Clinical Medicine最新文献

{"title":"Developing an electronic surprise question to predict end-of-life prognosis in a prospective cohort study of acute hospital admissions.","authors":"Baldev Singh, Nisha Kumari-Dewat, Adam Ryder, Vijay Klaire, Hannah Jennens, Kamran Ahmed, Mona Sidhu, Ananth Viswanath, Emma Parry","doi":"10.1016/j.clinme.2025.100292","DOIUrl":"10.1016/j.clinme.2025.100292","url":null,"abstract":"<p><strong>Objective: </strong>Determining the accuracy of a method calculating the Gold Standards Framework Surprise Question (GSFSQ) equivalent end-of-life prognosis amongst hospital inpatients.</p><p><strong>Design: </strong>A prospective cohort study with regression calculated 1-year mortality probability. Probability cut points triaged unknown prognosis into the GSFSQ equivalent 'Yes' or 'No' survival categories (> or < 1-year respectively), with subsidiary classification of 'No'. Prediction was tested against prospective mortality.</p><p><strong>Setting: </strong>An acute NHS hospital.</p><p><strong>Participants: </strong>18,838 acute medical admissions.</p><p><strong>Interventions: </strong>Allocation of mortality probability by binary logistic regression model (X²=6,650.2, p<0.001, r² = 0.43) and stepwise algorithmic risk-stratification.</p><p><strong>Main outcome measure: </strong>Prospective mortality at 1-year.</p><p><strong>Results: </strong>End-of-life prognosis was unknown in 67.9%. The algorithm's prognosis allocation (100% vs baseline 32.1%) yielded cohorts of GSFSQ-Yes 15,264 (81%), GSFSQ-No Green 1,771 (9.4%) and GSFSQ-No Amber or Red 1,803 (9.6%). There were 5,043 (26.8%) deaths at 1-year. In Cox's survival, model allocated cohorts were discrete for mortality (GSFSQ-Yes 16.4% v GSFSQ-No 71.0% (p<0.001). For the GSFSQ-No classification, the mortality odds ratio was 12.4 (11.4-13.5) (p<0.001) vs GSFSQ-Yes (c-statistic 0.72 (0.70-0.73), p<0.001; accuracy, positive and negative predictive values 81.2%, 83.6%, 83.6%, respectively). Had the tool been utilised at the time of admission, the potential to reduce possibly avoidable subsequent hospital admissions, death-in-hospital and bed days was significant (p<0.001).</p><p><strong>Conclusion: </strong>This study is unique in methodology with prospectively evidenced outcomes. The model algorithm allocated GSFSQ equivalent EOL prognosis universally to a cohort of acutely admitted patients with statistical accuracy validated against prospective mortality outcomes.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100292"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373999","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: \"Implementation of ultrasound-guided cannulation training for foundation doctors\".","authors":"Kushal Krishna Banerjee, Rabia Batool Hussain","doi":"10.1016/j.clinme.2025.100284","DOIUrl":"10.1016/j.clinme.2025.100284","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100284"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001450","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":"Respiratory effects of electronic cigarette use in individuals who never smoked: A systematic review.","authors":"Grazia Caci, Arielle Selya, Giusy Rita Maria La Rosa, Lucia Spicuzza, Jaymin B Morjaria, Giulio Geraci, Riccardo Polosa","doi":"10.1016/j.clinme.2025.100295","DOIUrl":"10.1016/j.clinme.2025.100295","url":null,"abstract":"<p><p>Current evidence on whether electronic cigarettes (ECs) pose respiratory risks is unclear, due to confounding by cigarette smoking; evidence among never-smoking individuals is needed. Following a narrative review and critical appraisal, a systematic review assessed possible respiratory outcomes prospectively associated with EC use among individuals who never smoked. Bias risk was evaluated using a Joanna Briggs Institute tool. Ten eligible studies examined outcomes of self-reported respiratory diagnosis, symptoms and lung function. Eight examined adults and three examined youth (with overlap). Overall, seven studies showed no significant association between respiratory outcomes and EC use among never-smoking individuals (P>0.05). Evidence for coughing and wheezing symptoms varied by model specification. Overall, EC use by never-smoking individuals is not associated with risk of severe respiratory outcomes, but may be associated with mild coughing/wheezing. Further research is needed using larger samples, long-term follow-ups (>5 years), and information on detailed patterns of EC use.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100295"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491015","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":"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":"Perinatal care in primary care for cardiovascular risk reduction.","authors":"Clare Macdonald, Elizabeth Dapre","doi":"10.1016/j.clinme.2025.100297","DOIUrl":"10.1016/j.clinme.2025.100297","url":null,"abstract":"<p><p>General practitioners (GPs) and multidisciplinary members of the primary care team in the UK have, since the earliest days of the NHS, played a key role in the care of women throughout their perinatal journey, particularly postnatally. With cardiometabolic complications of pregnancy becoming increasingly common, and bringing an associated increased lifetime risk of adverse maternal and neonatal outcomes, GPs and the wider primary care team play a crucial role in risk reduction and management. Managing healthcare effectively to reduce adverse maternal and neonatal outcomes and health inequalities requires a system-wide change in approach where women's pre-conception to postnatal health is optimised. GPs' role in postnatal care, and other opportunistic moments in primary care for health promotion and risk management, is a key part of the solution.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100297"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491013","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":"10.1016/j.clinme.2025.100299","url":null,"abstract":"<p><strong>Objective: </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 were 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 individualised 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":"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}