Clinical Medicine最新文献

{"title":"A mixed-methods evaluation of a novel targeted health messaging intervention to promote COVID-19 protective behaviours and vaccination among Black and South Asian communities living in the UK (the COBHAM study).","authors":"Katie Sutton, Jo Armes, Lindsay Forbes, Amran Mohamed, Shuja Shafi, Reham Mustafa, Sunayana Shah, Andrew Hayward, Tasneem Pirani, Tushna Vandrevala, Jane Hendy, Osman Dar, Miqdad Asaria, Alimuddin Zumla, Aftab Ala","doi":"10.1016/j.clinme.2025.100285","DOIUrl":"10.1016/j.clinme.2025.100285","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate an intervention (a film and electronic leaflet) disseminated via text message by general practices to promote COVID-19 preventative behaviours in Black and South Asian communities.</p><p><strong>Methods: </strong>We carried out a before-and-after questionnaire study of attitudes to and implementation of COVID-19 preventative behaviours, and qualitative interviews about the intervention, with people registered with 26 general practices in England who identified as Black or South Asian.</p><p><strong>Results: </strong>In the 108 people who completed both questionnaires, we found no significant change in attitudes to and implementation of COVID-19 preventative behaviours, although power was too low to detect significant effects. A key qualitative finding was that participants felt they did not 'belong' to the group targeted by the intervention.</p><p><strong>Conclusion: </strong>Interventions targeting ethnic minorities in the UK need to acknowledge the heterogeneity of experience and circumstances of the target group so that people feel that the intervention is relevant to them.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100285"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11876826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037387","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":"Body fat changes and risk of new onset of hypertension and hyperlipidaemia among Korean adults: A longitudinal study.","authors":"Jinyoung Shin, Sang-Hyun Park, Jae Hoon Cho, Tae-Eun Kim","doi":"10.1016/j.clinme.2025.100293","DOIUrl":"10.1016/j.clinme.2025.100293","url":null,"abstract":"<p><strong>Background: </strong>This study examined the association between changes in body fat, body mass index (BMI), and the risk of newly developed hypertension and hyperlipidaemia in the general population.</p><p><strong>Methods: </strong>This longitudinal study included 17,598 individuals without prior hypertension and hyperlipidaemia who underwent at least three health examinations between January 2015 and December 2022. Body fat was classified as decreased (≥ 5%), stable (within 5%), and increased (≥ 5%) using bioelectrical impedance analysis. BMIs were categorised as healthy weight/underweight (BMI < 23), overweight (23 ≤ BMI < 25), and obesity (BMI ≥ 25). Hypertension and hyperlipidaemia were identified through self-reported medication use or clinical measurements.</p><p><strong>Results: </strong>Increases in BMI or body fat were associated with higher incidence rates of hypertension and hyperlipidaemia. Decreased body fat was associated with a lower risk of hypertension in the overweight (odds ratio: 0.638, 95% confidence interval: 0.464-0.876) and obese groups (0.724, 0.577-0.909). Individuals with healthy weight/underweight with increased body fat had a higher incidence of hyperlipidaemia than individuals with overweight with decreased body fat (87.2 vs 66.4 per 1,000 people). Compared to the stable body fat group, increased body fat raised the risk of hyperlipidaemia (healthy weight/underweight: 1.522, 1.248-1.855; overweight: 1.278, 1.032-1.583; and obesity: 1.214, 1.028-1.433). Individuals living with overweight with decreased body fat demonstrated a lower risk of hyperlipidaemia (0.546, 0.400-0.747).</p><p><strong>Conclusions: </strong>Increased body fat was associated with a higher risk of hyperlipidaemia, even within the same BMI category. Decreasing body fat, particularly in individuals living with overweight, is associated with a lower risk of hypertension and hyperlipidaemia.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100293"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413624","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":"Risk Factors and An Interpretability Tool of In-hospital Mortality in Critically Ill Patients with Acute Myocardial Infarction.","authors":"Rui Yang, Tao Huang, Renqi Yao, Di Wang, Yang Hu, Longbing Ren, Shaojie Li, Yali Zhao, Zhijun Dai","doi":"10.1016/j.clinme.2025.100299","DOIUrl":"https://doi.org/10.1016/j.clinme.2025.100299","url":null,"abstract":"<p><strong>Purpose: </strong>We aim to develop and validate an interpretable machine-learning model that can provide critical information for the clinical treatment of critically ill patients with acute myocardial infarction (AMI).</p><p><strong>Methods: </strong>All data was extracted from the multi-centre database (training and internal validation cohorts: MIMIC-III/-IV, external validation cohort: eICU). After comparing different machine-learning models and several unbalanced data processing methods, the model with the best performance was selected. Lasso regression was used to build a compact model. Seven evaluation methods, PR, and ROC curves were used to assess the model. The SHapley Additive exPlanations (SHAP) values were calculated to evaluate the feature's importance. The SHAP plots were adopted to explain and interpret the results. A web-based tool was developed to help application.