Clinical Medicine最新文献

{"title":"The impact of workplace support components on the mental health and burnout of UK-based healthcare professionals: Insights from the CoPE-HCP cohort study.","authors":"George Collett, Alaa Emad, Ajay K Gupta","doi":"10.1016/j.clinme.2025.100324","DOIUrl":"10.1016/j.clinme.2025.100324","url":null,"abstract":"<p><strong>Study objective: </strong>To evaluate the influence of the perceived level of workplace support and its individual components in improving mental health and reducing burnout among healthcare professionals (HCPs).</p><p><strong>Design: </strong>In a cohort of 400 HCPs followed up since July 2020, a follow-up survey was done online (August 2023) containing detailed questionnaires regarding workplace support and mental health.</p><p><strong>Participants: </strong>400 UK-based HCPs.</p><p><strong>Main outcome measure(s): </strong>The level of individual workplace support components (perceived manager's concern for staff welfare, transparent communication, adequate staffing/safety, visible and approachable leadership, and collegial/peer support) were assessed using self-rating scales. Depression (PHQ-9), anxiety (GAD-7), insomnia (ISI), mental wellbeing (SWEMWBS) and burnout (emotional exhaustion, aMBI-EE; and depersonalisation, aMBI-DP) were assessed using validated tools.</p><p><strong>Results: </strong>Compared with feeling unsupported, feeling supported was associated with a reduced risk of probable depression, insomnia, low wellbeing and burnout, and was associated with an increased perceived level of all individual support components. An increase in the perceived level of collegial/peer support was associated with reduced depression, anxiety, insomnia and burnout, and increased wellbeing scores (all p-values <0.01). An increase in the perceived level of managerial understanding of staff welfare was associated with reduced burnout (emotional exhaustion) among HCPs (p<0.05). There was also evidence that varying levels of visible and approachable leadership may impact on depression, anxiety and insomnia (p<0.05).</p><p><strong>Conclusions: </strong>Adverse mental health and burnout among HCPs may be mitigated by good quality workplace support, specifically by fostering collegial/peer support among staff and ensuring that managers show genuine understanding for staff welfare and are visible and approachable in their leadership. These findings may guide the allocation of workplace support resources for HCPs.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100324"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985123","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":"Advance care planning.","authors":"Lucy Robinson, Paul Paes","doi":"10.1016/j.clinme.2025.100339","DOIUrl":"10.1016/j.clinme.2025.100339","url":null,"abstract":"<p><p>Advance care planning (ACP) is done in anticipation of something adverse happening and the likelihood of losing the capacity to be involved in future decision making. ACP encourages people to think about what might happen in serious illness scenarios and to consider their needs or wishes. As long-term conditions, multimorbidity, frailty and end-of-life care become more dominant health challenges, planning for future problems and giving patients and their carers the tools to self-manage becomes more imperative. ACP is part of this philosophy of care, anticipating and planning for future health and care needs. Increasingly, the utility of ACP seems to lie more in promoting conversations and particularly shining a light on the values that give people their identity. Patient relationships with family caregivers and health professionals, and a collective shared understanding, improve through the ACP process. Enabling people to be cared for in a way that preserves their identities and values for as long as possible seems to be more effective than focusing on documentary outputs.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100339"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483427","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":"From research to reality: A review of three clinical problems in the last days of life.","authors":"Tasneem Wadee, Simon Noble","doi":"10.1016/j.clinme.2025.100486","DOIUrl":"10.1016/j.clinme.2025.100486","url":null,"abstract":"<p><p>All of us will one day die. For most of us, death will be anticipated, usually following a period of ill health. The opportunity to anticipate and manage clinical conditions associated with the agonal process is an essential part of advance care planning. Guidelines exist for the palliation of most symptomatic events at the end of life, although many recommendations are based on low-quality evidence or consensus. Furthermore, when potentially practice-changing data emerge, there is an inevitable lag time before clinical practice changes. In this paper, we shall discuss the management of three challenging scenarios faced by teams looking after patients at the end of life: delirium, terminal haemorrhage and noisy upper airway secretions. We aim to critically evaluate the utility of current evidence, pharmacological and non-pharmacological, and how it translates into clinical practice.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100486"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648773","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":"Harveian Oration 2024: From bench to bedside and beyond - new horizons for translational ageing research.","authors":"Avan Aihie Sayer","doi":"10.1016/j.clinme.2025.100334","DOIUrl":"10.1016/j.clinme.2025.100334","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100334"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233399","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":"Associations of hepatic steatosis index in early pregnancy with perinatal outcomes: A prospective birth cohort study.","authors":"Shaofei Su, Enjie Zhang, Shen Gao, Yue Zhang, Jianhui Liu, Shuanghua Xie, Jinghan Yu, Qiutong Zhao, Wentao Yue, Ruixia Liu, Chenghong Yin","doi":"10.1016/j.clinme.2025.100343","DOIUrl":"10.1016/j.clinme.2025.100343","url":null,"abstract":"<p><strong>Background: </strong>This study aims to evaluate the association between maternal hepatic steatosis index (HSI) in the first trimester and adverse perinatal outcomes.</p><p><strong>Methods: </strong>A prospective birth cohort study was conducted from 19 February 2018 to 31 December 2022 in China. Logistic regression models and restricted cubic splines were used to estimate the associations of maternal HSI in early pregnancy and the risk of perinatal outcomes. Subgroup analyses stratified by maternal age and gravidity were carried out.