have similar efficacy for controlling gout flare with differing adverse effect profiles. Consequently, the drug choice depends on comorbidities and patient preference.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100331"},"PeriodicalIF":3.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173122","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
Population-specific risk models and AI in clinical practice: Are we ready for the next step in managing common disorders? 特定人群风险模型和人工智能在临床实践中的应用：我们准备好进入管理常见疾病的下一步了吗？
IF 3.6 4区 医学
Clinical Medicine Pub Date : 2025-05-17 DOI: 10.1016/j.clinme.2025.100329
Kartik Kumar, Ponnusamy Saravanan
{"title":"Population-specific risk models and AI in clinical practice: Are we ready for the next step in managing common disorders?","authors":"Kartik Kumar, Ponnusamy Saravanan","doi":"10.1016/j.clinme.2025.100329","DOIUrl":"10.1016/j.clinme.2025.100329","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100329"},"PeriodicalIF":3.6,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101509","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
Sarcoidosis: Key disease aspects and update on management. 结节病：主要疾病特征及管理进展。
IF 3.6 4区 医学
Clinical Medicine Pub Date : 2025-05-15 DOI: 10.1016/j.clinme.2025.100326
Robina K Coker, Kathy M Cullen
{"title":"Sarcoidosis: Key disease aspects and update on management.","authors":"Robina K Coker, Kathy M Cullen","doi":"10.1016/j.clinme.2025.100326","DOIUrl":"10.1016/j.clinme.2025.100326","url":null,"abstract":"<p><p>Sarcoidosis is a complex disease of unknown origin, primarily affecting the lungs but capable of involving almost any organ. Diagnosis is challenging due to the lack of specific markers and requires assessment of clinical features, careful imaging, exclusion of other conditions and, ideally, a tissue biopsy demonstrating non-necrotising granulomas. Over 90% of patients have pulmonary involvement, presenting with symptoms like dry cough and breathlessness, along with systemic signs such as fever and weight loss. Extrapulmonary manifestations occur in about 30% of cases and can affect any organ, including the heart, nervous system and eyes. Management involves a multidisciplinary approach with some patients requiring immunosuppressive and antifibrotic therapies. Despite generally good outcomes, sarcoidosis can lead to significant morbidity and mortality, particularly from pulmonary and cardiac complications. Emerging treatments like infliximab and nintedanib offer hope for refractory cases, although they carry risks of serious infections and other side effects.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100326"},"PeriodicalIF":3.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092962","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
Lung transplant: A clinical overview. 肺移植：临床综述。
IF 3.6 4区 医学
Clinical Medicine Pub Date : 2025-05-15 DOI: 10.1016/j.clinme.2025.100328
Usman Feroze Khatana, Jasvir Singh Parmar, Caroline M Patterson
{"title":"Lung transplant: A clinical overview.","authors":"Usman Feroze Khatana, Jasvir Singh Parmar, Caroline M Patterson","doi":"10.1016/j.clinme.2025.100328","DOIUrl":"10.1016/j.clinme.2025.100328","url":null,"abstract":"<p><p>Lung transplant is a recognised treatment option for end-stage respiratory failure. It is, however, a complex process and involves careful patient selection, comprehensive work-up followed by a technically challenging surgical procedure and a rigorous follow-up. In this article we provide an overview of the process, condensed down to the important facts for physicians with limited experience with transplant patients or medicine. Our aim is to take the reader through the journey from patient selection to post-transplant care and attempt to address commonly faced issues with such a niche cohort of patients.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100328"},"PeriodicalIF":3.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093042","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
Pneumothorax: An update on clinical spectrum, diagnosis and management. 气胸：临床谱、诊断和治疗的最新进展。
IF 3.6 4区 医学
Clinical Medicine Pub Date : 2025-05-13 DOI: 10.1016/j.clinme.2025.100327
Beenish Iqbal, Rob Hallifax, Najib M Rahman
{"title":"Pneumothorax: An update on clinical spectrum, diagnosis and management.","authors":"Beenish Iqbal, Rob Hallifax, Najib M Rahman","doi":"10.1016/j.clinme.2025.100327","DOIUrl":"10.1016/j.clinme.2025.100327","url":null,"abstract":"<p><p>Pneumothorax is defined as air in the pleural space and is characterised by chest pain and breathlessness. It is commonly divided into spontaneous and non-spontaneous subtypes based on the underlying mechanism. Chest X-ray is the most common investigation to diagnose and monitor pneumothorax, but CT-chest is being increasingly used to aid decision making in complex cases and to investigate an underlying lung disease. There should be a low threshold to investigate for an underlying familial or catamenial cause in suspected cases. Treatment for pneumothorax is based on clinical condition and symptoms of the patient rather than the size of pneumothorax. Conservative care can be offered to minimally symptomatic primary spontaneous pneumothorax patients, while needle aspiration, ambulatory Heimlich valve device and chest drain remain the interventional treatment options. Chest drain is a common treatment for patients with secondary spontaneous pneumothorax due to poor lung reserve. Recurrence after spontaneous pneumothorax is common and smoking cessation reduces the risk of future recurrence in active smokers. Surgical treatment with pleurodesis ± bullectomy should be considered for treatment of suitable patients with persistent air leak and for pneumothorax recurrence prevention in high-risk populations.