</p><p><strong>Results: </strong>A total of 12,170 critically ill patients with AMI were included. The balance random forest (BRF) model had the best performance in predicting in-hospital mortality. The compact model did not differ from the full variable model in performance (AUC: 0.891 vs 0.885, P = 0.06). The external validation results also demonstrated the stability of the model (AUC: 0.784). All SHAP plots have shown the contribution ranking of all variables in the model, the relationship trend between variables and outcomes, and the interaction mode between variables. A web-based tool is constructed that can provide individualized risk stratification probabilities (https://github.com/huangtao36/BRF-web-tool) .</p><p><strong>Conclusion: </strong>We built the BRF model and the web-based tool by the model algorithm. The model effect has been verified externally. The tool can help clinical decision-making.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100299"},"PeriodicalIF":3.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536893","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 management of severe eczema in pregnancy.","authors":"E Keeling, C H Smith, R T Woolf","doi":"10.1016/j.clinme.2024.100282","DOIUrl":"10.1016/j.clinme.2024.100282","url":null,"abstract":"<p><p>Atopic eczema (eczema; also known as atopic dermatitis) is a chronic inflammatory skin condition. The burden of eczema can be very substantial with significant itch, skin pain, secondary infection, sleep disturbance and psychological distress. Eczema is common in pregnancy. It is therefore important to offer effective treatment to pregnant women, especially those with moderate to severe disease where the burden is greatest. When eczema cannot be adequately managed with skin-directed approaches such as topical preparations and/or phototherapy, systemic therapy may be required to achieve disease control and requires early input from dermatology specialists. The aim of this short review is to summarise this approach.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100282"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902792","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":"Clinical inertia - It is imperative to avoid delays in managing common conditions in pregnancy.","authors":"Anita Banerjee, Ponnusamy Saravanan","doi":"10.1016/j.clinme.2025.100286","DOIUrl":"10.1016/j.clinme.2025.100286","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100286"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001481","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":"Impact on clinical outcomes, surgical interventions, anaesthetic decisions and complication rates following implementation of the NICE obstructive sleep apnoea guidelines during preoperative screening.","authors":"Gabrielle Shaw, Ricki Leggatt, Paige Roberts, Amanda Peace Witton, Nicole Moll, Akshay Dwarakanath","doi":"10.1016/j.clinme.2024.100266","DOIUrl":"10.1016/j.clinme.2024.100266","url":null,"abstract":"<p><strong>Introduction: </strong>Unidentified obstructive sleep apnoea (OSA) can lead to unexpected perioperative complications, unplanned postoperative admissions and increased length of hospital stay. NICE (National Institute for Health and Care Excellence) recommends a rapid preoperative assessment for patients undergoing elective surgery.</p><p><strong>Methods: </strong>We have evaluated the impact on implementing the NICE guidelines on clinical outcomes, surgical interventions, anaesthetic decisions and complication rates in surgical patients referred from the pre-assessment clinic prior to an elective intervention. All patients with a clinical suspicion of OSA based on a STOP-Bang score of 3 or more were referred for an overnight oximetry. Demographics, clinical outcomes and the impact on the planned surgical procedures were evaluated.</p><p><strong>Results: </strong>450 patients (Age 55 ± 14 years, male 69%, Epworth Sleepiness Scale (ESS) 7 ± 5) with a STOP-Bang score of 3 or more underwent overnight oximetry (32%; normal, 44%; mild, 15%; moderate and 9%; severe OSA). All patients with moderate and severe OSA were recommended for continuous positive airway pressure (CPAP) therapy to facilitate their surgical procedures and for long-term cardiometabolic benefits. Diagnosis of moderate/severe OSA had an impact on the surgical decision (P < 0.0001, odds ratio (OR) = 3.79, 95% confidence interval (CI) = 2.39-6.02). Severity of OSA affected the planned anaesthetic route (P < 0.0001, OR = 3.94, 95% CI = 2.21-7.05). No significant difference in day case vs non-day case, or need for unplanned admissions to critical care due to better planning pre-procedure. CPAP was initiated preoperatively in a third of patients (mean compliance 3.75 hours/day) and the overall complication rate was 11.6% in the moderate/severe OSA group vs 9.6% in the normal/mild OSA group.