Clinical Medicine最新文献

{"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}

{"title":"The approach to a pregnancy after bariatric surgery.","authors":"Harriet D Morgan, Amy E Morrison, Malak Hamza, Cathy Jones, Caroline Borg Cassar, Claire L Meek","doi":"10.1016/j.clinme.2024.100275","DOIUrl":"10.1016/j.clinme.2024.100275","url":null,"abstract":"<p><p>With a rising worldwide incidence of obesity, particularly in the young, bariatric surgery offers an effective method of meaningful and sustained weight loss. At present, most bariatric procedures are carried out in women and increasingly in younger age groups. In line with the fertility benefits associated with weight loss, pregnancy after bariatric surgery is now a very common scenario. Although there is limited evidence to support optimal care in this group, most women appear to have good pregnancy outcomes, with reduced rates of pre-eclampsia and gestational diabetes (GDM). However, rates of stillbirth and small-for-gestational-age (SGA) babies are increased, suggesting that screening and supplementation of micronutrients is likely to be very important in this cohort. The risks and benefits that bariatric surgery may pose to pregnancy outcomes, both maternal and fetal, are largely dependent upon the degree of weight loss, weight stability upon entering pregnancy, surgical complications and the time interval between bariatric surgery and pregnancy. Ideally, preconception care would be more widely available, helping to assess and address micronutrient deficiencies and support preparation for pregnancy.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100275"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863583","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":"Impact on clinical outcomes, surgical interventions, anaesthetic decisions and complication rates following implementation of the NICE obstructive sleep apnoea guidelines during preoperative screening.","authors":"Gabrielle Shaw, Ricki Leggatt, Paige Roberts, Amanda Peace Witton, Nicole Moll, Akshay Dwarakanath","doi":"10.1016/j.clinme.2024.100266","DOIUrl":"10.1016/j.clinme.2024.100266","url":null,"abstract":"<p><strong>Introduction: </strong>Unidentified obstructive sleep apnoea (OSA) can lead to unexpected perioperative complications, unplanned postoperative admissions and increased length of hospital stay. NICE (National Institute for Health and Care Excellence) recommends a rapid preoperative assessment for patients undergoing elective surgery.</p><p><strong>Methods: </strong>We have evaluated the impact on implementing the NICE guidelines on clinical outcomes, surgical interventions, anaesthetic decisions and complication rates in surgical patients referred from the pre-assessment clinic prior to an elective intervention. All patients with a clinical suspicion of OSA based on a STOP-Bang score of 3 or more were referred for an overnight oximetry. Demographics, clinical outcomes and the impact on the planned surgical procedures were evaluated.</p><p><strong>Results: </strong>450 patients (Age 55 ± 14 years, male 69%, Epworth Sleepiness Scale (ESS) 7 ± 5) with a STOP-Bang score of 3 or more underwent overnight oximetry (32%; normal, 44%; mild, 15%; moderate and 9%; severe OSA). All patients with moderate and severe OSA were recommended for continuous positive airway pressure (CPAP) therapy to facilitate their surgical procedures and for long-term cardiometabolic benefits. Diagnosis of moderate/severe OSA had an impact on the surgical decision (P < 0.0001, odds ratio (OR) = 3.79, 95% confidence interval (CI) = 2.39-6.02). Severity of OSA affected the planned anaesthetic route (P < 0.0001, OR = 3.94, 95% CI = 2.21-7.05). No significant difference in day case vs non-day case, or need for unplanned admissions to critical care due to better planning pre-procedure. CPAP was initiated preoperatively in a third of patients (mean compliance 3.75 hours/day) and the overall complication rate was 11.6% in the moderate/severe OSA group vs 9.6% in the normal/mild OSA group.</p><p><strong>Conclusion: </strong>Prevalence of OSA is high in presurgical patients identified through preoperative screening. A diagnosis of moderate to severe OSA impacts surgical decision and planned anaesthetic route. Prior awareness of the diagnosis may help clinicians to identify the at-risk group. Timely CPAP initiation to facilitate surgery remains a challenge and, despite low compliance, CPAP may reduce postoperative complications. A multidisciplinary team (MDT) approach and a dedicated CPAP pathway post-diagnosis may help the clinicians and patients.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100266"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11696840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681075","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":"Cerebrospinal fluid leak-associated ventriculitis - a case report.","authors":"Amir Waheed, Faryal Amir","doi":"10.1016/j.clinme.2024.100279","DOIUrl":"10.1016/j.clinme.2024.100279","url":null,"abstract":"<p><p>We present a case of a 74-year-old woman with headaches, pyrexia and intermittent right-sided otorrhoea and rhinorrhoea. Her nasal discharge tested positive for beta-2-transferrin, confirming a cerebrospinal fluid (CSF) leak. High-resolution CT (HRCT) mastoids showed a defect in the right tegmen, and CSF within the middle ear and mastoid air cells. A gadolinium-enhanced MRI brain showed high signal in the occipital horns of the lateral ventricles with diffusion-weighted imaging (DWI) and a low signal with DWI-apparent diffusion coefficient (DWI-ADC), consistent with ventriculitis. She made an uneventful recovery after 6 weeks of intravenous antibiotics. The patient had surgical repair of bony defects to prevent recurrence. This highlights a rare case of ventriculitis associated with a spontaneous CSF leak, with no existing set diagnostic criteria, and high mortality. High clinical suspicion aided by appropriate imaging, and a multidisciplinary approach to management are imperative.