Clinical Medicine最新文献

{"title":"Palliative care: what's the evidence?","authors":"Sophie Pask, Fliss E M Murtagh, Jason W Boland","doi":"10.1016/j.clinme.2025.100320","DOIUrl":"10.1016/j.clinme.2025.100320","url":null,"abstract":"<p><p>Palliative care is essential for people with an advanced life-limiting illness. Most palliative care is delivered by healthcare professionals who do not specialise in palliative care ('non-specialists'). Multidisciplinary specialist palliative care services manage more complex problems, providing more comprehensive support when needed. Both 'non-specialist' and specialist palliative care improve patient and family outcomes and reduce formal healthcare costs. However, there are inconsistencies in the delivery of, and access to, 'non-specialist' and specialist palliative care. These inconsistencies and inequities lead to unrecognised and unmet palliative care needs. There is also inconsistent referral to specialist palliative care services. Unless there are greater resources and training, these issues will be exacerbated by an increasing need for palliative care with changing population demographics.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100320"},"PeriodicalIF":3.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968727","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":"The impact of workplace support components on the mental health and burnout of UK-based healthcare professionals: Insights from the CoPE-HCP cohort study.","authors":"George Collett, Alaa Emad, Ajay K Gupta","doi":"10.1016/j.clinme.2025.100324","DOIUrl":"10.1016/j.clinme.2025.100324","url":null,"abstract":"<p><strong>Study objective: </strong>To evaluate the influence of the perceived level of workplace support and its individual components in improving mental health and reducing burnout among healthcare professionals (HCPs).</p><p><strong>Design: </strong>In a cohort of 400 HCPs followed up since July 2020, a follow-up survey was done online (August 2023) containing detailed questionnaires regarding workplace support and mental health.</p><p><strong>Participants: </strong>400 UK-based HCPs.</p><p><strong>Main outcome measure(s): </strong>The level of individual workplace support components (perceived manager's concern for staff welfare, transparent communication, adequate staffing/safety, visible and approachable leadership, and collegial/peer support) were assessed using self-rating scales. Depression (PHQ-9), anxiety (GAD-7), insomnia (ISI), mental wellbeing (SWEMWBS) and burnout (emotional exhaustion, aMBI-EE; and depersonalisation, aMBI-DP) were assessed using validated tools.</p><p><strong>Results: </strong>Compared with feeling unsupported, feeling supported was associated with a reduced risk of probable depression, insomnia, low wellbeing and burnout, and was associated with an increased perceived level of all individual support components. An increase in the perceived level of collegial/peer support was associated with reduced depression, anxiety, insomnia and burnout, and increased wellbeing scores (all p-values <0.01). An increase in the perceived level of managerial understanding of staff welfare was associated with reduced burnout (emotional exhaustion) among HCPs (p<0.05). There was also evidence that varying levels of visible and approachable leadership may impact on depression, anxiety and insomnia (p<0.05).</p><p><strong>Conclusions: </strong>Adverse mental health and burnout among HCPs may be mitigated by good quality workplace support, specifically by fostering collegial/peer support among staff and ensuring that managers show genuine understanding for staff welfare and are visible and approachable in their leadership. These findings may guide the allocation of workplace support resources for HCPs.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100324"},"PeriodicalIF":3.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985123","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":"Pregnancy-specific dermatoses for the resident physician.","authors":"Niamh Theresa McSwiney, Eliza Hutchison, Hannah Wainman","doi":"10.1016/j.clinme.2025.100316","DOIUrl":"10.1016/j.clinme.2025.100316","url":null,"abstract":"<p><p>Pregnancy is associated with a wide range of cutaneous changes. Some are physiological and triggered by normal hormonal fluctuations during pregnancy. There are also a small number of pathological pruritic eruptions that exclusively occur during pregnancy, known as pregnancy-specific dermatoses (PSDs). In patients presenting with a PSD, features often include severe pruritus and characteristic inflammatory skin changes differing in onset, morphology and configuration. This article gives an overview of benign dermatological changes during pregnancy and the most important presentations of PSDs in order of prevalence: atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis and pustular psoriasis of pregnancy. Importantly, we outline how a resident physician can identify these disorders, how to initiate management and when a specialty referral for further investigations and monitoring of the mother and unborn fetus is warranted.