</p><p><strong>Conclusion: </strong>Prevalence of OSA is high in presurgical patients identified through preoperative screening. A diagnosis of moderate to severe OSA impacts surgical decision and planned anaesthetic route. Prior awareness of the diagnosis may help clinicians to identify the at-risk group. Timely CPAP initiation to facilitate surgery remains a challenge and, despite low compliance, CPAP may reduce postoperative complications. A multidisciplinary team (MDT) approach and a dedicated CPAP pathway post-diagnosis may help the clinicians and patients.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100266"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11696840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681075","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":"Clinical approach to palpitations in pregnancy.","authors":"Ferha Saeed, Kirun Gunganah, Anna S Herrey","doi":"10.1016/j.clinme.2024.100276","DOIUrl":"10.1016/j.clinme.2024.100276","url":null,"abstract":"<p><p>Palpitations are common in pregnancy and warrant investigation. Palpitations may be caused by non-cardiac and cardiac causes. Patients with structural or functional abnormalities or inherited cardiovascular disease are more likely to develop arrhythmia, especially during pregnancy when the mother's body undergoes extensive physiological adaptations, which further contribute to an increased arrhythmia risk. While isolated ectopic beats do not require treatment, some heart rhythm disturbances can be life-threatening for mother and baby and mandate prompt intervention. Haemodynamically unstable patients should be electrically cardioverted. If the patient is stable, medical management is indicated, and early involvement of the pregnancy heart team can help facilitate appropriate treatment. In complex arrhythmia, consultation of an arrhythmia expert should be sought . Many anti-arrhythmics are safe in pregnancy, and it is important to reassure the pregnant patient of this.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100276"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853170","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":"The approach to a pregnancy after bariatric surgery.","authors":"Harriet D Morgan, Amy E Morrison, Malak Hamza, Cathy Jones, Caroline Borg Cassar, Claire L Meek","doi":"10.1016/j.clinme.2024.100275","DOIUrl":"10.1016/j.clinme.2024.100275","url":null,"abstract":"<p><p>With a rising worldwide incidence of obesity, particularly in the young, bariatric surgery offers an effective method of meaningful and sustained weight loss. At present, most bariatric procedures are carried out in women and increasingly in younger age groups. In line with the fertility benefits associated with weight loss, pregnancy after bariatric surgery is now a very common scenario. Although there is limited evidence to support optimal care in this group, most women appear to have good pregnancy outcomes, with reduced rates of pre-eclampsia and gestational diabetes (GDM). However, rates of stillbirth and small-for-gestational-age (SGA) babies are increased, suggesting that screening and supplementation of micronutrients is likely to be very important in this cohort. The risks and benefits that bariatric surgery may pose to pregnancy outcomes, both maternal and fetal, are largely dependent upon the degree of weight loss, weight stability upon entering pregnancy, surgical complications and the time interval between bariatric surgery and pregnancy. Ideally, preconception care would be more widely available, helping to assess and address micronutrient deficiencies and support preparation for pregnancy.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100275"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863583","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":"Cerebrospinal fluid leak-associated ventriculitis - a case report.","authors":"Amir Waheed, Faryal Amir","doi":"10.1016/j.clinme.2024.100279","DOIUrl":"10.1016/j.clinme.2024.100279","url":null,"abstract":"<p><p>We present a case of a 74-year-old woman with headaches, pyrexia and intermittent right-sided otorrhoea and rhinorrhoea. Her nasal discharge tested positive for beta-2-transferrin, confirming a cerebrospinal fluid (CSF) leak. High-resolution CT (HRCT) mastoids showed a defect in the right tegmen, and CSF within the middle ear and mastoid air cells. A gadolinium-enhanced MRI brain showed high signal in the occipital horns of the lateral ventricles with diffusion-weighted imaging (DWI) and a low signal with DWI-apparent diffusion coefficient (DWI-ADC), consistent with ventriculitis. She made an uneventful recovery after 6 weeks of intravenous antibiotics. The patient had surgical repair of bony defects to prevent recurrence. This highlights a rare case of ventriculitis associated with a spontaneous CSF leak, with no existing set diagnostic criteria, and high mortality. High clinical suspicion aided by appropriate imaging, and a multidisciplinary approach to management are imperative.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100279"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871647","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":"Long COVID services: Implementing discrete event simulation, a quality improvement proposition.","authors":"Eman Albastaki","doi":"10.1016/j.clinme.2024.100280","DOIUrl":"10.1016/j.clinme.2024.100280","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100280"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823813","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}