Clinical Medicine最新文献_第2页

Hypertension and heart failure: Navigating blood pressure targets and medication titration and tolerance. 高血压和心力衰竭：导航血压目标和药物滴定和耐受性。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-04-17 DOI: 10.1016/j.clinme.2026.100584

Irfan Helmy, Mohamad Karnib, Varun Sundaram

引用次数: 0

Letter to the Editor: 'Using data and artificial intelligence to improve care pathways of older people experiencing falls and frailty: Opportunities, challenges and practical considerations for clinicians'. 致编辑的信：“利用数据和人工智能改善老年人跌倒和虚弱的护理途径：临床医生的机遇、挑战和实际考虑”。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-04-15 DOI: 10.1016/j.clinme.2026.100586

Preeti Lamba

引用次数: 0

Pitfalls in the pharmacotherapy of hypertension. 高血压药物治疗的陷阱。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-04-07 DOI: 10.1016/j.clinme.2026.100582

Ryan J McNally, Maisarah Amran, Albert Ferro, Carmela Maniero, Stefano Taddei, Luca Faconti

{"title":"Pitfalls in the pharmacotherapy of hypertension.","authors":"Ryan J McNally, Maisarah Amran, Albert Ferro, Carmela Maniero, Stefano Taddei, Luca Faconti","doi":"10.1016/j.clinme.2026.100582","DOIUrl":"10.1016/j.clinme.2026.100582","url":null,"abstract":"Despite the widespread availability of effective antihypertensive medications, blood pressure control remains unsatisfactory in a large number of patients, often due to avoidable dosing misconceptions rather than actual treatment resistance. This educational review aims to facilitate continuing medical education and clinical practice by exploring existing challenges in the pharmacological management of hypertension, focusing on the common drugs prescribed to manage hypertension. After reading this article, clinicians should be able recognise non-linear dose-response relationships, select appropriate medications and doses to achieve better blood pressure control, improve compliance alongside managing side effects that have led to premature discontinuation of beneficial medications. The review further explores how pharmacokinetic properties and patient-specific considerations, such as renal function and ethnicity, might influence choice of antihypertensive medications. This article aims to strengthen clinical choice, medication adherence and long-term management of blood pressure.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100582"},"PeriodicalIF":3.9,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644470","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

Dyslipidaemia and cardiovascular risk - Key considerations in South Asians. 血脂异常和心血管风险——南亚人的主要考虑因素。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-04-07 DOI: 10.1016/j.clinme.2026.100571

Aneesha Chauhan, Shaan Sahota, Lavandan Jegatheeswaran, Haneesh Kaur Johal, Rubin Minhas, Prashanth Patel, Pankaj Gupta, Vinod Patel, Amitava Banerjee, Kiran Patel, Anvesha Singh

引用次数: 0

Life expectancy of UK physicians in the early 21st century: An analysis of 1,000 fellows from the Royal College of Physicians' Munk's Roll. 21世纪初英国医生的预期寿命：对皇家医师学院蒙克名册1000名研究员的分析。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-04-06 DOI: 10.1016/j.clinme.2026.100579

I Dafydd Woolley, Peter N Taylor, Justyna Witczak, Fizzah Iqbal, Anna Scholz, Andrew Lansdown

{"title":"Life expectancy of UK physicians in the early 21st century: An analysis of 1,000 fellows from the Royal College of Physicians' Munk's Roll.","authors":"I Dafydd Woolley, Peter N Taylor, Justyna Witczak, Fizzah Iqbal, Anna Scholz, Andrew Lansdown","doi":"10.1016/j.clinme.2026.100579","DOIUrl":"10.1016/j.clinme.2026.100579","url":null,"abstract":"Study objective: To determine life expectancy among UK physicians using the Royal College of Physicians' (RCP) Munk's Roll and to identify demographic or professional factors associated with longevity.Design: Retrospective observational study of biographical records.Setting: Munk's Roll, RCP.Participants: Random sample of 1,000 fellows from Volume XII (2005-2023).Main outcome measures: Age at death; associations with sex, birthplace, place of qualification, specialty and hobbies.Results: 995 fellows (915 male, 80 female) were included. Median age at death: 84.0 years (range 34.7-105.0). Men lived longer than women (84.2 vs 80.5 years, p = 0.033). Fellows with obituaries mentioning gardening lived longer than those without (86.0 vs 83.5 years, p = 0.0008). Median age at death varied by region of qualification: North America 94.0, Europe 92.9, Australasia 87.5, Ireland 87.7, UK 84.1, and Indian subcontinent 76.0 years. Age at death differed significantly by region of qualification (p < 0.0001), with fellows qualifying in the Indian subcontinent living notably shorter lives. There were no consistent differences in longevity across specialty groups after adjustment, although pathologists had longer survival (+8.0 years vs cardiologists, p = 0.004).Conclusions: UK physicians recorded in the Munk's Roll have substantially higher life expectancy than the general population. Sex differences favouring male physicians and longevity advantages associated with gardening and certain qualification regions were observed. Specialty was not a major determinant of survival. These findings highlight historical inequalities within the profession and the potential importance of wellbeing-related activities in supporting physician longevity.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100579"},"PeriodicalIF":3.9,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638094","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

