Clinical Medicine最新文献

{"title":"Isolated cardiac sarcoidosis: A clinical challenge.","authors":"Paul Njoku, Sumbal Rani, Orestis Paschalis, Emanuela Alati, Amit K J Mandal, Constantinos G Missouris","doi":"10.1016/j.clinme.2024.100245","DOIUrl":"10.1016/j.clinme.2024.100245","url":null,"abstract":"<p><p>Sarcoidosis is an inflammatory disease characterised by non-caseating granulomas of unclear aetiology. Isolated cardiac sarcoidosis (ICS) is rare and occurs when there is granulomatous infiltration of myocardial tissue without evidence of extracardiac sarcoidosis. The heterogeneity in clinical manifestations often presents a diagnostic challenge which leads to delays in treatment initiation. Our case highlights the often quiescent presentation of ICS, the importance of early treatment and the diagnostic challenges that contribute to its underdiagnosis.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100245"},"PeriodicalIF":3.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281398","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":"Individualised therapeutic approach to the patient with atypical haemolytic-uraemic syndrome.","authors":"Ivana Mikačić, Nikolina Marić","doi":"10.1016/j.clinme.2024.100250","DOIUrl":"10.1016/j.clinme.2024.100250","url":null,"abstract":"<p><p>Atypical haemolytic-uraemic syndrome (aHUS) is a rare disease associated with uncontrolled activation of the alternative complement pathway, leading to thrombotic microangiopathy (TMA). Early diagnosis and treatment with eculizumab, a monoclonal antibody targeting the complement component C5, are crucial to improve outcomes and prevent renal failure and mortality. Current recommendations include lifelong eculizumab therapy, yet this practice presents challenges including high treatment costs and increased infection risks from prolonged complement inhibition. We hypothesise that a personalised eculizumab dosing strategy tailored to individual patient responses could optimise therapy, reduce costs and improve safety. This hypothesis was evaluated through a presentation of a patient who was managed with a specific eculizumab treatment approach. The patient's condition improved significantly, allowing for a gradual reduction in eculizumab dosage based on clinical response and drug level monitoring. Throughout treatment, the patient's complement activity and eculizumab levels were closely monitored, showing that lower doses maintained therapeutic efficacy without evident TMA recurrence. This case supports the feasibility of transitioning from fixed regimens to personalised dosing strategies in managing aHUS. Such approaches could mitigate the risks and costs associated with lifelong therapy while maintaining disease control, especially considering the variability in relapse risk among different genetic mutations. This personalised treatment model might significantly impact the management of aHUS, aligning clinical care with individual patient needs and economic considerations. Further research should relate drug pharmacokinetics/pharmacodynamics to clinical/genetic setting to identify milestones of individual patient treatment approach.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100250"},"PeriodicalIF":3.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379195","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":"Hospital at home - developing a simulation induction programme for junior doctors.","authors":"Gareth Watson, Amelia Paveley, Katherine Chin, Alexandra Lindsay-Perez, Rebekah Schiff","doi":"10.1016/j.clinme.2024.100259","DOIUrl":"10.1016/j.clinme.2024.100259","url":null,"abstract":"<p><p>Hospital at Home (HaH) provides hospital-level care within patients' homes. With services expanding, a London HaH service embedded new junior doctor posts. Currently, gaps exist in the under- and postgraduate curriculum to develop clinical skills required to deliver care in this context. HaH simulation (HaH-SIM) was developed, through a multi-cycle QIP, to improve early-career doctors' confidence in providing care in this unfamiliar environment. Surveys before and after HaH-SIM assessed confidence in practical, clinical and communication skills; ranked concerns; rated sessions and gained qualitative feedback. 41 doctors participated over 2 years. It currently includes six low-fidelity stations and three high-fidelity stations. Confidence improved, particularly in managing end of life, decision-making around hospital admission and administering intravenous medications/fluids. High-fidelity scenarios, practical skills and prescribing stations were most highly rated. As HaH services expand, HaH-SIM is a feasible, effective and transferable way of improving early-career doctors' confidence and skills to provide care in patients' homes.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100259"},"PeriodicalIF":3.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544155","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":"Differential effects of oral versus intravenous hydrocortisone and dexamethasone on capillary blood glucose levels in adult inpatients - a single centre study.","authors":"Vaishali Limbachia, Ian Nunney, Daniel J Page, Hannah A Barton, Leena K Patel, Georgia N Thomason, Stephan L Green, Kieran F J Lewis, Ketan Dhatariya","doi":"10.1016/j.clinme.2024.100249","DOIUrl":"10.1016/j.clinme.2024.100249","url":null,"abstract":"<p><strong>Background: </strong>Corticosteroids raise blood glucose concentrations; however, it remains unknown which form of administration, oral or intravenous, is associated with the greatest degree of blood glucose rise in hospitalised patients. Furthermore, it is not known whether the pattern of the associated hyperglycaemia throughout the day differs depending on the route of administration.