Clinical Medicine最新文献

Emergency management of anaphylaxis and the impact of the new UK ALS guidelines. 过敏反应的紧急管理和新的英国ALS指南的影响。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2025-09-30 DOI: 10.1016/j.clinme.2025.100519

Mahmoud Elshehawy, Madhavi Kadambi, Deborah Hughes, Daniel Clarke, Angela Cooper, Mohit Inani, Polat Goktas, Sarah Goddard, Lavanya Diwakar

{"title":"Emergency management of anaphylaxis and the impact of the new UK ALS guidelines.","authors":"Mahmoud Elshehawy, Madhavi Kadambi, Deborah Hughes, Daniel Clarke, Angela Cooper, Mohit Inani, Polat Goktas, Sarah Goddard, Lavanya Diwakar","doi":"10.1016/j.clinme.2025.100519","DOIUrl":"https://doi.org/10.1016/j.clinme.2025.100519","url":null,"abstract":"Background: Anaphylaxis is a severe, potentially life-threatening allergic reaction that requires urgent and effective management. The UK Resuscitation Council updated its Advanced Life Support (ALS) guidelines for anaphylaxis in 2021, emphasizing early and repeated adrenaline administration, IV fluid use, and reduced reliance on antihistamines and steroids.Methods: A retrospective audit was carried out to compare the management of anaphylaxis at two English NHS hospitals, namely the University Hospital of North Midlands (UHNM) and the Shrewsbury and Telford Hospital (SATH) before (2018) and after (2022/23) the ALS guideline implementation. Adherence to NICE anaphylaxis guidance was also assessed.Results: Data from 272 patients revealed significant improvements in recognition of anaphylaxis in 2022 compared with 2018 (70.8% vs. 50%; p=0.001). The use of adrenaline and IV fluids increased, whereas the use of antihistamines and steroids declined, aligning with the new guidance. Tryptase measurement (checked in 45% patients) and specialist referral rates (67% at UHNM vs. 3% at SATH; p=0.0001) remained suboptimal at both centers. A case example highlights the risks of misdiagnosis and adrenaline overuse in patients with recurrent urticarial presentations.Conclusion: Anaphylaxis management in these centers has changed in keeping with the new ALS guidelines, although antihistamines and steroids were still used in the acute management of around 50% of the patients. Adrenaline overuse may be an unintended consequence of the guideline, which needs monitoring. There may have been some improvement in anaphylaxis recognition, but serum tryptase measurement and referral to allergy specialists remain poor.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100519"},"PeriodicalIF":3.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211867","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

Risk factors for mortality in patients with peripheral artery disease: an umbrella analysis. 外周动脉疾病患者死亡率的危险因素：一项综合分析

IF 3.9 4区医学

Clinical Medicine Pub Date : 2025-09-30 DOI: 10.1016/j.clinme.2025.100517

Ying He, Xiaoci He, Haijiao Zhang, Jin Jin, Yang Liu, Kui Chi, Limei Tang

{"title":"Risk factors for mortality in patients with peripheral artery disease: an umbrella analysis.","authors":"Ying He, Xiaoci He, Haijiao Zhang, Jin Jin, Yang Liu, Kui Chi, Limei Tang","doi":"10.1016/j.clinme.2025.100517","DOIUrl":"https://doi.org/10.1016/j.clinme.2025.100517","url":null,"abstract":"Background: This study provides an umbrella review to assess the methodological quality, biases, and the reliability of evidence regarding the factors influencing mortality in individuals with peripheral artery disease (PAD). It also offers a consolidated overview of the identified risk factors.Methods: The review protocol was registered in PROSPERO (CRD42024615105) PubMed, Web of Science, the Cochrane Database of Systematic Reviews and Embase were used to search, covering the period from inception until September 2024. AMSTAR and GRADE were used to independently evaluate the methodological rigor and quality of the evidence.Results: The review identified a total of 29 risk factors, of which 17 were significantly associated with higher mortality risk, while 12 did not show a notable association. The majority of the evidence was rated as low or very low quality, with only three risk factors being classified as having moderate-quality evidence. Key findings indicated that comorbidities such as chronic kidney disease, diabetes, underweight status, atrial fibrillation and depression were major contributors to higher mortality risk. In contrast, obesity and statin use were identified as being linked to a reduced risk of mortality. Additionally, blood biomarkers, including N-terminal pro-B-type natriuretic peptide, high-sensitivity C-reactive protein (CRP), and high-sensitivity cardiac troponin T were identified as important predictors of mortality.Conclusion: Comorbid conditions are key factors contributing to elevated mortality among individuals with PAD, whereas obesity and statin use are linked to reduced mortality risk. Additionally, blood biomarkers offer valuable insights into assessing mortality risk within this patient group.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100517"},"PeriodicalIF":3.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211968","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

How are generalist doctors made aware, on an ongoing basis, of the key new and updated clinical guidelines which are relevant to their practice? A systematic review. 如何让全科医生在持续的基础上了解与他们的实践相关的关键的新的和更新的临床指南？系统回顾。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2025-09-29 DOI: 10.1016/j.clinme.2025.100518

Clare Elizabeth Leong, Leonie Kallis, Isla L Kuhn, Graham P Martin, Zoe Fritz

{"title":"How are generalist doctors made aware, on an ongoing basis, of the key new and updated clinical guidelines which are relevant to their practice? A systematic review.","authors":"Clare Elizabeth Leong, Leonie Kallis, Isla L Kuhn, Graham P Martin, Zoe Fritz","doi":"10.1016/j.clinme.2025.100518","DOIUrl":"https://doi.org/10.1016/j.clinme.2025.100518","url":null,"abstract":"Introduction: Clinical guidelines are an essential component of evidence-based medicine, and doctors have a responsibility to stay up-to-date. However, doctors' lack of awareness of publication of new guidelines may limit adherence and impact on patient care. This paper systematically reviews evidence on strategies used to make doctors aware of new/updated clinical guidelines.Methods: Electronic databases (Medline, Embase via Ovid) were searched 2004-2024 for papers examining such strategies. Experimental, observational and qualitative studies were included. Data was extracted and critically analysed. PRISMA guidelines were followed.Results: Fourteen relevant articles were identified; they were heterogeneous and the overall quality of evidence was poor. Two multifaceted interventions resulted in better adherence to some aspects of guidelines; some others showed improvements in self-reported awareness-related outcomes.Conclusion: The evidence in this area is currently insufficient to recommend any strategy. Future research should focus on evaluation of interventions using appropriate study designs and objective outcome measures.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100518"},"PeriodicalIF":3.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205865","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

Medicine's beauty lies in lifelong learning, reflection and research. 医学之美在于终身学习、终身反思、终身研究。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2025-09-24 DOI: 10.1016/j.clinme.2025.100516

Ilfita Sahbudin, Ponnusamy Saravanan

引用次数: 0

DIABETES AND TRANSPLANTATION. 糖尿病和移植。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2025-09-12 DOI: 10.1016/j.clinme.2025.100514

Dorcas Mukuba, Ritwika Mallik, Tahseen A Chowdhury

引用次数: 0

Diabetes and the heart. 糖尿病和心脏。