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100316"},"PeriodicalIF":3.6,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982767","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":"Primary ciliary dyskinesia: Aetiology, diagnosis and clinical management.","authors":"Rachael Collison, Saara A Hyatali, Antoniya Kamenova, Adam Rashed, Dylan Riley, Kartik Kumar, Janet M Stowell, Michael R Loebinger","doi":"10.1016/j.clinme.2025.100319","DOIUrl":"10.1016/j.clinme.2025.100319","url":null,"abstract":"<p><p>Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterised by abnormal function of motile cilia. The condition usually manifests in early life with neonatal distress, chronic sinopulmonary disease and organ laterality disorders. In adults, it is an underdiagnosed cause of bronchiectasis as well as subfertility. This review provides an overview of PCD for clinicians. We discuss its aetiology, its presentation, how it is diagnosed and its multidisciplinary clinical management.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100319"},"PeriodicalIF":3.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955201","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":"Validation of ARIC heart failure risk score in an Asian population: Results from the CORE-Thailand registry.","authors":"Nichanan Osataphan, Ply Chichareon, Wanwarang Wongcharoen, Krit Leemasawat, Narawudt Prasertwitayakij, Pannipa Suwannasom, Siriluck Gunaparn, Kasem Rattanasumawong, Rungroj Krittayaphong, Arintaya Phrommintikul","doi":"10.1016/j.clinme.2025.100322","DOIUrl":"10.1016/j.clinme.2025.100322","url":null,"abstract":"<p><strong>Background: </strong>The Atherosclerotic Risk in Communities (ARIC) heart failure (HF) score was originally developed in the USA to predict new-onset HF. Our goal was to validate the ARIC-HF score and develop a new score to predict HF in an Asian population.</p><p><strong>Methods: </strong>The Cohort Of patients with high Risk for cardiovascular Events (CORE-Thailand) was a prospective registry of Thai patients with high atherosclerotic risk. Patients were followed for 5 years for HF events. The ARIC-HF score was applied to predict HF. The new ARIC-CORE score was developed by re-estimating the coefficients of ARIC score variables using ridge regression. The discrimination and calibration of the models were assessed. The net reclassification index (NRI) was used to compare the prediction performance between the models. Clinical utility was assessed with a decision curve analysis.</p><p><strong>Results: </strong>From a total of 8,919 patients, 185 (2.1 %) developed HF. The ARIC-HF score and ARIC-CORE HF risk score provided good discrimination with C-statistics of 0.710, (95 % confidence interval (CI); 0.673-0.747) and 0.75, (95 % CI; 0.715-0.785), respectively. Both models showed a good calibration. Using the ARIC-CORE HF score was associated with an improved reclassification of HF (NRI 0.369, 95 % CI; 0.286-0.551) compared to the ARIC-HF score. The net clinical benefit of the ARIC-CORE HF score was higher than the ARIC-HF score in the decision curve analysis.</p><p><strong>Conclusion: </strong>The ARIC-HF score performed well in predicting heart failure in the CORE population. The ARIC-CORE HF score showed superior predictive ability and clinical benefit. Further research is needed to validate these models in diverse Asian populations.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100322"},"PeriodicalIF":3.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964758","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":"Incidence of gestational diabetes in pregnant women with a history of bariatric surgery using a service evaluation.","authors":"B Jenner, D Jones, L C Kusinski, C Patient, A Park, A Sarker, V Bansiya, E M Gurnell, C L Meek","doi":"10.1016/j.clinme.2025.100318","DOIUrl":"10.1016/j.clinme.2025.100318","url":null,"abstract":"<p><strong>Background: </strong>Pregnant women with previous bariatric surgery are at increased risk of gestational diabetes mellitus (GDM) but many cannot safely tolerate the oral glucose tolerance test (OGTT). Consensus recommendations advise self-monitoring of blood glucose (SMBG) for GDM diagnosis, but diagnostic thresholds are unexplored in this population.</p><p><strong>Study objective: </strong>To assess the incidence of SMBG-defined GDM (fasting, 1-hr postprandial thresholds: 90, 140 mg/dL (5.3, 7.8 mmol/L)) after bariatric surgery, compared to the incidence of OGTT-defined GDM in women with risk factors for GDM but no history of bariatric surgery.</p><p><strong>Design and setting: </strong>Patients with a history of bariatric surgery (n=24) were included in a retrospective service evaluation based at a single tertiary referral centre in England, with results compared to a national study of women at high risk of GDM but without a history of bariatric surgery (n=1,308).</p><p><strong>Main outcome measures: </strong>The incidence of GDM diagnosed according to SMBG vs OGTT.</p><p><strong>Results: </strong>GDM incidence was 16/24 (66.7%; SMBG-defined) after bariatric surgery and 121/1,308 (9.3%; OGTT-defined) in the control group, with the highest incidence rates seen after gastric bypass (85.7%). In women with previous bariatric surgery, HbA1c showed no association with GDM diagnosis, the requirement for treatment or offspring birth weight.</p><p><strong>Conclusions: </strong>SMBG at standard thresholds is not able to reliably diagnose GDM after bariatric surgery and is likely to over-diagnose GDM, especially after gastric bypass, although small sample size limits generalisability of this study. Alternative diagnostic and prognostic markers are warranted for diagnosis of GDM after bariatric surgery.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100318"},"PeriodicalIF":3.