Clinical Medicine最新文献

{"title":"Modern multidisciplinary management of brain metastasis.","authors":"Melyda, Ahmad Ozair, Sean E H Lau, Irene S Guterman, Faisal Fa'ak, Manmeet S Ahluwalia, Laura Alder, Paul M Brennan, Mahua Dey, Samuel Emerson, Vinton W T Cheng","doi":"10.1016/j.clinme.2026.100652","DOIUrl":"10.1016/j.clinme.2026.100652","url":null,"abstract":"<p><p>Brain metastases (BrM) are no longer considered to be a uniform end-stage complication of cancer, but as a biologically and clinically heterogeneous disease requiring coordinated management. This article synthesises the fundamentals of BrM diagnosis and treatment, relevant to primary and urgent care settings. Treatment sequencing should account for acuity of neurologic symptoms, anticipated intracranial response, extracranial disease tempo, steroid requirements, and risks of local therapy. Focal radiotherapy is now the dominant local modality for limited BrM. Surgery remains central for large, symptomatic, diagnostically uncertain, or mass-effect-producing lesions. Postoperative stereotactic radiosurgery is favoured over whole-brain radiotherapy. Novel CNS-active targeted agents and immune checkpoint inhibitors can permit deferral of radiotherapy in carefully selected asymptomatic patients with certain molecularly defined cancers. Follow-up, based on longitudinal MRI, requires multidisciplinary surveillance and decision-making. Optimal care combines integrated multidisciplinary management and risk-adapted sequencing to jointly achieve preservation of neurologic function while maintaining durable systemic control.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100652"},"PeriodicalIF":3.9,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105160","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}

{"title":"Evaluating the use of artificial intelligence and human guidance to teach generic and specialist skills in breaking bad news: A mixed methods exploration.","authors":"Miriam E Armstrong, Philip Bright, Stephen Glen, David Marshall, Michael C Jones","doi":"10.1016/j.clinme.2026.100649","DOIUrl":"10.1016/j.clinme.2026.100649","url":null,"abstract":"<p><strong>Objective: </strong>Breaking bad news (BBN) is specified in the General Medical Council's Generic Professional Capabilities framework, which sets out core skills to be developed alongside curricula-specified capabilities in postgraduate training. To date, a wide variety of approaches to teaching BBN have been used, however, the application of artificial intelligence (AI) to learning in this field remains in its early stages and requires further investigation.</p><p><strong>Design, setting, participants and intervention: </strong>Two approaches were compared in response to the question What is the best way to break bad news?: a human-facilitated discussion versus an AI-generated response using ChatGPT-4. Both approaches produced high-level guidance condensed into short statements for online mixed methods evaluation by experienced medical educators.</p><p><strong>Outcome measures and results: </strong>41 doctors from 17 specialties and eight lay representatives provided free-text commentary as part of the assessment. Overall findings were compared with popular patient-focused BBN protocols, such as SPIKES, with qualitative analysis providing more details of skills requirements for generic and specialist levels of practice by adding more depth and nuance via three themes: patient experience, professionalism and access to support. Both approaches matched well with patient-focused protocols albeit they also addressed doctors' debriefing after BBN.</p><p><strong>Conclusions: </strong>Overall, AI produced more comprehensive, highly rated guidance suitable for early careers, but qualitative evaluation highlighted the need for more specialised skills, their nature and application, plus differences in preferred style and content between approaches. The value of tailoring communication, via a personalised approach developed from real-life experience, was also confirmed.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100649"},"PeriodicalIF":3.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073786","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}

{"title":"Management of epilepsy in the brain tumour patient: Current concepts and practical approaches.","authors":"Jeremy Rees","doi":"10.1016/j.clinme.2026.100650","DOIUrl":"10.1016/j.clinme.2026.100650","url":null,"abstract":"<p><p>Brain tumour-related epilepsy (BTRE) is among the most common, disabling and feared complications of primary and metastatic brain tumours. Seizures cause significant suffering, psychosocial burden, reduced quality of life and lead inevitably to the loss of a driving license. The mechanisms underlying BTRE are multifactorial, including tumour-driven alterations in neuronal excitability and pro-epileptogenic metabolites. Management is more challenging than idiopathic epilepsy due to high rates of drug resistance, the natural history of brain tumours and potential interactions between anti-seizure medications (ASMs) and chemotherapy/steroids. This review summarises the pathophysiology of BTRE, outlines risk factors, and provides practical recommendations for ASM selection, prophylaxis, withdrawal, and the role of surgery, radiotherapy, chemotherapy, and neuromodulation. Updated clinical evidence supports the use of non-enzyme-inducing ASMs as first line treatment as these do not interact with chemotherapy/steroids and are better tolerated than the first generation ASMs. ASM prophylaxis is not recommended and ASM withdrawal, particularly in patients with gliomas, should be made only after careful consideration of the patient's seizure history and the stability of their disease.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100650"},"PeriodicalIF":3.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073756","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}

