Clinical Medicine最新文献_第10页

Secondary hyperparathyroidism in chronic kidney disease: A narrative review focus on therapeutic strategy. 慢性肾病中的继发性甲状旁腺功能亢进症：以治疗策略为重点的叙述性综述。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-09-01 Epub Date: 2024-08-30 DOI: 10.1016/j.clinme.2024.100238

Shin-Hwa Tsai, Wei-Chih Kan, Rong-Na Jhen, Yu-Ming Chang, Jsun-Liang Kao, Hsien-Yung Lai, Hung-Hsiang Liou, Chih-Chung Shiao

{"title":"Secondary hyperparathyroidism in chronic kidney disease: A narrative review focus on therapeutic strategy.","authors":"Shin-Hwa Tsai, Wei-Chih Kan, Rong-Na Jhen, Yu-Ming Chang, Jsun-Liang Kao, Hsien-Yung Lai, Hung-Hsiang Liou, Chih-Chung Shiao","doi":"10.1016/j.clinme.2024.100238","DOIUrl":"10.1016/j.clinme.2024.100238","url":null,"abstract":"Chronic kidney disease (CKD) affects over 10% of the global population. One crucial complication of CKD is secondary hyperparathyroidism (SHPT), marked by elevated parathyroid hormone levels due to hyperphosphataemia, hypocalcaemia, and low active vitamin D from impaired renal function. SHPT increases risks of bone deformities, vascular calcification, cardiovascular events and mortality. This review examines SHPT treatment strategies in patients with CKD. First-line treatments include phosphate binders, vitamin D receptor activators and calcimimetics. When these fail, invasive options like parathyroidectomy (PTX) and thermal ablation are considered. PTX effectively reduces symptoms and improves radiological outcomes, outperforming medical treatment alone in reducing cardiovascular risk and mortality. Thermal ablation techniques, such as microwave, radiofrequency, laser or high-intensity focused ultrasound, offer less invasive alternatives with promising results. Future research should explore the molecular mechanisms of parathyroid gland hyperplasia and evaluate various treatments' impacts.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100238"},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11414656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Gliomas in adults: Guidance on investigations, diagnosis, treatment and surveillance. 成人胶质瘤：调查、诊断、治疗和监测指南》。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-09-01 Epub Date: 2024-09-02 DOI: 10.1016/j.clinme.2024.100240

Anna Lerner, Kieran Palmer, Tom Campion, Thomas O Millner, Emily Scott, Cressida Lorimer, Dimitrios Paraskevopoulos, Grainne McKenna, Silvia Marino, Rachel Lewis, Nick Plowman

{"title":"Gliomas in adults: Guidance on investigations, diagnosis, treatment and surveillance.","authors":"Anna Lerner, Kieran Palmer, Tom Campion, Thomas O Millner, Emily Scott, Cressida Lorimer, Dimitrios Paraskevopoulos, Grainne McKenna, Silvia Marino, Rachel Lewis, Nick Plowman","doi":"10.1016/j.clinme.2024.100240","DOIUrl":"10.1016/j.clinme.2024.100240","url":null,"abstract":"Primary brain tumours are rare but carry a significant morbidity and mortality burden. Malignant gliomas are the most common subtype and their incidence is increasing within our ageing population. The diagnosis and treatment of gliomas involves substantial interplay between multiple specialties, including general medical physicians, radiologists, pathologists, surgeons, oncologists and allied health professionals. At any point along this pathway, patients can present to acute medicine with complications of their cancer or anti-cancer therapy. Increasing the awareness of malignant gliomas among general physicians is paramount to delivering prompt radiological and histopathological diagnoses, facilitating access to earlier and individualised treatment options and allows for effective recognition and management of anticipated complications. This article discusses evidence-based real-world practice for malignant gliomas, encompassing patient presentation, diagnostic pathways, treatments and their complications, and prognosis to guide management outside of specialist centres.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100240"},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Utilising accessible and reproducible neurological assessments in clinical studies: Insights from use of the Neurological Impairment Scale in the multi-centre COVID-CNS study. 在临床研究中使用可访问和可重复的神经学评估：多中心 COVID-CNS 研究中使用神经学损伤量表的启示。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-09-01 Epub Date: 2024-09-06 DOI: 10.1016/j.clinme.2024.100241

Ali M Alam, Glynn W Webb, Ceryce Collie, Sashini Mariathasan, Yun Huang, Orla Hilton, Rajish Shil, Katherine C Dodd, James B Lilleker, Craig J Smith, Ava Easton, Arina Tamborska, Rhys H Thomas, Nicholas W S Davies, Thomas M Jenkins, Michael Zandi, Laura Benjamin, Mark A Ellul, Tom Solomon, Thomas A Pollak, Tim Nicholson, Gerome Breen, Daniel J van Wamelen, Nicholas W Wood, Benedict D Michael

