Clinical Medicine最新文献

{"title":"Premature ventricular complexes.","authors":"Reuben Yap, Delia Calian, Matthew Wright, Aldo Rinaldi, John Whitaker","doi":"10.1016/j.clinme.2026.100609","DOIUrl":"10.1016/j.clinme.2026.100609","url":null,"abstract":"<p><p>Premature ventricular complexes (PVCs) are early ventricular contractions triggered by an ectopic focus from within the ventricle. They are common in the general population and may cause symptoms at any burden. They become clinically relevant in the context of symptoms or complications such as PVC-induced cardiomyopathy or, more rarely, PVC-triggered malignant ventricular arrhythmias. Investigating for underlying structural heart disease is essential in patients with clinically relevant PVCs as this will inform patient counselling and management options. Treatment is guided by symptoms or left ventricular dysfunction associated with PVCs. Management options include conservative management, medical therapy and catheter ablation. In this review, we discuss the definition of PVCs and how they may present, outline relevant investigations for these patients, and discuss management considerations and treatment options.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100609"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13380790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316012","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":"Age, sex and ethnicity changes in creatine kinase and sex- and ethnicity-specific reference intervals of creatine kinase.","authors":"Tejas Kalaria, Rousseau Gama, Emma Tuddenham, Catherine Collingwood, Hem Sapkota, Latika Gupta, Mariam El Hawli, Rachel L Griffiths","doi":"10.1016/j.clinme.2026.100596","DOIUrl":"10.1016/j.clinme.2026.100596","url":null,"abstract":"<p><strong>Background: </strong>Creatine kinase (CK) reference intervals (RIs) derived from predominantly White cohorts do not account for well-documented ethnic differences in CK. This misclassification may lead to unnecessary investigations or inappropriate treatment. We aimed to characterise age-, sex- and ethnicity-related variation in CK and establish RIs for a multi-ethnic population.</p><p><strong>Methods: </strong>Deidentified CK results of primary care requests between 2008 and 2024 from a laboratory in the West Midlands (UK) were partitioned into six groups (male and female of White, Asian and Black ethnicities). Indirect RIs were derived from 58,096 individuals (33,879 female; 24,217 male) with the refineR algorithm. Derived RIs were verified in two independent datasets.</p><p><strong>Results: </strong>Median CK and upper reference limits (URLs) were highest in Black, intermediate in Asian and lowest in White groups. Female URLs for ≥13 years were 389 IU/L (Black), 188 IU/L (Asian) and 170 IU/L (White); male URLs were 757 IU/L, 357 IU/L and 314 IU/L, respectively. Applying the UK Pathology Harmony sex-specific RIs to all ethnicities classified 22.6-30.3% of results from Black individuals as high, versus 5.1-7.7% of White individuals. Using the new ethnicity-specific RIs reduced high-result rates in Black men and women. In individuals of mixed ethnicity, CK levels aligned more closely with the parent group with higher CK. After excluding outliers, the 97.5th percentile CK values for female and male children <13 years of Black ethnicities were 1.22 and 1.28 times higher, respectively, than those of White ethnicities.</p><p><strong>Conclusions: </strong>Adoption of CK RIs stratified by sex and ethnicity will allow more precise interpretation of the results, supporting equitable clinical decision-making and appropriate use of healthcare resources.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100596"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147959844","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":"UK Foundation Programme training needs a national minimum standard for advanced life support.","authors":"Adam Baker, Michael Okorie","doi":"10.1016/j.clinme.2026.100605","DOIUrl":"10.1016/j.clinme.2026.100605","url":null,"abstract":"<p><p>Since 2021, advanced life support (ALS) has no longer been a mandatory requirement of the UK Foundation Programme. Although the shift towards capability rather than certification was educationally defensible, in practice it has created marked national variation in how resuscitation preparedness is developed, evidenced and signed off. Foundation doctors now enter emergencies with unequal access to funded ALS training, simulation and supervised assessment, while supervisors are left to judge equivalence without a consistent national threshold. This matters not because patient-level harm has been neatly proven, but because high-stakes clinical capability should not depend on local opportunity or variable interpretation. A capability-based curriculum and a national minimum standard are not mutually exclusive. The Foundation Programme should therefore restore a national ALS requirement, or a formally recognised equivalent standard, alongside funded access, blended delivery and transparent national evaluation of uptake, exemptions and outcomes.