Clinical Medicine最新文献_第5页

Specialist referrals and diagnostic delays in motor neurone disease: Mapping patients' journey through hoops and hurdles in healthcare. 运动神经元疾病的专科转诊和诊断延误：绘制患者在医疗保健领域的 "圈套 "和 "障碍 "之旅。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-07-01 Epub Date: 2024-07-14 DOI: 10.1016/j.clinme.2024.100228

Samuel James Reynolds, Suresh Kumar Chhetri

{"title":"Specialist referrals and diagnostic delays in motor neurone disease: Mapping patients' journey through hoops and hurdles in healthcare.","authors":"Samuel James Reynolds, Suresh Kumar Chhetri","doi":"10.1016/j.clinme.2024.100228","DOIUrl":"10.1016/j.clinme.2024.100228","url":null,"abstract":"Motor neuron disease (MND) is an uncommon but invariably fatal condition, with a median survival of 24-48 months from symptom onset. Although there is no cure at the moment, early diagnosis is crucial to enable timely access to multidisciplinary care, and enrolment in clinical trials utilising investigational therapies. Unfortunately, diagnostic delays remain common, and the average delay between symptom onset and diagnosis is 12 months. Large numbers of specialist referrals have been suggested as a key contributor to diagnostic delays. We conducted a retrospective review of the medical records of patients diagnosed with MND in Lancashire and South Cumbria, to investigate whether large numbers of specialty referrals are a common occurrence in MND. Our review identified that 35% of patients with MND were seen by two or more specialties before being referred to neurology. This rose to 49% when patients with bulbar onset disease were considered. 9% of cases saw three or more specialists. There was a statistically significant correlation between the number of specialist referrals and delays in neurology referral. We hope our findings will increase awareness of the importance of early neurology referral in the diagnosis of MND and promote the use of the MND Red Flag tool as a means of identifying patients in need of prompt neurological evaluation.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100228"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603341","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}

引用次数: 0

Statin-induced, immune-mediated necrotising myopathy triggered by malignancy successfully treated with immunosuppression. 通过免疫抑制成功治疗恶性肿瘤诱发的他汀类药物免疫介导坏死性肌病

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-05-01 Epub Date: 2024-05-06 DOI: 10.1016/j.clinme.2024.100217

Ahmed Abouelazm, Kirollos Philops, Amr Amine, Yahia Golam

引用次数: 0

A case of spinal epidural abscess concealed by delirium in a young man. 每月一课一例被谵妄掩盖的年轻男子脊髓硬膜外脓肿病例。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-05-01 Epub Date: 2024-05-04 DOI: 10.1016/j.clinme.2024.100214

Benjamin Page, Sam Waddy

引用次数: 0

Adenosine-sensitive ventricular tachycardia. 腺苷敏感性室性心动过速

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-05-01 Epub Date: 2024-05-06 DOI: 10.1016/j.clinme.2024.100216

Rahul K Mukherjee, Magdi M Saba

引用次数: 0

Design, implementation and evaluation of a spiral module combining data science, digital health and evidence-based medicine in the undergraduate medical curriculum: A mixed methods study. 在医学本科课程中结合数据科学、数字健康和循证医学的螺旋模块的设计、实施和评估：一项混合方法研究。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-05-01 Epub Date: 2024-04-20 DOI: 10.1016/j.clinme.2024.100207

Nader Al-Shakarchi, Jaya Upadhyay, Ivan Beckley, Faye Gishen, Anna Di Iorio, Robert Stephens, Sarah Clegg, Fiona C Lampe, Amitava Banerjee

{"title":"Design, implementation and evaluation of a spiral module combining data science, digital health and evidence-based medicine in the undergraduate medical curriculum: A mixed methods study.","authors":"Nader Al-Shakarchi, Jaya Upadhyay, Ivan Beckley, Faye Gishen, Anna Di Iorio, Robert Stephens, Sarah Clegg, Fiona C Lampe, Amitava Banerjee","doi":"10.1016/j.clinme.2024.100207","DOIUrl":"10.1016/j.clinme.2024.100207","url":null,"abstract":"Background: Digital health, data science and health informatics are increasingly important in health and healthcare, but largely ignored in undergraduate medical training.Methods: In a large UK medical school, with staff and students, we co-designed a new, 'spiral' module (with iterative revisiting of content), covering data science, digital health and evidence-based medicine, implementing in September 2019 in all year groups with continuous evaluation and improvement until 2022.Results: In 2018/19, a new module, 'Doctor as Data Scientist', was co-designed by academic staff (n = 14), students (n = 23), and doctors (n = 7). The module involves 22 staff, 120 h (43 sessions: 22 lectures, 15 group and six other) over a 5-year curriculum. Since September 2019, 5,200 students have been taught with good attendance. Module student satisfaction ratings were 92%, 84%, 84% and 81% in 2019, 2020, 2021 and 2022 respectively, compared to the overall course (81%).Conclusions: We designed, implemented and evaluated a new undergraduate medical curriculum that combined data science and digital health with high student satisfaction ratings.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100207"},"PeriodicalIF":3.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11091512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853958","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}