{"title":"Utilising accessible and reproducible neurological assessments in clinical studies: Insights from use of the Neurological Impairment Scale in the multi-centre COVID-CNS study.","authors":"Ali M Alam, Glynn W Webb, Ceryce Collie, Sashini Mariathasan, Yun Huang, Orla Hilton, Rajish Shil, Katherine C Dodd, James B Lilleker, Craig J Smith, Ava Easton, Arina Tamborska, Rhys H Thomas, Nicholas W S Davies, Thomas M Jenkins, Michael Zandi, Laura Benjamin, Mark A Ellul, Tom Solomon, Thomas A Pollak, Tim Nicholson, Gerome Breen, Daniel J van Wamelen, Nicholas W Wood, Benedict D Michael","doi":"10.1016/j.clinme.2024.100241","DOIUrl":"10.1016/j.clinme.2024.100241","url":null,"abstract":"Reproducible and standardised neurological assessment scales are important in quantifying research outcomes. These scales are often performed by non-neurologists and/or non-clinicians and must be robust, quantifiable, reproducible and comparable to a neurologist's assessment. COVID-CNS is a multi-centre study which utilised the Neurological Impairment Scale (NIS) as a core assessment tool in studying neurological outcomes following COVID-19 infection. We investigated the strengths and weaknesses of the NIS when used by non-neurology clinicians and non-clinicians, and compared performance to a structured neurological examination performed by a neurology clinician. Through our findings, we provide practical advice on how non-clinicians can be readily trained in conducting reproducible and standardised neurological assessments in a multi-centre study, as well as illustrating potential pitfalls of these tools.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100241"},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pure red cell aplasia secondary to erythropoietin therapy. 继发于促红细胞生成素疗法的纯红细胞再生不良。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-07-01 Epub Date: 2024-07-17 DOI: 10.1016/j.clinme.2024.100229

Gwenno Mair Edwards, Abdulfattah A Alejmi

引用次数: 0

Reducing the harm associated in treating hyperkalaemia with insulin and dextrose. 减少使用胰岛素和葡萄糖治疗高钾血症的危害。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-07-01 Epub Date: 2024-06-12 DOI: 10.1016/j.clinme.2024.100222

Sara Abou Sherif, Irene Katsaiti, Hannah Jebb, Serena Banh, Rachna Bedi, Jeremy Levy, David Thomas, Damien Ashby, Richard Corbett

引用次数: 0

Vertebral body and spinal cord infarction in a pile-driver operator with fibrocartilaginous disc embolism. 一名患有纤维软骨椎间盘栓塞的打桩机操作员的椎体和脊髓梗塞。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-07-01 Epub Date: 2024-07-05 DOI: 10.1016/j.clinme.2024.100226

Sjx Murphy, Djh McCabe, R L O Donohoe, A J McCarthy

引用次数: 0

Mandibular movement monitor provides faster, yet accurate diagnosis for obstructive sleep apnoea: A randomised controlled study. 下颌运动监测仪为阻塞性睡眠呼吸暂停提供更快更准确的诊断：随机对照研究。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-07-01 Epub Date: 2024-07-22 DOI: 10.1016/j.clinme.2024.100231

Sulaiman S Alsaif, Wendy Douglas, Joerg Steier, Mary J Morrell, Michael I Polkey, Julia L Kelly

{"title":"Mandibular movement monitor provides faster, yet accurate diagnosis for obstructive sleep apnoea: A randomised controlled study.","authors":"Sulaiman S Alsaif, Wendy Douglas, Joerg Steier, Mary J Morrell, Michael I Polkey, Julia L Kelly","doi":"10.1016/j.clinme.2024.100231","DOIUrl":"10.1016/j.clinme.2024.100231","url":null,"abstract":"Many patients with obstructive sleep apnoea (OSA) remain undiagnosed and thus untreated, and in part this relates to delay in diagnosis. Novel diagnostic strategies may improve access to diagnosis. In a multicentre, randomised study, we evaluated time to treatment decision in patients referred for suspected OSA, comparing a mandibular movement (MM) monitor to respiratory polygraphy, the most commonly used OSA detection method in the UK. Adults with high pre-test probability OSA were recruited from both northern Scotland and London. 40 participants (70 % male, mean±SD age 46.8 ± 12.9 years, BMI 36.9 ± 7.5 kg/m2, ESS 14.9 ± 4.1) wore a MM monitor and respiratory polygraphy simultaneously overnight and were randomised (1:1) to receive their treatment decision based on results from either device. Compared to respiratory polygraphy, MM monitor reduced time to treatment decision by 6 days (median(IQR): 13.5 (7.0-21.5) vs. 19.5 (13.7-35.5) days, P = 0.017) and saved an estimated 29 min of staff time per patient.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100231"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Strongyloides stercoralis infection in the UK: A systematic review and meta-analysis of published cases. 英国的盘尾丝虫感染：对已发表病例的系统回顾和荟萃分析。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-07-01 Epub Date: 2024-07-14 DOI: 10.1016/j.clinme.2024.100227