</p><p><strong>Results: </strong>A total of 42,589 participants were included in this study. The overall prevalence of caesarean delivery, preterm birth, large-for-gestational age (LGA), shoulder dystocia and low Apgar scores were 39.17%, 5.18%, 9.45%, 0.92% and 0.77%, respectively. With the increase of HSI quartiles, the incidence of caesarean delivery, preterm birth, large-for-gestational age (LGA) and shoulder dystocia significantly increased (P < 0.0001). The highest quartile of HSI was associated with the highest risk of caesarean delivery (odds ratio (OR) 1.777, 95% CI 1.674-1.886), preterm birth (OR 1.323, 95% CI 1.160-1.510), LGA (OR 2.743, 95% CI 2.468-3.049) and shoulder dystocia (OR 1.487, 95% CI 1.094-2.021). The associations between HSI and adverse perinatal outcomes showed non-linear relationships except for shoulder dystocia (P < 0.0001 for all, P = 0.4792 for non-linearity). Subgroup analyses revealed that the associations between HSI and the risks of LGA and caesarean delivery were significantly stronger in younger and first-time pregnant women.</p><p><strong>Conclusion: </strong>Elevated maternal HSI in early pregnancy was positively associated with the risk of adverse perinatal outcomes.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100343"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526725","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":"Pregnancy-specific dermatoses for the resident physician.","authors":"Niamh Theresa McSwiney, Eliza Hutchison, Hannah Wainman","doi":"10.1016/j.clinme.2025.100316","DOIUrl":"10.1016/j.clinme.2025.100316","url":null,"abstract":"<p><p>Pregnancy is associated with a wide range of cutaneous changes. Some are physiological and triggered by normal hormonal fluctuations during pregnancy. There are also a small number of pathological pruritic eruptions that exclusively occur during pregnancy, known as pregnancy-specific dermatoses (PSDs). In patients presenting with a PSD, features often include severe pruritus and characteristic inflammatory skin changes differing in onset, morphology and configuration. This article gives an overview of benign dermatological changes during pregnancy and the most important presentations of PSDs in order of prevalence: atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis and pustular psoriasis of pregnancy. Importantly, we outline how a resident physician can identify these disorders, how to initiate management and when a specialty referral for further investigations and monitoring of the mother and unborn fetus is warranted.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100316"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982767","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":"Population-specific risk models and AI in clinical practice: Are we ready for the next step in managing common disorders?","authors":"Kartik Kumar, Ponnusamy Saravanan","doi":"10.1016/j.clinme.2025.100329","DOIUrl":"10.1016/j.clinme.2025.100329","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100329"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101509","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":"An insight into interventional bronchoscopy.","authors":"Ashish Karir, Pallav L Shah, Christopher M Orton","doi":"10.1016/j.clinme.2025.100321","DOIUrl":"10.1016/j.clinme.2025.100321","url":null,"abstract":"<p><p>The emergent field of interventional bronchoscopy provides an alternative approach for the diagnosis and management of a range of respiratory conditions. Within malignant disease, robotic navigational bronchoscopy provides a stable platform to sample small and difficult to reach pulmonary nodules, while malignant central airway obstruction can be managed through transcopic stent insertion. A range of therapeutic modalities have been developed for benign disease, which provide alternatives to standard therapy, particularly in the context of endobronchial valves for chronic obstructive pulmonary disease, and bronchial thermoplasty for asthma, while transbronchial cryoexcision lung biopsy offers a non-surgical option for undiagnosed interstitial lung disease. With a rich pipeline of technology being developed through robust clinical trial processes, the field of interventional bronchoscopy will continue to grow to become an invaluable asset, not only to the field of respiratory medicine, but to the general physician.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100321"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971513","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":"Occupational lung disease: What the general physician needs to know.","authors":"Patrick Howlett, Joanna Szram, Johanna Feary","doi":"10.1016/j.clinme.2025.100305","DOIUrl":"10.1016/j.clinme.2025.100305","url":null,"abstract":"<p><p>Occupational exposures are a common and preventable cause of lung disease. About one in six cases of chronic obstructive pulmonary disease (COPD) and asthma worldwide are related to work. Early recognition of occupational lung disease improves outcomes. Doctors should ask about work history in patients with respiratory symptoms. This educational review article briefly outlines key clinical features, relevant to the general physician, of common occupational lung diseases seen in the UK. These conditions include work-related asthma, pneumoconioses, hypersensitivity pneumonitis and COPD. Referral to a specialist is recommended when an occupational cause is suspected. Most occupational lung diseases are preventable with adequate workplace safety measures and early medical attention.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100305"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788127","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":"Pneumothorax: An update on clinical spectrum, diagnosis and management.","authors":"Beenish Iqbal, Rob Hallifax, Najib M Rahman","doi":"10.1016/j.clinme.2025.100327","DOIUrl":"10.1016/j.clinme.2025.100327","url":null,"abstract":"<p><p>Pneumothorax is defined as air in the pleural space and is characterised by chest pain and breathlessness. It is commonly divided into spontaneous and non-spontaneous subtypes based on the underlying mechanism. Chest X-ray is the most common investigation to diagnose and monitor pneumothorax, but CT-chest is being increasingly used to aid decision making in complex cases and to investigate an underlying lung disease. There should be a low threshold to investigate for an underlying familial or catamenial cause in suspected cases. Treatment for pneumothorax is based on clinical condition and symptoms of the patient rather than the size of pneumothorax. Conservative care can be offered to minimally symptomatic primary spontaneous pneumothorax patients, while needle aspiration, ambulatory Heimlich valve device and chest drain remain the interventional treatment options. Chest drain is a common treatment for patients with secondary spontaneous pneumothorax due to poor lung reserve. Recurrence after spontaneous pneumothorax is common and smoking cessation reduces the risk of future recurrence in active smokers. Surgical treatment with pleurodesis ± bullectomy should be considered for treatment of suitable patients with persistent air leak and for pneumothorax recurrence prevention in high-risk populations.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100327"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076441","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}