Renin-aldosterone testing: The essentials. 肾素-醛固酮测试：必需品。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-03-31 DOI: 10.1016/j.clinme.2026.100576

Eunice K T Phillips, Abilash Sathyanarayanan

{"title":"Renin-aldosterone testing: The essentials.","authors":"Eunice K T Phillips, Abilash Sathyanarayanan","doi":"10.1016/j.clinme.2026.100576","DOIUrl":"10.1016/j.clinme.2026.100576","url":null,"abstract":"Primary aldosteronism (PA) is a common yet significantly underdiagnosed cause of secondary hypertension, estimated to affect around 9.4% of hypertensive adults. This is critical because patients with PA face markedly higher rates of adverse cardiovascular and renal outcomes, risks substantially mitigated by targeted treatment (surgery or medical therapy). Despite this, screening rates remain critically low. This article provides a practical, evidence-based approach to PA screening specifically for generalist settings, focusing on contemporary test interpretation and mitigating common pitfalls. Screening involves a simple blood test for plasma aldosterone and renin. The diagnostic hallmark is renin-independent aldosterone production, demonstrated by suppressed renin. While most antihypertensives interfere, the initial approach is to test patients on their current regimen. If results are inconclusive, medication withdrawal is warranted. Specialist referral is necessary when results are suggestive of PA, or in complex cases like chronic kidney disease. Improving PA screening offers a significant opportunity for substantial global benefit in reducing hypertension-related morbidity and mortality.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100576"},"PeriodicalIF":3.9,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13127190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615852","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

Renin-angiotensin system inhibitors (RASi) are not nephrotoxic - they protect the kidneys and the heart. 肾素-血管紧张素系统抑制剂（RASi）没有肾毒性——它们保护肾脏和心脏。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-03-30 DOI: 10.1016/j.clinme.2026.100577

Jonathan S Murray, Paul R Kalra, Lisa J Anderson, Nicholas M Selby, Simon Sawhney, William S McKane, Marlies Ostermann, Nitin V Kolhe, Stephen J McWilliam, Karen Nagalingam, Shelagh Bickerton, Andrew J P Lewington, William T Hinchliffe, Simon J Smith, Michael Wise, Alan Hancock, Edward Kingdon, Paul Cockwell, Matthew T James, Thomas Blakeman, John D Dean, Clare Morlidge, Laurie A Tomlinson, Darren Green

{"title":"Renin-angiotensin system inhibitors (RASi) are not nephrotoxic - they protect the kidneys and the heart.","authors":"Jonathan S Murray, Paul R Kalra, Lisa J Anderson, Nicholas M Selby, Simon Sawhney, William S McKane, Marlies Ostermann, Nitin V Kolhe, Stephen J McWilliam, Karen Nagalingam, Shelagh Bickerton, Andrew J P Lewington, William T Hinchliffe, Simon J Smith, Michael Wise, Alan Hancock, Edward Kingdon, Paul Cockwell, Matthew T James, Thomas Blakeman, John D Dean, Clare Morlidge, Laurie A Tomlinson, Darren Green","doi":"10.1016/j.clinme.2026.100577","DOIUrl":"10.1016/j.clinme.2026.100577","url":null,"abstract":"Healthcare professionals should not label medications as 'kidney toxins' unless this is actually the case, especially medications that instead confer clear prognostic benefit, such as renin-angiotensin system inhibitors (RASi). This is imperative when discussing treatments with people with long-term health conditions, for whom RASi significantly reduce death, progression of chronic kidney disease (CKD) and hospitalisation. RASi are fundamental to management of heart failure with reduced ejection fraction (HFrEF) and CKD with proteinuria, yet are frequently called 'nephrotoxic'. The association between RASi use and acute kidney injury (AKI) is too often mistaken for 'causation'; it is largely driven by the use of RASi to treat long-term conditions that increase AKI risk, such as HFrEF, CKD and diabetes mellitus. Mislabelling RASi as 'nephrotoxic' adversely affects vital decision making, driving a tendency for RASi avoidance, even when RASi use has clear prognostic benefit. Healthcare education must embed this clinically important change to convention.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100577"},"PeriodicalIF":3.9,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147589962","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: 'Diabetes and technology - an update for the general physician'. 对“糖尿病和技术——给普通医生的更新”的评论。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-03-27 DOI: 10.1016/j.clinme.2026.100578