{"title":"Risk factors and clinical outcomes for acute kidney injury after surgery for primary spinal and pelvic bone tumours: Analysis of the US Nationwide Inpatient Sample 2005-2020.","authors":"Wen Yan Lin, Chun-Yen Chen","doi":"10.1016/j.clinme.2026.100651","DOIUrl":"10.1016/j.clinme.2026.100651","url":null,"abstract":"<p><strong>Study objective: </strong>Primary spinal tumours and pelvic bone tumours are rare but clinically challenging when they arise due to their complex anatomical locations and aggressive behaviour. Surgical resection is first-line treatment but is associated with a high risk of perioperative complications, including acute kidney injury (AKI)-a serious complication with limited evidence in adults undergoing surgery for primary spinal or pelvic bone tumours. This study aimed to evaluate the incidence, risk factors, and outcomes of AKI in adults undergoing surgery for primary spinal or pelvic bone tumours.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Nationwide Inpatient Sample (2006-2020).</p><p><strong>Participants: </strong>Adults aged 18 and older who underwent surgery for primary spinal or pelvic bone tumours (identified using ICD-9/10 codes).</p><p><strong>Interventions: </strong>Postoperative AKI (observational study).</p><p><strong>Comparisons: </strong>AKI.</p><p><strong>Main outcome measure(s): </strong>Risk factors of postoperative AKI and AKI-associated in-hospital outcomes, including complications, length of stay (LOS), and total hospital charges.</p><p><strong>Results: </strong>A total of 11,712 inpatients were included, representing 57,164 US hospitalisations after weighting. Postoperative AKI incidence was 2.4%. Patients with AKI had significantly longer hospital stays (adjusted β = 10.60 days), higher total hospital charges (adjusted β = $154,890), and increased risk of acute respiratory failure (aOR = 3.81), venous thromboembolism (aOR = 2.81), sepsis (aOR = 5.11), urinary tract infection (aOR = 2.20), and postoperative transfusion (aOR = 2.72) than those without AKI.</p><p><strong>Conclusions: </strong>Identifying high-risk patients and implementing perioperative kidney-protective strategies might improve outcomes in adults undergoing surgery for primary spinal or pelvic bone tumours.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100651"},"PeriodicalIF":3.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058852","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}

{"title":"Aspirin for the prevention of migraine in pregnancy: A retrospective, descriptive case series from a tertiary centre.","authors":"Cleodie Swire, Melanie Nana, Catherine Tew, Catherine Williamson, Catherine Nelson-Piercy","doi":"10.1016/j.clinme.2026.100648","DOIUrl":"10.1016/j.clinme.2026.100648","url":null,"abstract":"<p><strong>Study objective: </strong>To assess the use of low-dose aspirin for the prevention of migraine in pregnant women.</p><p><strong>Design: </strong>This was a single-centre, retrospective, descriptive case series. Data were obtained through a retrospective review of electronic clinical records. Data are reported on migraine history and pharmacological management of migraine prior to and during the index pregnancy, as well as maternal and neonatal outcomes.</p><p><strong>Setting: </strong>A specialist obstetric medicine clinic in London, UK.</p><p><strong>Participants: </strong>Pregnant women seen due to headache in the clinic between January 2020 and August 2023, with a diagnosis of 'migraine' in their electronic clinical records were selected for this study. 73 patients were eligible for inclusion.</p><p><strong>Interventions: </strong>Patients received routine clinical care as determined by the clinical team at the time; no study-specific interventions were applied.</p><p><strong>Main outcome measure(s): </strong>The main outcomes were frequency of low-dose aspirin use for migraine prevention in pregnancy, and change in migraine symptoms after aspirin was started for migraine prevention.</p><p><strong>Results: </strong>Pharmacological prevention for migraine was used by 66/73 (90%) women. Low-dose aspirin was taken for migraine prevention by 61/73 (86%); 36/61 (59%) had aspirin monotherapy and the remainder took more than one medication for this indication. In the aspirin monotherapy group, 30/31 (97%, 5/36 not documented) subsequently reported an improvement in their migraine. Maternal and neonatal outcomes were consistent with baseline data for the population.</p><p><strong>Conclusion: </strong>This case series adds to the literature describing use of low-dose aspirin for migraine prevention in pregnancy.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100648"},"PeriodicalIF":3.9,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036806","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}

{"title":"Letter to the Editor: Prevalence and cardiovascular associations of elevated lipoprotein(a) in people living with HIV: A cross-sectional study.","authors":"Ellesa Ahmad Nor Hisham, Devon Ward","doi":"10.1016/j.clinme.2026.100647","DOIUrl":"10.1016/j.clinme.2026.100647","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100647"},"PeriodicalIF":3.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024024","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}