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100605"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210415","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":"Comparative prognostic performance of SOFA-1 and SOFA-2 in patients with sepsis at ICU admission.","authors":"Lifang Lin, Zhifei Fu, Hongxia Sun, Yongye Wang, Sheng Zhang, Songjie Bai, Xuehuan Wen","doi":"10.1016/j.clinme.2026.100601","DOIUrl":"10.1016/j.clinme.2026.100601","url":null,"abstract":"<p><strong>Study objective: </strong>SOFA-1 underpins Sepsis-3 definitions but may no longer optimally reflect contemporary ICU practice; SOFA-2 was recently developed from large multinational datasets, yet its prognostic performance in septic populations remains unknown. We aimed to compare the prognostic performance of SOFA-1 and SOFA-2 in ICU patients with sepsis.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting and participants: </strong>This study was conducted using the MIMIC-IV database. A total of 30,667 adult patients (≥18 years) with first ICU admissions meeting Sepsis-3 criteria were included.</p><p><strong>Main outcome measures: </strong>ICU mortality and in-hospital mortality. We compared discrimination (AUC), calibration, net reclassification improvement (NRI), integrated discrimination improvement (IDI), decision curve analysis and time-dependent survival.</p><p><strong>Results: </strong>Among 30,667 patients, 87.0% met both SOFA-1 and SOFA-2 criteria, 12.0% met only SOFA-2 criteria, and 1.0% met only SOFA-1 criteria. SOFA-2 total scores were systematically higher than SOFA-1, driven primarily by updated renal, cardiovascular and brain scoring criteria. SOFA-2 demonstrated modestly but consistently better discrimination for ICU mortality (AUC 0.779 vs. 0.755; P < 0.001) and hospital mortality (AUC 0.745 vs. 0.725; P < 0.001), with significant reclassification improvement for ICU mortality (NRI 0.143; IDI 0.020). In multivariable Cox models, SOFA-2 achieved higher AUCs for 7-day (0.790 vs. 0.771), 28-day (0.709 vs. 0.697) and 90-day mortality (0.682 vs. 0.671; all P < 0.001), with consistent advantages across all prespecified subgroups.</p><p><strong>Conclusions: </strong>SOFA-2 provides modestly but consistently better prognostic performance than SOFA-1 in septic ICU patients. Whether this incremental gain justifies the added scoring complexity warrants prospective evaluation.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100601"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13273132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148013613","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":"Frailty phenotype, genetic risk and long-term incident systemic lupus erythematosus risk: Insights from the UK Biobank study integrated with multi-omics analysis.","authors":"Peizhi Deng, Siyu Yan, Jianyun Lu","doi":"10.1016/j.clinme.2026.100598","DOIUrl":"10.1016/j.clinme.2026.100598","url":null,"abstract":"<p><strong>Background: </strong>Frailty, a marker of biological ageing and reduced physiological reserve, is linked to many chronic conditions, yet its role in the development of systemic lupus erythematosus (SLE) remains unclear.</p><p><strong>Aims: </strong>To examine the association between frailty and incident SLE and to investigate potential inflammatory and genetic mechanisms underlying this relationship.</p><p><strong>Methods: </strong>We conducted a prospective cohort study among 462,762 participants from the UK Biobank to examine the associations of physical frailty and frailty index with incident SLE. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals, with further analyses assessing the interaction and joint effects of frailty and polygenic risk. Gene-level overlap between frailty and SLE was evaluated using MAGMA. In addition, we integrated circulating inflammatory markers and plasma proteomic profiles to identify potential mediating pathways and candidate biomarkers.