Clinical Medicine最新文献_第6页

The future of clinical lipidology in the UK. 英国临床血脂学的未来。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-16 DOI: 10.1016/j.clinme.2024.100026

Jaimini Cegla, Dev Datta, Alan Rees, Handrean Soran, Gilbert Thompson

引用次数: 0

Tertiary centre study highlights low inpatient deintensification and risks associated with adverse outcomes in frail people with diabetes. 三级中心研究突显了虚弱糖尿病患者的低住院去势率和与不良后果相关的风险。

IF 4.4 4区医学

Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-20 DOI: 10.1016/j.clinme.2024.100029

Eka Melson, Mohamed Fazil, Hnin Lwin, Anu Thomas, Ting Fong Yeo, Kevin Thottungal, HayMar Tun, Faseeha Aftab, Meri Davitadze, Alison Gallagher, Samuel Seidu, Kath Higgins

{"title":"Tertiary centre study highlights low inpatient deintensification and risks associated with adverse outcomes in frail people with diabetes.","authors":"Eka Melson, Mohamed Fazil, Hnin Lwin, Anu Thomas, Ting Fong Yeo, Kevin Thottungal, HayMar Tun, Faseeha Aftab, Meri Davitadze, Alison Gallagher, Samuel Seidu, Kath Higgins","doi":"10.1016/j.clinme.2024.100029","DOIUrl":"10.1016/j.clinme.2024.100029","url":null,"abstract":"Introduction: The community deintensification rates in older people with diabetes are low and hospital admission presents an opportunity for medication review. We audited the inpatient assessment and deintensification rate in people with diabetes and frailty. We also identified factors associated with adverse inpatient outcomes.Methods: A retrospective review of electronic charts was conducted in all people with diabetes and clinical frailty score ≥6 who were discharged from the medical unit in 2022. Data on demographics, comorbidities and background glucose-lowering medications were collected.Results: Six-hundred-and-sixty-five people with diabetes and moderate/severe frailty were included in our analysis. For people with no HbA1c in the last six months preceding admission, only 9.0% had it assessed during inpatient. Deintensification rates were 19.1%. Factors that were associated with adverse inpatient outcomes included inpatient hypoglycaemia, non-White ethnicity, and being overtreated (HbA1c <7.0% [53 mmol/mol] with any glucose-lowering medication).Conclusion: The assessment and deintensification rate in secondary care for people with diabetes and frailty is low. Inpatient hypoglycaemia, non-White ethnicity, and overtreatment are important factors in determining inpatient outcomes highlighting the importance of deintensification and the need for an evidence-based risk stratification tool.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100029"},"PeriodicalIF":4.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11091443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930315","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

A novel mutation in the ABCC8 gene causing maturity-onset diabetes of the young: A case report. ABCC8基因突变导致青年成熟型糖尿病：病例报告。

IF 4.4 4区医学

Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-03-20 DOI: 10.1016/j.clinme.2024.100033

Yifan Guo, Yangli Chen, Wen Liang, Lirong Zeng, Fang Hu, Yingjuan Zeng, Li Cong

引用次数: 0

Lesson of the month: Large vessel vasculitis: A rare cause of transaminitis. 本月课程大血管炎：转氨酶炎的罕见病因。

IF 4.4 4区医学

Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-03-29 DOI: 10.1016/j.clinme.2024.100035

Sumaya Hussein, Greg Allister, Azeem Ahmed

引用次数: 0

A case report on rapid development of simultaneous liver and musculature calcifications in severe sepsis. 重症脓毒症患者肝脏和肌肉同时快速钙化的病例报告。

IF 4.4 4区医学

Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-04-06 DOI: 10.1016/j.clinme.2024.100036

Tiara Joy Foo, Su-Ann Cheng, Xi Zhen Low, Chun En Chua

引用次数: 0

Huntington's disease: A clinical primer for acute and general physicians. 亨廷顿氏病：面向急诊和普通医生的临床入门书。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-04-06 DOI: 10.1016/j.clinme.2024.100200

Thomas H Massey, Duncan J McLauchlan

引用次数: 0

A National audit of the care of patients with acute kidney injury in England and Wales in 2019 and the association with patient outcomes. 2019 年英格兰和威尔士急性肾损伤患者护理及患者预后相关性全国审计。

IF 4.4 4区医学

Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-20 DOI: 10.1016/j.clinme.2024.100028

M P M Graham-Brown, A Casula, M Savino, T Humphrey, R Pyart, M Amaran, J Williams, K Crowe, J F Medcalf

{"title":"A National audit of the care of patients with acute kidney injury in England and Wales in 2019 and the association with patient outcomes.","authors":"M P M Graham-Brown, A Casula, M Savino, T Humphrey, R Pyart, M Amaran, J Williams, K Crowe, J F Medcalf","doi":"10.1016/j.clinme.2024.100028","DOIUrl":"10.1016/j.clinme.2024.100028","url":null,"abstract":"Background: Acute kidney injury (AKI) is a common complication of hospitalisations. This national audit assessed the care received by patients with AKI in hospital Trusts in England and Wales.Methods: Twenty four hospital Trusts across England and Wales took part. Patients with AKI stage2/3 were identified using the UK Renal Registry AKI master patient index. Data was returned through a secure portal with linkage to hospital episode statistic mortality and hospitalisation data. Completion rates of AKI care standards and regional variations in care were established.Results: 989 AKI episodes were included in the analyses. In-hospital 30-day mortality was 31-33.1% (AKI 2/3). Standard AKI interventions were completed in >80% of episodes. Significant inter-hospital variation remained in attainment of AKI care standards after adjustment for age and sex. Recording of urinalysis (41.9%) and timely imaging (37.2%) were low. Information on discharge summaries relating to medication changes/re-commencement and follow-up blood tests associated with reduced mortality. No quality indicators relating to clinical management associated with mortality. Better communication on discharge summaries associated with reduced mortality.Conclusions: Outcomes for patients with AKI in hospital remain poor. Regional variation in care exists. Work is needed to assess whether improving and standardising care improves patient outcomes.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100028"},"PeriodicalIF":4.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11091442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930354","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

