Clinical Medicine最新文献

{"title":"Beyond unconscious bias: A practical model for improving equality and inclusion.","authors":"David S Sanders, Suneil A Raju, Anton Emmanuel","doi":"10.1016/j.clinme.2025.100309","DOIUrl":"10.1016/j.clinme.2025.100309","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100309"},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788123","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":"From eschar to diagnosis: A case report on scrub typhus causing multi-organ failure in a returning traveller.","authors":"Patrick Eaton, Ahmed Ahmed, Emyr Huws","doi":"10.1016/j.clinme.2025.100307","DOIUrl":"10.1016/j.clinme.2025.100307","url":null,"abstract":"<p><p>Scrub typhus, caused by Orientia tsutsugamushi, is a rickettsial infection transmitted by mite bites, often underdiagnosed in travellers from endemic regions. This case report describes a 65-year-old female with hypertension who developed severe scrub typhus after a trip to Sri Lanka. She presented with fever, myalgia, headache, fatigue and a scabbed lesion. Initial tests showed neutrophilia, lymphocytopenia and elevated liver enzymes. Malaria was ruled out, and empiric treatment with intravenous Tazocin was initiated. On day 5, she developed Clostridium difficile infection, requiring a switch to oral vancomycin. By day 5, her condition worsened with hypoxia, hypotension, oliguria and renal failure. Chest X-ray revealed bilateral infiltrates and subsequently, she was transferred to critical care. Tests showed positive IgM test for O. tsutsugamushi. Oral doxycycline was started, resulting in rapid improvement. PCR confirmed scrub typhus. This case underscores the importance of early diagnosis and treatment with doxycycline in travellers from endemic areas presenting with febrile illness.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100307"},"PeriodicalIF":3.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779343","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":"Implementation of SAMPL guidelines: Recommendations for improving statistical reporting in biomedical journals.","authors":"Michal Ordak","doi":"10.1016/j.clinme.2025.100304","DOIUrl":"10.1016/j.clinme.2025.100304","url":null,"abstract":"<p><p>The quality of statistical reporting in biomedical journals remains insufficient despite the introduction of SAMPL guidelines in 2015. These guidelines aim to improve clarity and accuracy but are underutilised by authors and editorial boards. Common deficiencies include unclear descriptions of statistical test purposes, inadequate reporting of effect sizes, poor analysis of assumptions, and limited consideration of outliers. Addressing these challenges requires broader adoption of SAMPL recommendations, improved statistical literacy among researchers and editors, and stronger editorial oversight. To enhance transparency and reliability in biomedical research, the SAMPL guidelines should become standard practice, supported by targeted training and clear guidance for authors.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100304"},"PeriodicalIF":3.6,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742433","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":"Transforming transnasal endoscopy services: A multicentre service evaluation pilot project.","authors":"Mohamed Hussein, Jason Dunn, Farhana Sultana-Miah, Sami Hoque, Ahmed Albusoda, Esra Asilmaz, Laura Marelli, Regina Raymond, Mohsen Eldragini, Michael Grimes, Shraddha Gulati, Juriese Saramosing, Mayur Kumar, Eleanor Knights, Vinay Sehgal, Paul Maxwell, Arun Rajendran, Shamima Padaruth, Sophie Stevens, Sergio Coda, Edward Despott, Saswata Banerjee","doi":"10.1016/j.clinme.2025.100300","DOIUrl":"10.1016/j.clinme.2025.100300","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the impact of pilot transnasal endoscopy (TNE) services on workforce efficiency, allocated procedure times and patient tolerance of procedures. The aim was to also understand the challenges of setting up a TNE service.</p><p><strong>Methods: </strong>Six-month data were collected from ten sites. Data captured included productivity, performance, workforce numbers, facilities and quality metrics. A patient survey was done to capture patients' experience. An eight Likert-style and open question survey was designed and used. Pilot sites were visited using a semi-structured interview process.</p><p><strong>Results: </strong>About 30% of the pilot sites carried out the TNE service outside of the endoscopy unit. There is an overall 25% improvement in workforce efficiency with TNE. Of those patients who had both a TNE and an oesophagogastroduodenoscopy, 78% reported that having the TNE procedure was a better experience. All sites reported that they will continue providing TNE beyond the pilot period. Sites carrying out TNE reported a high satisfaction with the services. Overall satisfaction with the quality of TNE imaging was very high.