</p><p><strong>Results: </strong>During a median follow-up of 13.2 years, 309 of 462,762 participants (0.07%) developed incident SLE. Compared to non-frail individuals, both pre-frail and frail participants had a higher risk of developing SLE, with stronger associations observed in those with higher polygenic risk scores. Gene analysis identified 39 shared genes that were significantly correlated with both frailty and SLE. Circulating inflammatory markers, including C-reactive protein, were found to partially mediate the frailty-SLE relationship. Proteomic analyses identified ANGPTL3, CST3 and TNFSF8 as the candidate risk-related biomarkers associated with future incident SLE.</p><p><strong>Conclusion: </strong>Frailty is associated with an increased long-term risk of incident SLE, particularly in genetically susceptible individuals. Inflammatory cell measures and circulating proteins, including ANGPTL3, CST3 and TNFSF8, may help identify elevated SLE risk in pre-frail and frail populations.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100598"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13314888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161805","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":"How useful is a casual BP measurement?","authors":"Philip S Lewis","doi":"10.1016/j.clinme.2026.100626","DOIUrl":"10.1016/j.clinme.2026.100626","url":null,"abstract":"<p><p>Blood pressure (BP) varies continuously dependent on numerous personal and external factors as well as on the way it is measured and the methodology used. A casual BP reading may give some clues about a person's cardiovascular health, but risk can only be determined with repeated careful measurements. If high (≥140/90), systematic measurement following approved guidelines using a validated monitor is necessary, especially if the person is symptomatic and/or BP ≥180/120. A low casual BP (<90/60) should be similarly rechecked, especially if related symptoms are present. Despite the availability of guidelines for measuring BP, there is often poor compliance with these standards leading to less-than-ideal risk assessment. The lack of regulation of what BP home monitors are available to purchase, ignorance about how to measure BP accurately, the use of unvalidated monitors and of incorrect cuff sizes may lead to significant under- or over-assessment of BP with potentially avoidable consequences. Casual BP measurements, especially if elevated, need a systematic non-casual approach to remeasurement and interpretation.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100626"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469403","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":"Persistent (patent) foramen ovale assessment and closure for the general physician.","authors":"Peter Wilmshurst","doi":"10.1016/j.clinme.2026.100600","DOIUrl":"10.1016/j.clinme.2026.100600","url":null,"abstract":"<p><p>One-quarter of adults have a persistent (patent) foramen ovale (PFO). Right-to-left shunting through a PFO can facilitate paradoxical thromboembolism, cryptogenic stroke, paradoxical gas embolism, decompression sickness, arterial hypoxaemia and migraine with aura. Atrial septal defects and pulmonary shunts are also associated with these diseases, and investigation must differentiate them from a PFO. The detection and assessment of PFOs and other right-to-left shunts uses ultrasound techniques augmented with intravenous injection of bubble contrast. When diseases are attributed to a PFO, the PFO is usually large, typically about 10 mm diameter and associated with a large right-to-left shunt. Transcatheter closure of a PFO is relatively simple, but it is not always effective. Therefore, patients require careful pre-procedure counselling about risks, benefits, success rates and alternative treatments.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100600"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13273876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148004766","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":"Cardiovascular disease: everybody's business.","authors":"Tevfik F Ismail, Ponnusamy Saravanan","doi":"10.1016/j.clinme.2026.100630","DOIUrl":"10.1016/j.clinme.2026.100630","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100630"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548120","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":"Cardiopulmonary point-of-care ultrasound for critical care.","authors":"Hatem Soliman Aboumarie","doi":"10.1016/j.clinme.2026.100624","DOIUrl":"10.1016/j.clinme.2026.100624","url":null,"abstract":"<p><p>Point-of-care