Impact of penicillin allergy records on antimicrobial prescribing in hospitalised patients. 青霉素过敏记录对住院病人抗菌药物处方的影响。

IF 4.4 4区医学

Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-20 DOI: 10.1016/j.clinme.2024.100024

Vanesa Anton-Vazquez, Francesca Ferretti, Deniz Kaya, Shashwat Mishra, Sven Kerneis, Charlotte Eden, Hong Doan, Hiu Fung Leung, Jeanelli Baltazar, Sarah Starkey, Juliet Uwagwu, Martino Dall'Antonia, Jorge Cepeda

{"title":"Impact of penicillin allergy records on antimicrobial prescribing in hospitalised patients.","authors":"Vanesa Anton-Vazquez, Francesca Ferretti, Deniz Kaya, Shashwat Mishra, Sven Kerneis, Charlotte Eden, Hong Doan, Hiu Fung Leung, Jeanelli Baltazar, Sarah Starkey, Juliet Uwagwu, Martino Dall'Antonia, Jorge Cepeda","doi":"10.1016/j.clinme.2024.100024","DOIUrl":"10.1016/j.clinme.2024.100024","url":null,"abstract":"Background: The overdiagnosis of penicillin allergy and misclassification of non-truly allergic reactions is a growing public health problem, associated with the overuse of broad-spectrum and restricted antimicrobials. We aimed to evaluate the impact of penicillin allergy status on antimicrobial prescribing.Methods: A retrospective study of inpatients with a documented penicillin allergy receiving antimicrobials was conducted from 1 April to 1 July 2021. Antimicrobial prescribing and clinical characteristics were compared between patients with an active penicillin allergy label and those whose label was removed following antimicrobial stewardship team review. Antimicrobials were classified in two categories: i) 'Access' (recommended), ii) 'Watch and Reserve' (restricted) according to WHO AWaRe classification, a tool to guide appropriate antibiotic use.Results: 437 patients with a documented penicillin allergy receiving antimicrobials were included. 353 patients with an active penicillin allergy label, more frequently received antimicrobials from the 'Watch and Reserve list' (283;80% vs 30;37%; p<0.001). In contrast, 84 patients who were de-labelled received more often antimicrobials from the 'Access list' (53;63% vs 64;18%; p<0.001).Conclusions: Penicillin allergy reviews and de-labelling strategies may reduce the use of restricted antimicrobials under the 'Watch and Reserve list'. This practice should be encouraged and reinforced in all hospitals.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100024"},"PeriodicalIF":4.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11091395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930355","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

The new national clinical guideline for stroke: an opportunity to transform stroke care. 新的《国家卒中临床指南》：转变中风护理的契机。

IF 4.4 4区医学

Clinical Medicine Pub Date : 2024-03-01 Epub Date: 2024-02-20 DOI: 10.1016/j.clinme.2024.100025

Ajay Bhalla, Louise Clark, Rebecca Fisher, Martin James

引用次数: 0

Cardio pulmonary resuscitation (CPR) in the frail and those with multiple health conditions: Outcomes before and during the COVID pandemic. 体弱者和患有多种疾病者的心肺复苏术（CPR）：COVID 大流行之前和期间的结果。

IF 4.4 4区医学

Clinical Medicine Pub Date : 2024-01-01 Epub Date: 2024-01-19 DOI: 10.1016/j.clinme.2023.100001

Aled Lloyd, Elin Thomas, Julia Scaife, Nicky Leopold

{"title":"Cardio pulmonary resuscitation (CPR) in the frail and those with multiple health conditions: Outcomes before and during the COVID pandemic.","authors":"Aled Lloyd, Elin Thomas, Julia Scaife, Nicky Leopold","doi":"10.1016/j.clinme.2023.100001","DOIUrl":"10.1016/j.clinme.2023.100001","url":null,"abstract":"Coronavirus 2019 (COVID-19)-era resuscitation guidelines advised personal protective equipment before chest compressions and proactive advanced care planning. We investigated the impact of COVID-19 on cardiopulmonary resuscitation (CPR) outcomes according to scoring of frailty and of multiple health conditions. A retrospective single-centre analysis of clinical and electronic records for all adult cardiac arrest calls on wards between June 2020 and June 2021 was performed. Data were compared with a cohort pre-COVID (March 2017-March 2018). In total, 62 patients received CPR in 2020-21 compared with 113 in 2017-18. Similar rates of return of spontaneous circulation (ROSC) and a statistically insignificant survival increase from 23.8% to 32.2% (p=0.210). There were linear relationships between Clinical Frailty Scale (CFS) or Charlson Comorbidity Index (CCI) and diminished survival in the pooled data (both p<0.001). Both increasing frailty (measured by CFS) and comorbidity (measured by CCI) were associated with reduced survival from CPR. However, survival and ROSC during COVID-19 were no worse than before the pandemic.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"24 1","pages":"100001"},"PeriodicalIF":4.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11024814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930370","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