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100327"},"PeriodicalIF":3.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076441","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
Is pulmonary embolism a chronic disease? 肺栓塞是一种慢性病吗？
IF 3.6 4区 医学
Clinical Medicine Pub Date : 2025-05-09 DOI: 10.1016/j.clinme.2025.100325
Gerard Gurumurthy, Lianna Reynolds, Kerstin de Wit, Lara N Roberts, Jecko Thachil
{"title":"Is pulmonary embolism a chronic disease?","authors":"Gerard Gurumurthy, Lianna Reynolds, Kerstin de Wit, Lara N Roberts, Jecko Thachil","doi":"10.1016/j.clinme.2025.100325","DOIUrl":"10.1016/j.clinme.2025.100325","url":null,"abstract":"<p><p>Pulmonary embolism (PE) is often regarded as an acute disorder, yet emerging evidence underscores its chronic trajectory. Many survivors endure long-term complications, including recurrent thrombosis, persistent dyspnoea and psychosocial challenges. These sequelae impair functional capacity and quality of life long after the initial event. To address these issues, we suggest that clinicians should adopt an integrated, multidisciplinary model that includes risk stratification for recurrence, structured follow-up, exercise rehabilitation, and support for psychological challenges. Recognising the potential chronic sequalae of PE ultimately fosters comprehensive care aimed at reducing morbidity and improving long-term outcomes for survivors.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100325"},"PeriodicalIF":3.6,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981907","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
Clinically assisted nutrition and hydration at the end of life. 临终时临床辅助营养和水合作用。
IF 3.6 4区 医学
Clinical Medicine Pub Date : 2025-05-08 DOI: 10.1016/j.clinme.2025.100323
Andrew Davies
{"title":"Clinically assisted nutrition and hydration at the end of life.","authors":"Andrew Davies","doi":"10.1016/j.clinme.2025.100323","DOIUrl":"10.1016/j.clinme.2025.100323","url":null,"abstract":"<p><p>The initiation, continuance or discontinuance of clinically assisted hydration and nutrition are some of the most challenging decisions in patients near the end of life. This article reviews the limited evidence to support or otherwise these medical treatments, and provides an overview of relevant clinical practice guidance. Essentially, decisions need to be individualised, and importantly regularly reviewed to ensure that the objectives of treatment are being achieved.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100323"},"PeriodicalIF":3.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955737","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
An insight into interventional bronchoscopy. 介入支气管镜检查的探讨。
IF 3.6 4区 医学
Clinical Medicine Pub Date : 2025-05-05 DOI: 10.1016/j.clinme.2025.100321
Ashish Karir, Pallav L Shah, Christopher M Orton
{"title":"An insight into interventional bronchoscopy.","authors":"Ashish Karir, Pallav L Shah, Christopher M Orton","doi":"10.1016/j.clinme.2025.100321","DOIUrl":"10.1016/j.clinme.2025.100321","url":null,"abstract":"<p><p>The emergent field of interventional bronchoscopy provides an alternative approach for the diagnosis and management of a range of respiratory conditions. Within malignant disease, robotic navigational bronchoscopy provides a stable platform to sample small and difficult to reach pulmonary nodules, while malignant central airway obstruction can be managed through transcopic stent insertion. A range of therapeutic modalities have been developed for benign disease, which provide alternatives to standard therapy, particularly in the context of endobronchial valves for chronic obstructive pulmonary disease, and bronchial thermoplasty for asthma, while transbronchial cryoexcision lung biopsy offers a non-surgical option for undiagnosed interstitial lung disease. With a rich pipeline of technology being developed through robust clinical trial processes, the field of interventional bronchoscopy will continue to grow to become an invaluable asset, not only to the field of respiratory medicine, but to the general physician.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100321"},"PeriodicalIF":3.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971513","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
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