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971747","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":"Advanced therapy screening in inflammatory bowel disease and the impact of clinical nurse specialists: A retrospective analysis of electronic patient records.","authors":"M Colwill, A Ward, K Jacob, R Hall, D Rasasingam, S O'Neill, F Donovan, J Clough, R Pollok, A Poullis","doi":"10.1016/j.clinme.2025.100317","DOIUrl":"https://doi.org/10.1016/j.clinme.2025.100317","url":null,"abstract":"<p><p>Advanced therapies (AT), encompassing biologics and small molecules, are a common and important treatment for inflammatory bowel disease (IBD). However, these treatments pose a risk of reactivating latent infections and therefore require pre-treatment infection screening, but compliance with this screening has previously been reported to be poor. Clinical nurse specialists (CNS) and pharmacists play a key role in facilitating this screening and safely initiating AT, but are understaffed compared to national standards. Through retrospective review of electronic patient records at St George's University Hospital, a tertiary IBD centre in London, UK, we evaluated the impact of staffing on rates of compliance with screening and time from prescription to administration of AT (TAT). 1,035 patients with IBD treated with an AT were identified, and we found a significant correlation between increased CNS staffing and improved screening compliance, as well as a numerical reduction in the TAT. Incidental findings were relatively low, with 8% of patients presenting positive results, all of whom had clinical risk factors. The study advocates for increased staffing and resources in IBD services to enhance patient safety and treatment efficacy.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"25 3","pages":"100317"},"PeriodicalIF":3.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968685","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":"The use of metaverse in medical education: A systematic review.","authors":"Qian Li, Hui Duan, Xinxu Zhou, Xiaobin Sun, Lan Tao, Xiuying Lu","doi":"10.1016/j.clinme.2025.100315","DOIUrl":"https://doi.org/10.1016/j.clinme.2025.100315","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to systematically evaluate the influence of metaverse-based teaching tools on the medical teaching effect and the improvement of students' ability, providing evidence-based support for curriculum development.</p><p><strong>Methods: </strong>A comprehensive search of PubMed, Cochrane, Embase and Web of Science databases was conducted up to 9 March 2025. Two researchers independently screened articles, extracted data, and assessed bias using the Cochrane Handbook 5.1.0 checklist. Data analysis was performed using RevMan 5.3.</p><p><strong>Results: </strong>Thirty studies involving 1,560 participants. The metaverse was applied in various areas such as surgery training, anatomy teaching and communication skills. Common metaverse approaches include AR, VR, MR etc, with simulated teaching times ranging from as little as 10 min to lasting several weeks. Most studies reported improved student guidance, reduced training time, and enhanced learning interest, and confidence.</p><p><strong>Conclusion: </strong>Metaverse technology proves effective for medical teaching, offering theoretical support for further research.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"25 3","pages":"100315"},"PeriodicalIF":3.6,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12059326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981534","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":"Unexplained breathlessness: Integrating pathophysiological insights with clinical evaluation.","authors":"Andrea Baccelli, Francesco Lo Giudice, Gulammehdi Haji, Rachel J Davies, Wendy Gin-Sing, Luke S Howard","doi":"10.1016/j.clinme.2025.100313","DOIUrl":"https://doi.org/10.1016/j.clinme.2025.100313","url":null,"abstract":"<p><p>Unexplained breathlessness is a challenging symptom encountered across diverse medical conditions. This review will briefly overview the interplay between central neural mechanisms and peripheral receptor activity leading to symptom perception. A holistic and multidisciplinary approach to unexplained breathlessness is crucial to assess and optimise known comorbidities, as well as investigate potential less common conditions associated with dyspnoea. Specific advanced testing modalities will be briefly discussed in the context of breathing pattern disorders, laryngeal hyperreactivity, disorders of the pulmonary vasculature, autonomic dysfunction and cardiovascular diseases.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"25 3","pages":"100313"},"PeriodicalIF":3.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971750","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":"Neurosyphilis: A rare cause of encephalitis in a young male.","authors":"William Cunningham, Michael Keogh, Nirmalan Arulanantham","doi":"10.1016/j.clinme.2025.100312","DOIUrl":"https://doi.org/10.1016/j.clinme.2025.100312","url":null,"abstract":"<p><p>Acute neurosyphilis is a rare but easily treatable cause of subacute confusion. Its clinical presentation is varied, with reported phenotypes ranging from acute stroke-like presentations to psychosis, dementia and meningoencephalitis. Neurosyphilis is easily detectable and treatable, despite its clinical heterogeneity. We present a 45-year-old man without HIV presenting with a subacute encephalitis, with cerebrospinal fluid and blood markers strongly positive for syphilis, with clinical improvement following 2 weeks of empirical intravenous antibiotic therapy.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"25 3","pages":"100312"},"PeriodicalIF":3.6,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962591","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}