</p><p><strong>Methods: </strong>This was a single centre retrospective study of 384 adult inpatients receiving oral or intravenous hydrocortisone and dexamethasone. Data on capillary glucose concentrations and time taken over 7 days were collected. A mixed model for repeated measures was applied to compare changes in glucose concentration over time for oral and intravenous corticosteroids. An auto-regressive covariance structure was employed to model correlations between repeated measurements. This was adjusted for age, sex, pre-admission diabetes, and/or pre-admission corticosteroid status.</p><p><strong>Results: </strong>No significant difference was found between oral and intravenous hydrocortisone on day 1 or across all 7 days (mean difference 0.17 mmol/L (-1.39, 1.75), p = 0.827, and mean difference 0.20 mmol/L (-0.61, 1.01), p = 0.639 respectively). There were no differences in mean glucose concentrations between those on oral or intravenous dexamethasone on day 1 or across all 7 days (mean difference 0.41 mmol/L (-0.55, 1.38), p = 0.404 and mean difference -0.09 mmol/L (-1.05,0.87), p = 0.855, respectively).</p><p><strong>Conclusion: </strong>This study found that oral and intravenous administration of hydrocortisone and dexamethasone do not have a significantly differing impact on blood glucose levels. Capillary glucose monitoring is strongly recommended in all individuals who are on either oral or intravenous corticosteroids.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100249"},"PeriodicalIF":3.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379194","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 integrated approach to neuroscience care: An innovative model to support the new integrated care system.","authors":"Michelle S Balaratnam, Fergus J Rugg-Gunn, Rachel Okin, Freya Powell, Stephen Prior, Panayiota Petrochilos, Dhiren Shivji, Salman Haider, Ali Alim-Marvasti, Arvind Chandratheva, Robert Simister, Charlie Lane, Roberto Macarimban, Diego Kaski, Bal Athwal, Rebecca Liu, Timothy Yates, Sanjeev Rajakulendran, Gerry Christofi, Jeremy Sandford, Alexis Ingram, Katherine Bluston, Caroline Weaver, Oluwaseun Odejide, George Glod, Gulsen Gungor, Edmund Nkrumah, Donal Markey, Gary Hotton, Katie Sidle, Jonathan Kennedy, Lisa Penniall, Helen Plum, Anthony Antoniou, Rakhee Prema, Nadia Jeffries, Carole Walters, Valerie L Stevenson, Malini Drysdale, Sabiha Tasnim, Shahrima Hussain, Lily Mackay, Ryan Baulk, Bianca IIii, David Egan, Adrian Capp, Patricia Turner, Christopher Turner","doi":"10.1016/j.clinme.2024.100234","DOIUrl":"10.1016/j.clinme.2024.100234","url":null,"abstract":"<p><p>Integrated care systems join up health and care services, so that people have the support they need, in the right place, at the right time. The aims include improving outcomes in healthcare, tackling inequalities in access and enhancing productivity and value for money. This is needed for neuroscience care as the traditional delivery of neuroscience care is inefficient, outdated and expensive, and can involve complex referral pathways and long waiting times. In preparation for the formation of the integrated care system (ICS), a novel innovative collaboration across multiple NHS trusts developed across North Central London in 2021. We developed a model where neuroscience specialists engage in collaborative care with clinicians outside the specialist hospital setting. Pivotal to the pathway is a multidisciplinary meeting, and collaborative working enables joint clinical reviews, diagnostics and medication initiation. This innovative collaboration has already significantly improved access, addressed inequalities due to borough variation and enhanced the delivery and quality of neuroscience care in our ICS. It is a translatable model that can be adapted to suit other regions in the UK. It fulfils many of the objectives of the integrated care system and these benefits are seen without the need for significantly more resource.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100234"},"PeriodicalIF":3.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11564059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035382","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 rare cause of atypical facial pain.","authors":"Suzannah Hall, Kevin Michell, David Howlett","doi":"10.1016/j.clinme.2024.100254","DOIUrl":"10.1016/j.clinme.2024.100254","url":null,"abstract":"<p><p>This case illustrates a rare cause of facial pain due to glossopharyngeal neuralgia in a 66-year-old male patient. Imaging confirmed an aneurysm of the cervical internal carotid artery as the cause; the aneurysm itself, likely secondary to an elongated styloid process (Eagle's syndrome). The imaging findings and management options are discussed below.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100254"},"PeriodicalIF":3.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11582405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459785","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":"Implementation of ultrasound-guided cannulation training for foundation doctors.","authors":"Mia Pham, Robert Aldous, Stephan Brincat","doi":"10.1016/j.clinme.2024.100256","DOIUrl":"10.1016/j.clinme.2024.100256","url":null,"abstract":"<p><p>Peripheral intravenous cannulation (PIVC) is an essential skill for newly qualified foundation doctors. It has high failure rates, resulting in care delays, pain and infection. We explored the perceived impact of ultrasound-guided PIVC (US-PIVC) training on confidence when performing difficult-access PIVC. We surveyed 88 foundation doctors to evaluate their perceptions of US-PIVC. Each cohort of participants was given two sessions over a 2-month period. Confidence was assessed using electronic questionnaires through 5-point Likert scales and free text responses. Confidence when performing PIVC with difficult access, regardless of US, increased significantly following the course (p < 0.01). This was also true regarding confidence when performing US-PIVC (p < 0.01.). Key themes identified included technical skills, confidence and clinical utility.