ultrasound (POCUS) has emerged as an essential bedside tool for the rapid assessment and management of critically ill patients. This review outlines the evolution of POCUS from a focused, rule-in/rule-out modality to an advanced, integrative diagnostic approach capable of supporting complex haemodynamic evaluation. Technological advances, including handheld devices and artificial intelligence, have enhanced accessibility, diagnostic accuracy, and training efficiency. In the intensive care setting, echocardiographic interpretation must be contextualised within dynamic physiological variables such as preload, ventilation, vasoactive support, and metabolic status. POCUS plays a pivotal role in differentiating shock phenotypes-cardiogenic, distributive, hypovolaemic and obstructive-by integrating structural and functional cardiac assessment with lung and systemic venous ultrasound findings. Key haemodynamic parameters, including left ventricular outflow tract velocity time integral (LVOT VTI) and Doppler-derived indices, enable evaluation of cardiac output and fluid responsiveness, while dynamic tests such as passive leg raising further refine management decisions. The review also highlights the role of POCUS in assessing hypoxaemia through combined cardiopulmonary evaluation and introduces the 'POCUS pyramid' framework, integrating cardiac, pulmonary, and venous domains into a unified physiological model. Ultimately, when performed by appropriately trained clinicians, POCUS and critical care echocardiography enhance diagnostic precision, guide therapy, and improve bedside decision-making while recognising inherent limitations and the need for structured training and governance.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100624"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535460","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":"A FeAsibility items Checklist for assessing implementation characTeristics of patient-reported Outcome measures in Research, Regulation and Routine clinical care (FACTOR3): Development and evaluation.","authors":"Asad Bhatty, Chris Wilkinson, Visvesh Jeyalan, Ali Wahab, Jeremy Dwight, Marcin Ruciński, Edwin de Beurs, Melanie Calvert, Richard P Gale, Mike Horton, Andrea Manca, Tom Melvin, Massimo Di Maio, Amar Rangan, Julie Sanders, Tonya Winders, Adam B Smith, Chris P Gale","doi":"10.1016/j.clinme.2026.100592","DOIUrl":"10.1016/j.clinme.2026.100592","url":null,"abstract":"<p><strong>Study objective: </strong>Patient-reported outcome measures (PROMs) provide valuable data to inform regulatory decision making, health technology assessment and routine clinical care. We aimed to develop a feasibility item checklist for PROMs and their selection, beyond their psychometric properties (FACTOR3).</p><p><strong>Methods: </strong>We followed a five-stage method to select parameters for PROM evaluation. 1) A scoping literature review identified candidate items for consideration; 2) round 1 modified Delphi was used to select items for inclusion or exclusion, conducted by the design group (n = 14); 3) feedback on the checklist was provided by representatives from the European Medicines Agency and National Institute for Health and Care Excellence; 4) round 2 modified Delphi was used to finalise item selection, conducted by the clinical domains group (n = 21) and 5) evaluation of the feasibility item checklist using a selection of PROMS (EQ5D-5L, HeartQOL, the Oxford Hip Score, The EORTC Core Questionnaire QLQ-C30, Re-QOL-10 and NEI-VFQ-25) (Fig. 1).</p><p><strong>Results: </strong>The scoping review identified 13 items relating to the intrinsic feasibility of using PROMs which were considered in the modified Delphi. The final FACTOR3 checklist included eight unique candidate items: price; licensing, comprehensibility, duration, coverage, translations, electronic device compatibility; and minimal important difference. Of the six PROMS evaluated, the intraclass correlation coefficient was 0.81, suggesting good reliability.</p><p><strong>Conclusions: </strong>FACTOR3 is a feasibility item checklist to assess the implementation characteristics of PROMs in research, regulation and routine clinical care. It may be used in conjunction with existing psychometric evaluation and user guides for PROMS to facilitate their use in health care.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100592"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13315201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148053206","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}