Ali M Alam, Cansu Ozdemir, Nada Reza

{"title":"Strongyloides stercoralis infection in the UK: A systematic review and meta-analysis of published cases.","authors":"Ali M Alam, Cansu Ozdemir, Nada Reza","doi":"10.1016/j.clinme.2024.100227","DOIUrl":"10.1016/j.clinme.2024.100227","url":null,"abstract":"Strongyloidiasis is a helminth infection where symptoms vary, and asymptomatic presentation is common. Chronic strongyloidiasis can cause a high mortality 'hyper-infection' in immunocompromised states. Understanding at risk populations and symptomology can guide screening and early treatment to reduce hyper-infection risk. A systematic review of studies describing patients in the UK with strongyloidiasis pooled a total of 1,308 patients. Weighted pooled prevalence (WPP) of asymptomatic cases was 27.7% (95% CI 17.1-39.5%, I2 = 92%, p < 0.01). At-risk populations included migrants, returning travellers and armed forces personnel. The most common symptoms reported were abdominal pain (WPP 32.1% (95% CI 20.5-44.8%), I2 = 93%, p < 0.01), rashes (WPP 38.4% (95% CI 13.1-67.7%), I2 = 99%, p < 0.01) and diarrhoea (WPP 12.6% (95% CI 6.7-19.9%), I2=70%, p = 0.03). Symptomatology varied with cohort characteristics. Although asymptomatic presentation is common, patients may present with abdominal pain, diarrhoea or rashes. A low threshold for screening symptomatic individuals in at-risk groups is required.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100227"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11342261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The appropriateness of penicillin allergy de-labelling by non-allergist clinical ward teams. 非过敏学家临床病房团队对青霉素过敏进行去标签处理的适当性。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-07-01 Epub Date: 2024-06-27 DOI: 10.1016/j.clinme.2024.100225

Neil Powell, Shuayb Elkhalifa, Daniel Hearsey, Michael Wilcock, Jonathan Sandoe

{"title":"The appropriateness of penicillin allergy de-labelling by non-allergist clinical ward teams.","authors":"Neil Powell, Shuayb Elkhalifa, Daniel Hearsey, Michael Wilcock, Jonathan Sandoe","doi":"10.1016/j.clinme.2024.100225","DOIUrl":"10.1016/j.clinme.2024.100225","url":null,"abstract":"Objectives: We aimed to assess the appropriateness of penicillin allergy (PenA) assessment conducted by clinical teams and to review the safety of subsequent exposure of these patients to penicillin.Methods: Opportunistic, prospective observational study of usual clinical care, between 16 May 2023 and 14 August 2023, of inpatients with a PenA and requiring antibiotics, in a 750-bed hospital in England. To assess the appropriateness of management, PenA patients prescribed penicillins were grouped into risk categories using a validated antibiotic allergy assessment tool: eligible for de-label on history alone (direct de-label; DDL), eligible for direct oral challenge (DOC), high risk or unable to obtain history.Results: Of the 123 patients admitted with a PenA (or sensitivity record) and exposed to a penicillin, data were collected for 50. Their PenA records were grouped follows: eligible for DDL 34 (68%), eligible for DOC 11 (22%), high risk 4 (8%) and unable to obtain history 1 (2%). In 14/50 (28%) patients there was no evidence of a current PenA assessment in the medical notes.Conclusions: Using the allergy risk tool, most patients with PenA records were exposed to penicillin appropriately. However, patients meeting high-risk criteria were also exposed to penicillin when the tool excluded them. PenA assessment needs to be carried out with appropriate training and governance structures in place.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100225"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141466705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Letter to the Editor on Outpatient parenteral antibiotic treatment (OPAT) for infective endocarditis. 感染性心内膜炎的门诊肠外抗生素治疗（OPAT）。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-07-01 Epub Date: 2024-06-13 DOI: 10.1016/j.clinme.2024.100221

Marina Zafeiri, Temi Lampejo

引用次数: 0