Clinical Medicine最新文献_第2页

Cerebrospinal fluid leak-associated ventriculitis - a case report. 本月经验：脑脊液漏相关脑室炎1例报告

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-01-01 Epub Date: 2024-12-18 DOI: 10.1016/j.clinme.2024.100279

Amir Waheed, Faryal Amir

引用次数: 0

Long COVID services: Implementing discrete event simulation, a quality improvement proposition. 致编辑的信--提高成人长期护理服务质量。实施离散事件模拟，提高质量。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-01-01 Epub Date: 2024-12-12 DOI: 10.1016/j.clinme.2024.100280

Eman Albastaki

引用次数: 0

Severe acute pulmonary embolism in pregnancy. 妊娠期严重急性肺栓塞。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-01-01 Epub Date: 2024-12-14 DOI: 10.1016/j.clinme.2024.100274

Bhaskar Narayan

引用次数: 0

Approach to investigation and management of proteinuria in pregnancy. 妊娠期蛋白尿的调查与处理方法。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-01-01 Epub Date: 2024-12-26 DOI: 10.1016/j.clinme.2024.100281

Isabela Bertoni, Sion Williams

{"title":"Approach to investigation and management of proteinuria in pregnancy.","authors":"Isabela Bertoni, Sion Williams","doi":"10.1016/j.clinme.2024.100281","DOIUrl":"10.1016/j.clinme.2024.100281","url":null,"abstract":"Pregnancy leads to significant changes in renal physiology, which result in increases in glomerular filtration rate (GFR) and enhanced protein excretion. These changes may continue in the postnatal period and might be observed for 5-6 months after birth. Once confirmed, proteinuria warrants investigation and close surveillance. Clinicians should establish the level of excretory kidney function and the presence or absence of proteinuria at booking/diagnosis. A history of proteinuria, PET and anti-hypertensive requirements in previous pregnancies is a helpful guide to what to expect in the current pregnancy. Maternal physiological adaptations mean that yet-undiagnosed kidney disease is unmasked during pregnancy. New onset of proteinuria before 20 weeks' gestation (with or without kidney impairment) suggests known or previously undetected kidney disease. As pregnancy evolves, hyperfiltration may lead to increasing proteinuria, posing a diagnostic challenge in the diagnosis and recognition of pre-eclampsia. This article was written as a guide for the evaluation and management of proteinuria in pregnancy, as well as appreciating diagnostic dilemmas.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100281"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892093","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 feasibility of a novel national quality improvement programme for tobacco dependency treatment pathways in acute UK hospitals. 英国急症医院烟草依赖治疗路径的新型国家质量改进计划的可行性。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-01-01 Epub Date: 2024-11-13 DOI: 10.1016/j.clinme.2024.100263

Robyn Fletcher, Alexander Hammant, Christina Moll, Miguel Souto, Sanjay Agrawal

{"title":"The feasibility of a novel national quality improvement programme for tobacco dependency treatment pathways in acute UK hospitals.","authors":"Robyn Fletcher, Alexander Hammant, Christina Moll, Miguel Souto, Sanjay Agrawal","doi":"10.1016/j.clinme.2024.100263","DOIUrl":"10.1016/j.clinme.2024.100263","url":null,"abstract":"Introduction: The prevalence of smoking remains stubbornly high in the UK despite comprehensive tobacco control measures. A national quality improvement (QI) approach to enhance the treatment of an estimated 1,000,000 annual hospital admissions of tobacco smokers could provide a new opportunity to improve population health and reduce healthcare demand. Barriers to QI include knowledge, costs and competing demands. This study aimed to evaluate the feasibility and effectiveness of a national QI programme hosted by the British Thoracic Society, focused on improving NHS tobacco dependency treatment in acute hospitals.Methods: The programme utilised the Model for Improvement as its QI framework and was delivered over a 6-month period. 25 teams from across the UK were upskilled through a series of webinars and coaching sessions and undertook QI projects focused on specific areas of their local tobacco dependency treatment pathways.Results: Results of the programme demonstrated improvements across the treatment pathway including screening for smoking status, rapid provision of nicotine replacement therapy to prevent nicotine withdrawal, referrals to inpatient tobacco dependency treatment teams and transfers of care to community services. Other programme outcomes included increases in QI knowledge, confidence and attitudes along with enhanced project management skills.Conclusion: This novel, national, online QI programme supported participating multidisciplinary teams in acute trusts across the UK to deliver tobacco dependency treatment pathway improvements using QI tools and methodology. This programme demonstrated the feasibility and effectiveness of delivering a national QI programme, at low cost using a microsystems approach applied to an important area of clinical medicine.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100263"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615145","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

Acute confusion in pregnancy. 妊娠期急性精神错乱。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-01-01 Epub Date: 2024-12-03 DOI: 10.1016/j.clinme.2024.100273

Amanda Hill, Francesca Neuberger

引用次数: 0

Management of asthma in pregnancy. 妊娠期哮喘的管理。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-01-01 Epub Date: 2024-12-17 DOI: 10.1016/j.clinme.2024.100277

C E Jones, Y Jamil

引用次数: 0

Acknowledgements of Reviewers in 2024.