</p><p><strong>Conclusions: </strong>This multicentre pilot project shows evidence that the integration of TNE services has a positive impact in increasing capacity and patient satisfaction. This should set the scene for scaling this up on a wider capacity. TNE services, particularly with an introduction into outpatients, will improve service capacity in endoscopy, patients will tolerate the procedures more, national 2-week wait and Faster Diagnosis Standard targets will improve, and it is potentially more cost efficient overall.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100300"},"PeriodicalIF":3.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572408","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":"GLP-1 receptor agonist therapy and pregnancy: Evolving and emerging evidence.","authors":"Maria S Varughese, Fidelma O'Mahony, Lakshminarayanan Varadhan","doi":"10.1016/j.clinme.2025.100298","DOIUrl":"10.1016/j.clinme.2025.100298","url":null,"abstract":"<p><p>The prevalence of type 2 diabetes mellitus (T2DM) and obesity is increasing in young adults, posing significant risks around pregnancy. Obesity also impacts on fertility and the co-existence of polycystic ovarian syndrome increases the prevalence of cardiovascular metabolic risk factors. There has been a renewed interest in glucagon-like peptide-1 receptor agonists (GLP-1RA) in this context, due to their multi-dimensional impact on the reproductive axis, as well as their ability to simultaneously target weight loss and glycaemic control. There is, however, limited availability of safety data with respect to these newer non-insulin-based diabetes medications from the perspective of fetal development. As GLP-1RA are not licensed for use in pregnancy, with the increasing chances of incidental exposure from pre-conception use for obesity and T2DM, it is imperative that pre-conception counselling should be an integral part of consultation prior to the initiation of these drugs.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100298"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491007","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":"Bilateral adrenal infarction and secondary haemorrhage in pregnancy: implications of factor V Leiden heterozygosity. A review of the literature and a case report.","authors":"Wiaam Elradi, Samreen Innayat, Ahmed Hanafy, Sharifah Naseem, Abuzar Awadelkareem, Deepika Meneni","doi":"10.1016/j.clinme.2025.100288","DOIUrl":"10.1016/j.clinme.2025.100288","url":null,"abstract":"<p><p>Adrenal haemorrhage in pregnancy is rare but can lead to significant maternal and fetal morbidity if unrecognised. We present the case of a 25-year-old woman in her second pregnancy, who was admitted at 34 + 4 weeks of gestation with severe abdominal pain. Despite initial unremarkable assessments, further imaging revealed a left adrenal haemorrhage, with evidence of prior right adrenal infarction, resulting in primary adrenal insufficiency. Haematological investigations later confirmed heterozygous factor V Leiden as a likely contributing factor. This report underscores the diagnostic challenges of adrenal pathology in pregnancy, where symptoms may overlap with more common conditions. Immediate management with hydrocortisone therapy, supported by a multidisciplinary team (MDT), was employed, with a successful outcome for both mother and child following delivery by caesarean section.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100288"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11847723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045760","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":"Early and rapid initiation of quadruple therapy for heart failure with reduced ejection fraction: A real-world experience.","authors":"Shirley Sze, Chokanan Thaitirarot, Sunanthiny Krishnan, Daniel Chan, Will Nicolson, Iain Squire, Louise Clayton, Ian Loke","doi":"10.1016/j.clinme.2025.100296","DOIUrl":"10.1016/j.clinme.2025.100296","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the feasibility, safety and efficacy of early and rapid initiation of quadruple therapy (four drugs in 4 weeks - '4×4 approach') for heart failure with reduced ejection fraction (HFrEF) patients in a real-world clinical setting.</p><p><strong>Design: </strong>Prospective service evaluation study.</p><p><strong>Setting: </strong>Secondary care.</p><p><strong>Participants: </strong>Consecutive patients with de novo HFrEF between March and August 2021.</p><p><strong>Intervention: </strong>'4×4 approach' - individualised initiation and up-titration of four pillars of HFrEF therapy by heart failure specialist.</p><p><strong>Main outcome: </strong>Proportion of patients initiated on four pillars of HFrEF therapy within 4 weeks.</p><p><strong>Results: </strong>Of 100 patients approached, 19 patients were not suitable for the rapid initiation and up-titration pathway due to severe frailty and significant comorbidities. 81 patients were enrolled (61% male, median age = 73 years, median N-terminal pro-brain natriuretic peptide [NT-proBNP] = 3,764 ng/L). 39 patients (48%) achieved 4×4. Of the 42 patients who did not, 26 (62%), nine (21%) and seven (17%) patients were on three drugs, two drugs and one drug, respectively. 