Prajakta Udmale, Vaishali Khobragade, Aparna Dixit

引用次数: 0

Obstructive sleep apnoea and hypertension: Current understanding, diagnosis and management. 阻塞性睡眠呼吸暂停和高血压：当前的认识、诊断和管理。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-03-26 DOI: 10.1016/j.clinme.2026.100575

Medhia Afzal, Alana Livesey, Mohammed Awais Hameed, Rahul Mukherjee

{"title":"Obstructive sleep apnoea and hypertension: Current understanding, diagnosis and management.","authors":"Medhia Afzal, Alana Livesey, Mohammed Awais Hameed, Rahul Mukherjee","doi":"10.1016/j.clinme.2026.100575","DOIUrl":"10.1016/j.clinme.2026.100575","url":null,"abstract":"Obstructive sleep apnoea (OSA) is a common, underdiagnosed disorder characterised by upper airway collapse, intermittent hypoxia and sympathetic activation. Hypertension frequently coexists with OSA, with evidence supporting OSA-driven hypertension mediated by sympathetic overactivity, RAAS (renin-angiotensin-aldosterone system) activation and endothelial dysfunction. OSA-related hypertension often manifests as nocturnal hypertension and is linked to adverse cardiovascular outcomes. Prevalence is high in resistant hypertension, supporting targeted screening. Diagnosis should be considered in patients with daytime somnolence or refractory hypertension, using validated screening tools and sleep studies. Continuous positive airway pressure (CPAP) is the cornerstone of OSA management and can modestly lower blood pressure with cardiovascular benefit. Pharmacological management should follow hypertension guidelines, favouring agents that target relevant mechanisms (eg RAAS blockade and beta-blockade). Aldosterone antagonists are recommended in resistant hypertension. Emerging therapies, including endothelin receptor antagonists and GLP-1 receptor agonists, show promise but require further trials. This article reviews the epidemiology, mechanisms, diagnosis and management of OSA-related hypertension.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100575"},"PeriodicalIF":3.9,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13126342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147572864","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

Post-surgical electron beam radiotherapy for prevention of keloid recurrence: A retrospective study of 619 cases demonstrating low recurrence (6.5%) with optimised 18 Gy in two fractions. 术后电子束放疗预防瘢痕疙瘩复发：619例低复发率（6.5%）的回顾性研究，优化18Gy分为两部分。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-03-26 DOI: 10.1016/j.clinme.2026.100572

Zong-An Chen, Qian-Yu Ma, Ling-Ling Xia, Wen-Bo Wang, Jie-Hua Wang, Wei Liu, Hui Yao, Zhen Gao, Xiao-Li Wu, Jun Yang

{"title":"Post-surgical electron beam radiotherapy for prevention of keloid recurrence: A retrospective study of 619 cases demonstrating low recurrence (6.5%) with optimised 18 Gy in two fractions.","authors":"Zong-An Chen, Qian-Yu Ma, Ling-Ling Xia, Wen-Bo Wang, Jie-Hua Wang, Wei Liu, Hui Yao, Zhen Gao, Xiao-Li Wu, Jun Yang","doi":"10.1016/j.clinme.2026.100572","DOIUrl":"10.1016/j.clinme.2026.100572","url":null,"abstract":"Background: Although post-surgical radiotherapy is common in keloid management, factors influencing its efficacy remain unclear. The aim of this study is to investigate postoperative electron beam radiotherapy's impact on recurrence and adverse effects.Methods: A retrospective study was conducted to evaluate the recurrence rates and complications across three radiation schemes: 17.5 Gy / five fractions, 20 Gy / four fractions, and 18 Gy / two fractions.Results: The overall recurrence rate was 6.5%, with the lowest recurrence (2.8%) observed in the 18 Gy / two-fraction regimen. Radiation schemes, lesion condition (type, location, and duration), and family history were associated with post-surgical recurrence. Furthermore, hyperpigmentation (32%) and dermatitis (11.8%) were identified as significant adverse events. No radiation-related cancers were observed during follow-up.Conclusion: The 18 Gy / two-fraction regimen post-surgical electron beam radiotherapy emerged as the most effective and safe option for keloid recurrence prevention. Features, including lesion type, location, family history and disease duration should be combined to guide therapeutic strategy.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100572"},"PeriodicalIF":3.9,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13127197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147572207","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