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100256"},"PeriodicalIF":3.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11651033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496441","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":"Determining factors influencing hospital stay for individuals admitted with diabetes-related ketoacidosis - findings from DEKODE length of stay quality improvement project.","authors":"Ankita Gupta, Benedict Brazier, Lakshmi Rengarajan, Parth Narendran, Punith Kempegowda","doi":"10.1016/j.clinme.2024.100255","DOIUrl":"10.1016/j.clinme.2024.100255","url":null,"abstract":"<p><p>There are significant variations in discharge post-diabetes-related ketoacidosis (DKA) hospitalisation, yet there is a paucity of research to understand or minimise the reasons. This quality improvement project (QIP) aimed to identify reasons for post-DKA discharge delays and assess intervention efficacy. Utilising the Digital Evaluation of Ketosis and Other Diabetes-related Emergencies (DEKODE) model, data from 177 DKA episodes from January 2021 to September 2023 across three hospitals were analysed. Factors affecting discharge were investigated through a plan, do, study, act (PDSA) methodology. While interventions focused on optimising data collection and refining discharge guidelines, no significant reduction in DKA duration or length of stay was observed. Findings highlight post-DKA hospitalisation's multifaceted nature and the limited impact of simple interventions. Collaborative efforts and further research are necessary to develop effective strategies for expedited discharge and improved patient care. This study's comprehensive tracking and analysis tool offers valuable insights for future interventions in managing DKA-related hospitalisations.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100255"},"PeriodicalIF":3.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11564021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459786","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":"Implementation of SAMPL Guidelines in 100 clinical medicine articles: enhancing statistical reporting and recommendations for biomedical journals.","authors":"Michal Ordak","doi":"10.1016/j.clinme.2024.100257","DOIUrl":"https://doi.org/10.1016/j.clinme.2024.100257","url":null,"abstract":"<p><strong>Background: </strong>Contemporary observations indicate insufficient quality in the reporting of statistical data. Despite the publication of the SAMPL guidelines in 2015, they have not been widely adopted. The aim of this article is to highlight the incorporation of SAMPL Guidelines in the statistical reviews of articles related to clinical medicine, as well as the changes implemented by authors in revised manuscripts as a result of such guidance. An additional objective is to provide recommendations for biomedical journals regarding the necessity of integrating SAMPL Guidelines into their daily practices.</p><p><strong>Methods: </strong>The study incorporated 100 selected statistical reviews of original clinical medicine articles from 8 biomedical journals, conducted between 2016 and 2023. Each of these reviews suggested specific SAMPL Guidelines to be implemented in the revised manuscript. It was evaluated which specific SAMPL Guidelines were most frequently enforced and what changes resulted from their implementation.</p><p><strong>Results: </strong>Seventy-five percent of the manuscripts in question garnered acceptance following a solitary round of statistical evaluation. Among the most frequently recommended and subsequently implemented SAMPL Guidelines by the authors are a more thorough description of the purpose of the applied statistical tests (65%), indication of the practical significance of the obtained results, including calculation of relevant effect size measures (64%), analysis of assumptions necessary for the application of specific statistical tests (58%), and consideration of the impact of outlier values on the obtained results (34%).</p><p><strong>Conclusion: </strong>To improve the quality of statistical reporting in biomedical journals, greater emphasis should be placed on implementing SAMPL Guidelines.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100257"},"PeriodicalIF":3.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approach to pancytopenia: From blood tests to the bedside.","authors":"Shaun Chew, Majeed Kamangar","doi":"10.1016/j.clinme.2024.100235","DOIUrl":"10.1016/j.clinme.2024.100235","url":null,"abstract":"<p><p>Pancytopenia is an uncommon abnormality detected on a full blood count. Features of presentation tend to be non-specific, and are due to impaired functions of the cell lines involved. These can include fatigue, infection and bleeding. However, the aetiology of pancytopenia is extensive. This narrative review aims to provide a minimally invasive diagnostic algorithm for generalist clinicians to approach pancytopenia, including investigations into the underlying aetiology, and when a referral to the haematologist is warranted for further investigations such as bone marrow aspiration and trephine biopsy.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100235"},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003786","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}