Clinical MedicinePub Date : 2025-07-01Epub Date: 2025-06-28DOI: 10.1016/j.clinme.2025.100341
Olav Erich Yri, Barry J A Laird
{"title":"Cancer pain - all change please?","authors":"Olav Erich Yri, Barry J A Laird","doi":"10.1016/j.clinme.2025.100341","DOIUrl":"10.1016/j.clinme.2025.100341","url":null,"abstract":"<p><p>Managing cancer-related pain remains a major clinical challenge, particularly in the context of increasing concerns around opioid use. The World Health Organization (WHO)'s analgesic ladder, a widely used framework for cancer pain management, is being re-evaluated - especially the second step involving weak opioids such as codeine and tramadol. Evidence suggests that these offer limited benefit and more side effects compared to initiating treatment with strong opioids. As cancer care advances, more patients live longer with chronic pain, requiring a tailored, multimodal approach. Meanwhile, the global opioid crisis has led to heightened regulatory scrutiny, making prescribers more cautious and potentially contributing to the under-treatment of pain. Long-term opioid use is also associated with risks including cognitive impairment, opioid-induced hyperalgesia and endocrine dysfunction. This review examines the ongoing relevance and limitations of the WHO ladder, highlights the challenges of opioid toxicity, and advocates for a personalised, multidisciplinary strategy to deliver safe, effective and compassionate cancer pain relief.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100341"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12275034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526726","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}
Clinical MedicinePub Date : 2025-07-01Epub Date: 2025-05-27DOI: 10.1016/j.clinme.2025.100330
A Barnes, G Heppenstall-Harris, A Dickman
{"title":"Opioid analgesics: Managing the predictable.","authors":"A Barnes, G Heppenstall-Harris, A Dickman","doi":"10.1016/j.clinme.2025.100330","DOIUrl":"10.1016/j.clinme.2025.100330","url":null,"abstract":"<p><p>It is imperative for clinicians to understand the common adverse effects of opioid therapy and ensure patients are properly counselled on them prior to opioid initiation. Predictable adverse effects are wide ranging, and include bowel dysfunction, nausea, sedation, endocrinopathy and pruritis. Many adverse effects (with the notable exception of constipation) improve with time; however, patients should undergo regular re-assessment to identify new or evolving symptoms. Opioid rotation can also be a useful therapeutic tool to mitigate intolerable opioid adverse effects. This article aims to provide a succinct review of important adverse effects and effective management techniques to enhance patient outcomes and quality of life.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100330"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180463","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}
Clinical MedicinePub Date : 2025-07-01Epub Date: 2025-05-26DOI: 10.1016/j.clinme.2025.100331
Abhishek Abhishek, Edoardo Cipolletta
{"title":"Gout on the acute medical take.","authors":"Abhishek Abhishek, Edoardo Cipolletta","doi":"10.1016/j.clinme.2025.100331","DOIUrl":"10.1016/j.clinme.2025.100331","url":null,"abstract":"<p><p>Gout is the commonest form of inflammatory arthritis. Flares are the commonest presentation of gout. Typically, gout flares present as acute monoarthritis, and most often affect the first metatarsophalangeal joint ('podagra'). Other joints in the lower limbs are affected more often than those in the upper limbs. Joint aspiration followed by examination of the synovial fluid using a polarised light microscope is the gold standard for a definite diagnosis of gout. Gout may be diagnosed without recourse to joint aspiration if there is podagra, elevated serum urate and no suspicion of infection. Ultrasonography and dual energy computed tomography may be used to diagnose gout if joint aspiration is unsuccessful or not feasible. Oral colchicine, NSAIDs and glucocorticoids have similar efficacy for controlling gout flare with differing adverse effect profiles. Consequently, the drug choice depends on comorbidities and patient preference.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100331"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173122","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}
Clinical MedicinePub Date : 2025-07-01Epub Date: 2025-05-09DOI: 10.1016/j.clinme.2025.100325
Gerard Gurumurthy, Lianna Reynolds, Kerstin de Wit, Lara N Roberts, Jecko Thachil
{"title":"Is pulmonary embolism a chronic disease?","authors":"Gerard Gurumurthy, Lianna Reynolds, Kerstin de Wit, Lara N Roberts, Jecko Thachil","doi":"10.1016/j.clinme.2025.100325","DOIUrl":"10.1016/j.clinme.2025.100325","url":null,"abstract":"<p><p>Pulmonary embolism (PE) is often regarded as an acute disorder, yet emerging evidence underscores its chronic trajectory. Many survivors endure long-term complications, including recurrent thrombosis, persistent dyspnoea and psychosocial challenges. These sequelae impair functional capacity and quality of life long after the initial event. To address these issues, we suggest that clinicians should adopt an integrated, multidisciplinary model that includes risk stratification for recurrence, structured follow-up, exercise rehabilitation, and support for psychological challenges. Recognising the potential chronic sequalae of PE ultimately fosters comprehensive care aimed at reducing morbidity and improving long-term outcomes for survivors.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100325"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981907","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}