33 patients had one or more contraindication at the outset; most commonly renal impairment (28%), bradycardia (18%) and hyperkalaemia (15%). Five patients experienced significant side effects during medication up-titration, most commonly symptomatic hypotension. During median follow-up of 554 days, 32 (40%) patients experienced the combined outcome (all-cause hospitalisation/death). Patients who did not achieve 4×4 had an increased risk of the combined outcome (HR 2.25 [1.09-4.68], p=0.029) compared to those who achieved 4×4.</p><p><strong>Conclusion: </strong>Early and rapid initiation of four pillars HFrEF therapy is clinically feasible and safe when implemented in selected patients and is associated with improved clinical outcomes.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100296"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476358","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":"Reduction in body fat improves metabolic risk: BMI-based measures alone are not adequate.","authors":"Ponnusamy Saravanan","doi":"10.1016/j.clinme.2025.100301","DOIUrl":"10.1016/j.clinme.2025.100301","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100301"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11982972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673450","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":"Training, experience and perceptions of point-of-care ultrasound among internal medicine trainees: Implications for training, curriculum development and service delivery.","authors":"Ben Joseph Probyn, Cyrus Daneshvar","doi":"10.1016/j.clinme.2025.100283","DOIUrl":"10.1016/j.clinme.2025.100283","url":null,"abstract":"<p><p>Point-of-care ultrasound (POCUS) has revolutionised modern-day medicine and has widespread utilisation throughout healthcare settings. Despite the availability of ultrasounds, there are no requirements for internal medicine trainees (IMTs) to undergo any form of POCUS training. This study aimed to explore the perceptions and experience of IMTs of POCUS. A multicentre survey was distributed via mass email to all internal medicine trainees (IMT1-ST8) across two deaneries in south-west England. A total of 42% (213/509) IMTs completed the survey. Of these, 97% (207/213) contributed to the acute medical or general medical rota and 95% (202/213) of trainees reported performing invasive procedures on call. Training in ultrasound site selection was reported by 30% (63/213) of IMTs, and 11% (23/213) worked in a trust with accessible POCUS training. Formal POCUS accreditation was reported by 16% (34/213) of trainees. Identifying sonographic findings of common medical conditions was considered useful by 86.9% of trainees. Identifying pleural effusions being the most useful (99%, 211/213), while identifying a deep vein thrombosis was the least (87%,185/213). Higher confidence scores were reported for ultrasound-assisted as opposed to ultrasound-guided ascitic or pleural procedures, although this was not significant. On a 10-point Likert scale, most trainees highly rated POCUS training (median = 10, interquartile range 8-10). Free text responses supported POCUS training in the IMT curriculum. We found that IMTs perceive POCUS training as highly valuable. However, few IMTs are obtaining sufficient experience or training of POCUS. Opportunities for enhanced POCUS training should be embedded in training programmes.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100283"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028146","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":"A case of ascending paralysis in pregnancy: Thiamine deficiency mimicking Guillain-Barré syndrome.","authors":"De Yee Gan, Chin Meng Lee, Shakirin Pairan, Raja Ahmad Reza Raja Lope Ahmad, Hamdi Najman Achok","doi":"10.1016/j.clinme.2025.100294","DOIUrl":"10.1016/j.clinme.2025.100294","url":null,"abstract":"<p><p>Thiamine (vitamin B1) deficiency may present with diverse symptoms and is often triggered by chronic alcoholism, severe malnutrition or hyperemesis gravidarum. While typically diagnosed clinically, atypical presentations may delay recognition and treatment. We report a 26-year-old pregnant woman in her second trimester with prolonged nausea and vomiting since early pregnancy. She developed ascending lower limb paralysis, dysarthria, horizontal nystagmus, and lagophthalmos. Initially managed as hypokalaemia periodic paralysis with thyrotoxicosis and later Guillain-Barré syndrome (GBS), her symptoms worsened despite treatment. Subsequent MRI brain imaging revealed findings indicative of Wernicke encephalopathy, prompting high-dose thiamine therapy. This resulted in significant neurological improvement. This case underscores the importance of considering thiamine deficiency in atypical neurological presentations, particularly in pregnancy. Early recognition and prompt treatment can mitigate irreversible neurological damage, emphasising the necessity of maintaining a high index of suspicion in clinical practice.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100294"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424848","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}