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-01-01 DOI: 10.1016/j.clinme.2025.100289

引用次数: 0

Controversies in thyroid disease management in pregnancy. 妊娠期甲状腺疾病管理的争议。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-01-01 Epub Date: 2025-01-17 DOI: 10.1016/j.clinme.2025.100287

Pushpa Singh, Kristien Boelaert

{"title":"Controversies in thyroid disease management in pregnancy.","authors":"Pushpa Singh, Kristien Boelaert","doi":"10.1016/j.clinme.2025.100287","DOIUrl":"10.1016/j.clinme.2025.100287","url":null,"abstract":"Adequate control of thyroid function is crucial for optimal pregnancy outcomes and neurodevelopment of the offspring, and testing for thyroid function is ideally performed using manufacturer- and gestation-specific reference ranges. While universal screening for thyroid dysfunction is not recommended, targeted case finding of women at risk of thyroid disease during pregnancy is advised. A number of controversies continue to fuel debate including: (i) the target range for thyroid stimulating hormone (TSH) in women with subfertility planning pregnancy, (ii) management of mild thyroid hypofunction before and during pregnancy, (iii) the treatment of thyroid peroxidase (TPO) antibody-positive euthyroid women with levothyroxine, (iv) the optimal choice of antithyroid treatment in women with hyperthyroidism. A significant body of evidence has accumulated in recent years, including large systematic reviews and meta-analyses of observational studies determining effects of thyroid dysfunction on pregnancy and fetal outcomes. In addition, outcomes from important randomised trials continue to inform current guidance on how to best care for women with thyroid dysfunction before and during pregnancy.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100287"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001486","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

Diabetic ketoacidosis and hyperglycaemic hyperosmolar syndrome in patients with cancer: A multicentre study. 癌症患者的糖尿病酮症酸中毒和高血糖高渗综合征：一项多中心研究。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-01-01 Epub Date: 2024-11-09 DOI: 10.1016/j.clinme.2024.100262

Rabia K Shahid, Qasem Haider, Sunil Yadav, Duc Le, Shahid Ahmed

{"title":"Diabetic ketoacidosis and hyperglycaemic hyperosmolar syndrome in patients with cancer: A multicentre study.","authors":"Rabia K Shahid, Qasem Haider, Sunil Yadav, Duc Le, Shahid Ahmed","doi":"10.1016/j.clinme.2024.100262","DOIUrl":"10.1016/j.clinme.2024.100262","url":null,"abstract":"Background: Diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar syndrome (HHS) are life-threatening complications of diabetes mellitus. However, limited data about DKA and HHS are available in patients with cancer. The current study aimed to determine characteristics and outcomes of patients with cancer who were admitted with DKA/HHS in a mid-size Canadian city.Methods: Consecutive adult patients with an active cancer who were admitted with DKA or HHS from January 2008 to December 2020 in the city of Saskatoon, Saskatchewan, Canada were retrospectively evaluated. A univariate logistic regression analysis was performed to examine the correlation of various clinical variables with hospital mortality.Results: During the study period 6,555 patients with diabetes and cancer were admitted in one of the three tertiary care hospitals. Among them 33 (0.5 %) eligible patients with DKA or HHS with a median age of 60 years (range 36-94 years) were identified. In 36 % of patients, DKA or HHS was the presenting manifestation of newly diagnosed diabetes. Of all patients, 66 % developed DKA and 73 % had an advanced cancer. Overall, 52 % patients received a systemic cancer therapy prior to the admission, and 41 % received steroids. Ten (42 %) of 24 patients with an advanced cancer died, compared to none of the nine patients with an early-stage cancer (p = 0.032). No clinical factors significantly correlated with hospital mortality.Conclusions: Although DKA or HHS is uncommon in patients with diabetes and cancer, it is the manifestation of undiagnosed diabetes in about one-third of patients with cancer. It has been associated with high hospital mortality in patients with advanced cancer.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100262"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615222","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