Clinical MedicinePub Date : 2025-07-01Epub Date: 2025-05-05DOI: 10.1016/j.clinme.2025.100320
Sophie Pask, Fliss E M Murtagh, Jason W Boland
{"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":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153365/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clinical MedicinePub Date : 2025-07-01Epub Date: 2025-07-14DOI: 10.1016/j.clinme.2025.100487
Amy Taylor, Andrew Davies
{"title":"Palliative care or supportive care?","authors":"Amy Taylor, Andrew Davies","doi":"10.1016/j.clinme.2025.100487","DOIUrl":"10.1016/j.clinme.2025.100487","url":null,"abstract":"<p><p>Palliative care is the active holistic (physical, psychological, social and spiritual) care of people who experience health-related suffering due to severe illness and those close to them, aiming to improve their quality of life. There are three levels of palliative care: palliative care approach, generalist palliative care, and specialist palliative care. Traditionally associated with end-of-life care, this article highlights the evolution of specialist palliative care, now deemed to be applicable throughout the course of an illness. Terminologies surrounding 'palliative care' are also considered, especially the notable nomenclature debate between 'palliative care' and 'supportive care'. Specialist palliative care has evolved somewhat over time, and will need to continue to evolve to maintain its relevance.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100487"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648774","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}
Clinical MedicinePub Date : 2025-07-01Epub Date: 2025-06-14DOI: 10.1016/j.clinme.2025.100338
Caroline Barry, Robert Brodrick, Gurpreet Gupta, Imranali Panjwani
{"title":"Palliative sedation at the end of life: Practical and ethical considerations.","authors":"Caroline Barry, Robert Brodrick, Gurpreet Gupta, Imranali Panjwani","doi":"10.1016/j.clinme.2025.100338","DOIUrl":"10.1016/j.clinme.2025.100338","url":null,"abstract":"<p><p>Sedation is commonly used at the end of life; however, there are several practical and ethical considerations for its use. It is important to identify any treatable causes for agitation prior to initiating medication. The drug, dose and route of administration may vary according to the indication for treatment, and specialist advice or supervision may be required. There are a number of ethical and cultural considerations relevant to the use of palliative sedation, which must also be understood to ensure best practice in this area.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100338"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309659","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}
Clinical MedicinePub Date : 2025-07-01Epub Date: 2025-06-16DOI: 10.1016/j.clinme.2025.100333
Paramjit Uppal, Edward Coats, Charlotte Frise
{"title":"Fertility treatments in patients with medical conditions.","authors":"Paramjit Uppal, Edward Coats, Charlotte Frise","doi":"10.1016/j.clinme.2025.100333","DOIUrl":"10.1016/j.clinme.2025.100333","url":null,"abstract":"<p><p>The use of assisted reproductive technology (ART) has dramatically changed the landscape for treatment of infertility. Increasingly, healthcare practitioners of all specialisms are likely to encounter patients who have had ART, and therefore are expected to have knowledge of this area and counsel patients appropriately. There is, however, a lack of education about fertility techniques at both undergraduate and postgraduate level. Here we outline the main treatment options available to those undergoing ART, and the key considerations relevant to specialty physicians.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100333"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12275039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324676","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}
Clinical MedicinePub Date : 2025-07-01Epub Date: 2025-06-08DOI: 10.1016/j.clinme.2025.100337
Jonathan Ayling-Smith, Richard Attanoos, Nicola-Xan Hutchinson
{"title":"Some sage advice: A case report of sage burning causing interstitial lung disease.","authors":"Jonathan Ayling-Smith, Richard Attanoos, Nicola-Xan Hutchinson","doi":"10.1016/j.clinme.2025.100337","DOIUrl":"10.1016/j.clinme.2025.100337","url":null,"abstract":"<p><strong>Background: </strong>Cigarette smoking remains the commonest cause of chronic obstructive pulmonary disease (COPD) and respiratory bronchiolitis-associated interstitial lung disease (RB-ILD). Biomass combustion remains a high risk for causing respiratory disease.</p><p><strong>Method: </strong>We present a case of a 41-year-old woman and never-smoker with worsening breathlessness. It was identified that she made fire pits burning sage and oils for spiritual work, but beyond this had no respiratory risk factors.</p><p><strong>Results: </strong>Radiological evidence of RB-ILD was identified and a bronchoscopic lavage demonstrated the presence of striking green pigmented macrophages, presumed to be chlorophyll uptake.</p><p><strong>Conclusions: </strong>Cessation of burning sage exposure has resulted in a positive outcome. This case highlights the need for an extensive occupational or exposure history in respiratory medicine and describes histological features of interstitial lung disease not previously identified.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100337"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265518","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}
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