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100279"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871647","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":"Long COVID services: Implementing discrete event simulation, a quality improvement proposition.","authors":"Eman Albastaki","doi":"10.1016/j.clinme.2024.100280","DOIUrl":"10.1016/j.clinme.2024.100280","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100280"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823813","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":"Severe acute pulmonary embolism in pregnancy.","authors":"Bhaskar Narayan","doi":"10.1016/j.clinme.2024.100274","DOIUrl":"10.1016/j.clinme.2024.100274","url":null,"abstract":"<p><p>Pulmonary embolism (PE) is a significant cause of morbidity and mortality in pregnancy and the puerperium. In severe cases, it causes haemodynamic instability and can lead to cardiac arrest due to obstructive shock. Patients with acute PE can be risk stratified to guide their monitoring and treatment; this article focuses on intermediate- and high-risk PE. The criteria for defining high-risk PE can be used unmodified in pregnancy. Diagnostic imaging should not be delayed due to pregnancy. Low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) can be used during pregnancy and breastfeeding, and systemic thrombolysis can be used in obstetric patients, but there are significant bleeding risks and it should be reserved for high-risk PE with hypotension and shock. Although pregnancy and the puerperium are risk factors for PE, it is important to avoid early diagnostic closure, and to consider other causes for the patient's presentation.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100274"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827614","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":"Approach to investigation and management of proteinuria in pregnancy.","authors":"Isabela Bertoni, Sion Williams","doi":"10.1016/j.clinme.2024.100281","DOIUrl":"10.1016/j.clinme.2024.100281","url":null,"abstract":"<p><p>Pregnancy leads to significant changes in renal physiology, which result in increases in glomerular filtration rate (GFR) and enhanced protein excretion. These changes may continue in the postnatal period and might be observed for 5-6 months after birth. Once confirmed, proteinuria warrants investigation and close surveillance. Clinicians should establish the level of excretory kidney function and the presence or absence of proteinuria at booking/diagnosis. A history of proteinuria, PET and anti-hypertensive requirements in previous pregnancies is a helpful guide to what to expect in the current pregnancy. Maternal physiological adaptations mean that yet-undiagnosed kidney disease is unmasked during pregnancy. New onset of proteinuria before 20 weeks' gestation (with or without kidney impairment) suggests known or previously undetected kidney disease. As pregnancy evolves, hyperfiltration may lead to increasing proteinuria, posing a diagnostic challenge in the diagnosis and recognition of pre-eclampsia. This article was written as a guide for the evaluation and management of proteinuria in pregnancy, as well as appreciating diagnostic dilemmas.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100281"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892093","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":"The feasibility of a novel national quality improvement programme for tobacco dependency treatment pathways in acute UK hospitals.","authors":"Robyn Fletcher, Alexander Hammant, Christina Moll, Miguel Souto, Sanjay Agrawal","doi":"10.1016/j.clinme.2024.100263","DOIUrl":"10.1016/j.clinme.2024.100263","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of smoking remains stubbornly high in the UK despite comprehensive tobacco control measures. A national quality improvement (QI) approach to enhance the treatment of an estimated 1,000,000 annual hospital admissions of tobacco smokers could provide a new opportunity to improve population health and reduce healthcare demand. Barriers to QI include knowledge, costs and competing demands. This study aimed to evaluate the feasibility and effectiveness of a national QI programme hosted by the British Thoracic Society, focused on improving NHS tobacco dependency treatment in acute hospitals.</p><p><strong>Methods: </strong>The programme utilised the Model for Improvement as its QI framework and was delivered over a 6-month period. 25 teams from across the UK were upskilled through a series of webinars and coaching sessions and undertook QI projects focused on specific areas of their local tobacco dependency treatment pathways.</p><p><strong>Results: </strong>Results of the programme demonstrated improvements across the treatment pathway including screening for smoking status, rapid provision of nicotine replacement therapy to prevent nicotine withdrawal, referrals to inpatient tobacco dependency treatment teams and transfers of care to community services. Other programme outcomes included increases in QI knowledge, confidence and attitudes along with enhanced project management skills.</p><p><strong>Conclusion: </strong>This novel, national, online QI programme supported participating multidisciplinary teams in acute trusts across the UK to deliver tobacco dependency treatment pathway improvements using QI tools and methodology. This programme demonstrated the feasibility and effectiveness of delivering a national QI programme, at low cost using a microsystems approach applied to an important area of clinical medicine.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100263"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11648157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615145","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}