引用次数: 0

Doing simple things well can achieve significant benefits. 把简单的事情做好，就能取得显著的效益。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.clinme.2024.100219

Ponnusamy Saravanan

引用次数: 0

Editorial: Learnings from all walks of medical practice. 社论：从各行各业的医疗实践中学习。

IF 4.4 4区医学

Clinical Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.clinme.2024.100201

Ponnusamy Saravanan

引用次数: 0

Pyroglutamate acidosis 2023. A review of 100 cases. 焦谷氨酸酸中毒 2023。100 例病例回顾。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-29 DOI: 10.1016/j.clinme.2024.100030

Gordon W Stewart

引用次数: 0

Optimising renal risk parameters in type 2 diabetes mellitus: Perspectives from a retinal viewpoint. 优化 2 型糖尿病肾脏风险参数：从视网膜角度看问题。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-16 DOI: 10.1016/j.clinme.2024.100031

Sarita Jacob, George I Varughese

{"title":"Optimising renal risk parameters in type 2 diabetes mellitus: Perspectives from a retinal viewpoint.","authors":"Sarita Jacob, George I Varughese","doi":"10.1016/j.clinme.2024.100031","DOIUrl":"10.1016/j.clinme.2024.100031","url":null,"abstract":"Diabetic retinopathy and nephropathy share pathophysiological mechanisms and there is a defined correlation between the severity of both these microvascular complications from suboptimal glycaemic control. The reno-protective properties offered by sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists should be applicable to diabetic retinopathy as well. However, in patients with pre-existing diabetic retinopathy, sudden improvement in glycaemic control is well documented to cause early worsening of the changes in the retina that is usually transient. This paradoxical phenomenon tends to occur with longer duration of diabetes, higher HbA1c at the outset, rapid improvement of glucose levels and the magnitude of HbA1c reduction with addition of more agents to tighten metabolic control. Interestingly, this progression of pre-existing diabetic retinopathy is not quite observed with newer sodium-glucose co-transporter-2 inhibitors. This article discusses potential further areas of future research where mechanisms of renal protection can be translated to the retina.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100031"},"PeriodicalIF":3.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11091439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899515","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}

引用次数: 0

Predictive value and interrater reliability of mental status and mobility assessment in the emergency department. 急诊科精神状态和行动能力评估的预测价值和相互间可靠性。

IF 4.4 4区医学

Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-16 DOI: 10.1016/j.clinme.2024.100027

Tanguy Espejo, Henk B Riedel, Sebastian Messingschlager, Wolfram Sonnleitner, John Kellett, Mikkel Brabrand, Tim Cooksley, Roland Bingisser, Christian H Nickel

{"title":"Predictive value and interrater reliability of mental status and mobility assessment in the emergency department.","authors":"Tanguy Espejo, Henk B Riedel, Sebastian Messingschlager, Wolfram Sonnleitner, John Kellett, Mikkel Brabrand, Tim Cooksley, Roland Bingisser, Christian H Nickel","doi":"10.1016/j.clinme.2024.100027","DOIUrl":"10.1016/j.clinme.2024.100027","url":null,"abstract":"Aim: To investigate the predictive value of both mental status, assessed with the AVPUC (Alert, responds to Voice, responds to Pain, Unresponsive, and new Confusion) scale, and mobility assessments, and their interrater reliability (IRR) between triage clinicians and a research team.Method: Prospective study of consecutive patients who presented to an ED. Mental status and mobility were assessed by triage clinicians and by a dedicated research team.Results: 4,191 patients were included. After adjustment for age and sex, patients with altered mental status have an odds ratio of 6.55 [4.09-10.24] to be admitted in the ICU and an odds ratio of 21.16 [12.06-37.01] to die within 30 days; patients with impaired mobility have an odds ratio of 7.08 [4.60-11.12] to be admitted in the ICU and an odds ratio of 12.87 [5.93-32.30] to die within 30 days. The kappa coefficient between triage clinicians and the research team for mental status assessment was 0.75, and 0.80 for mobility.Conclusion: Assessment of mental status by the AVPUC scale, and mobility by a simple dichotomous scale are suitable for ED triage. Both altered mental status and impaired mobility are associated with adverse outcomes. Mental status and mobility assessment have good interrater reliability.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100027"},"PeriodicalIF":4.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11091407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899516","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}

引用次数: 0