{"title":"Updates to contemporary care of glioblastoma.","authors":"Bernadeth Lyn C Piamonte, Wiley Gillam, Megan E H Still, Ashley P Ghiaseddin, Matt Williams, Sara Elsharkawy, Christine Lu-Emerson","doi":"10.1016/j.clinme.2026.100643","DOIUrl":"10.1016/j.clinme.2026.100643","url":null,"abstract":"<p><p>Glioblastoma is the most common and aggressive primary malignant brain tumour in adults. Over the years, the diagnostic criteria have been refined, incorporating molecular markers with histology to reflect the underlying tumour biology. Advances in genomics and molecular techniques are currently focused on trying to subcategorise the tumours for potential prognostic and clinical purposes. Treatment consists of multiple modalities including surgery, radiation, and systemic treatments. While targeted therapy traditionally has not been effective due to the heterogeneity of the tumour, fusions and certain mutations may benefit from specific targeted therapies. Tumour treating fields is a novel treatment that has shown survival benefit in newly diagnosed glioblastoma, and ongoing trials are underway to capitalise on its mechanism. Finally, special consideration should be given to palliative care in light of the high morbidity and mortality associated with glioblastoma. In particular, the balance of aggressive care and quality of life must be weighed in the geriatric population though contemporary studies have shown good tolerance for a hypofractionated course of chemoradiation.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100643"},"PeriodicalIF":3.9,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012064","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}

{"title":"Artificial intelligence for detecting fall events, assessing fall risks, and preventing fall occurrences in the elderly: A narrative review.","authors":"Chen-Chang Shih, Syaun-Huei Lin, Wei-Jang Yen, Guang-Chih Cheng, Whai-En Chen, Chih-Chung Shiao","doi":"10.1016/j.clinme.2026.100642","DOIUrl":"10.1016/j.clinme.2026.100642","url":null,"abstract":"<p><p>Falls in the elderly represent a critical public health crisis, necessitating a shift from reactive to proactive management. This review evaluates artificial intelligence (AI) across four primary modalities: wearable sensors, vision-based systems, ambient devices, and natural language processing and large language models applied to electronic health records. Machine learning and deep learning algorithms enable real-time detection, near-fall identification, and predictive risk stratification. Hybrid edge-cloud frameworks and multimodal fusion enhance accuracy and scalability. However, challenges include the 'simulation gap' in training data, 'black box' interpretability, and privacy concerns, 'alarm fatigue' among nursing staff, and 'class imbalance.' Future directions emphasise hybrid systems, integrating multiple sensor streams with edge-cloud computing, to enhance ecological validity and responsiveness. Ultimately, seamless integration of interpretable AI into clinical workflows offers a transformative path toward personalised prevention, reducing fall-related morbidity and empowering elderly independence.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100642"},"PeriodicalIF":3.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001341","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}

{"title":"Neuropalliative care in brain cancer.","authors":"Akanksha Sharma, Margaret Johnson, Hannah Kim, Priya Kumthekar, Lalanthica V Yogendran, Cara Siegel, Zarnie Lwin, Johan A F Koekkoek, Lewis Z Leng, James Balogun, Jennifer Philip","doi":"10.1016/j.clinme.2026.100645","DOIUrl":"10.1016/j.clinme.2026.100645","url":null,"abstract":"<p><p>People with brain cancer experience substantial symptom burden, rapid functional decline, complex decision-making needs, and high care partner distress. Neuropalliative care offers a framework for integrating palliative care principles with neuro-oncology expertise across the disease trajectory, from diagnosis and treatment through recurrence, later deterioration, end-of-life care, and bereavement. This CME article summarises practical recommendations for embedding palliative care in routine brain cancer care, including early communication about goals and values, individualised symptom assessment and management, multidisciplinary care coordination, advance care planning, support for care partners, and the use of clinical triggers for specialty palliative care referral. As therapeutic options evolve, aligning disease-directed treatment with quality of life, patient priorities, and family support remains a central responsibility of clinicians caring for this population.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100645"},"PeriodicalIF":3.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001355","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}

{"title":"Redefining care for IDH-mutant low-grade gliomas: Clinical implications of the INDIGO trial and updated guidelines.","authors":"Kristin S Bartman, Katherine B Peters","doi":"10.1016/j.clinme.2026.100644","DOIUrl":"10.1016/j.clinme.2026.100644","url":null,"abstract":"<p><p>Pathogenic variants in the genes encoding isocitrate dehydrogenase (IDH1 and IDH2) are the defining driver mutations in diffuse low-grade gliomas. When IDH is mutated, the production of the oncometabolite 2-hydroxyglutarate triggers downstream metabolic changes that promote gliomagenesis. The identification of the isocitrate dehydrogenase mutation (mIDH) in diffuse gliomas has not only redefined prognosis but also treatment for patients with these tumours. With the identification of the IDH mutation, targeted therapies have emerged as a promising therapeutic strategy in gliomas. The INDIGO trial compared the IDH inhibitor vorasidenib to a placebo. Progression-free survival (PFS) and time to next intervention were extended in patients who received vorasidenib vs. placebo. The side-effect profile was tolerable compared to that of traditional cytotoxic chemotherapies. In August 2024, vorasidenib received FDA approval for the treatment of grade 2 mIDH gliomas and is included in the National Comprehensive Cancer Network Guidelines for central nervous system tumours.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100644"},"PeriodicalIF":3.9,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988380","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}