Clinical Medicine最新文献_第7页

Milroy lecture 2024. Non-communicable versus communicable diseases: A paradigm unfit for the 21st century? 米罗伊讲座 2024。非传染性疾病与传染性疾病--不适合 21 世纪的范式？

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-05-01 Epub Date: 2025-04-02 DOI: 10.1016/j.clinme.2025.100308

Amitava Banerjee

引用次数: 0

Validation of ARIC heart failure risk score in an Asian population: Results from the CORE-Thailand registry. 亚洲人群中ARIC心力衰竭风险评分的验证：来自CORE-Thailand Registry的结果

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-05-01 Epub Date: 2025-04-30 DOI: 10.1016/j.clinme.2025.100322

Nichanan Osataphan, Ply Chichareon, Wanwarang Wongcharoen, Krit Leemasawat, Narawudt Prasertwitayakij, Pannipa Suwannasom, Siriluck Gunaparn, Kasem Rattanasumawong, Rungroj Krittayaphong, Arintaya Phrommintikul

{"title":"Validation of ARIC heart failure risk score in an Asian population: Results from the CORE-Thailand registry.","authors":"Nichanan Osataphan, Ply Chichareon, Wanwarang Wongcharoen, Krit Leemasawat, Narawudt Prasertwitayakij, Pannipa Suwannasom, Siriluck Gunaparn, Kasem Rattanasumawong, Rungroj Krittayaphong, Arintaya Phrommintikul","doi":"10.1016/j.clinme.2025.100322","DOIUrl":"10.1016/j.clinme.2025.100322","url":null,"abstract":"Background: The Atherosclerotic Risk in Communities (ARIC) heart failure (HF) score was originally developed in the USA to predict new-onset HF. Our goal was to validate the ARIC-HF score and develop a new score to predict HF in an Asian population.Methods: The Cohort Of patients with high Risk for cardiovascular Events (CORE-Thailand) was a prospective registry of Thai patients with high atherosclerotic risk. Patients were followed for 5 years for HF events. The ARIC-HF score was applied to predict HF. The new ARIC-CORE score was developed by re-estimating the coefficients of ARIC score variables using ridge regression. The discrimination and calibration of the models were assessed. The net reclassification index (NRI) was used to compare the prediction performance between the models. Clinical utility was assessed with a decision curve analysis.Results: From a total of 8,919 patients, 185 (2.1 %) developed HF. The ARIC-HF score and ARIC-CORE HF risk score provided good discrimination with C-statistics of 0.710, (95 % confidence interval (CI); 0.673-0.747) and 0.75, (95 % CI; 0.715-0.785), respectively. Both models showed a good calibration. Using the ARIC-CORE HF score was associated with an improved reclassification of HF (NRI 0.369, 95 % CI; 0.286-0.551) compared to the ARIC-HF score. The net clinical benefit of the ARIC-CORE HF score was higher than the ARIC-HF score in the decision curve analysis.Conclusion: The ARIC-HF score performed well in predicting heart failure in the CORE population. The ARIC-CORE HF score showed superior predictive ability and clinical benefit. Further research is needed to validate these models in diverse Asian populations.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100322"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964758","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 use of metaverse in medical education: A systematic review. meta - verse在医学教育中的应用：系统综述。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-05-01 Epub Date: 2025-04-15 DOI: 10.1016/j.clinme.2025.100315

Qian Li, Hui Duan, Xinxu Zhou, Xiaobin Sun, Lan Tao, Xiuying Lu

{"title":"The use of metaverse in medical education: A systematic review.","authors":"Qian Li, Hui Duan, Xinxu Zhou, Xiaobin Sun, Lan Tao, Xiuying Lu","doi":"10.1016/j.clinme.2025.100315","DOIUrl":"10.1016/j.clinme.2025.100315","url":null,"abstract":"Objective: This study aims to systematically evaluate the influence of metaverse-based teaching tools on the medical teaching effect and the improvement of students' ability, providing evidence-based support for curriculum development.Methods: A comprehensive search of PubMed, Cochrane, Embase and Web of Science databases was conducted up to 9 March 2025. Two researchers independently screened articles, extracted data, and assessed bias using the Cochrane Handbook 5.1.0 checklist. Data analysis was performed using RevMan 5.3.Results: Thirty studies involving 1,560 participants. The metaverse was applied in various areas such as surgery training, anatomy teaching and communication skills. Common metaverse approaches include AR, VR, MR etc, with simulated teaching times ranging from as little as 10 min to lasting several weeks. Most studies reported improved student guidance, reduced training time, and enhanced learning interest, and confidence.Conclusion: Metaverse technology proves effective for medical teaching, offering theoretical support for further research.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"25 3","pages":"100315"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12059326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981534","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

Incidence of gestational diabetes in pregnant women with a history of bariatric surgery using a service evaluation. 有减肥手术史的孕妇妊娠期糖尿病发病率的服务评价

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-05-01 Epub Date: 2025-04-29 DOI: 10.1016/j.clinme.2025.100318

B Jenner, D Jones, L C Kusinski, C Patient, A Park, A Sarker, V Bansiya, E M Gurnell, C L Meek

{"title":"Incidence of gestational diabetes in pregnant women with a history of bariatric surgery using a service evaluation.","authors":"B Jenner, D Jones, L C Kusinski, C Patient, A Park, A Sarker, V Bansiya, E M Gurnell, C L Meek","doi":"10.1016/j.clinme.2025.100318","DOIUrl":"10.1016/j.clinme.2025.100318","url":null,"abstract":"Background: Pregnant women with previous bariatric surgery are at increased risk of gestational diabetes mellitus (GDM) but many cannot safely tolerate the oral glucose tolerance test (OGTT). Consensus recommendations advise self-monitoring of blood glucose (SMBG) for GDM diagnosis, but diagnostic thresholds are unexplored in this population.Study objective: To assess the incidence of SMBG-defined GDM (fasting, 1-hr postprandial thresholds: 90, 140 mg/dL (5.3, 7.8 mmol/L)) after bariatric surgery, compared to the incidence of OGTT-defined GDM in women with risk factors for GDM but no history of bariatric surgery.Design and setting: Patients with a history of bariatric surgery (n=24) were included in a retrospective service evaluation based at a single tertiary referral centre in England, with results compared to a national study of women at high risk of GDM but without a history of bariatric surgery (n=1,308).Main outcome measures: The incidence of GDM diagnosed according to SMBG vs OGTT.Results: GDM incidence was 16/24 (66.7%; SMBG-defined) after bariatric surgery and 121/1,308 (9.3%; OGTT-defined) in the control group, with the highest incidence rates seen after gastric bypass (85.7%). In women with previous bariatric surgery, HbA1c showed no association with GDM diagnosis, the requirement for treatment or offspring birth weight.Conclusions: SMBG at standard thresholds is not able to reliably diagnose GDM after bariatric surgery and is likely to over-diagnose GDM, especially after gastric bypass, although small sample size limits generalisability of this study. Alternative diagnostic and prognostic markers are warranted for diagnosis of GDM after bariatric surgery.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100318"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971747","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

Unexplained breathlessness: Integrating pathophysiological insights with clinical evaluation. 原因不明的呼吸困难：将病理生理学见解与临床评估相结合。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-05-01 Epub Date: 2025-04-10 DOI: 10.1016/j.clinme.2025.100313

Andrea Baccelli, Francesco Lo Giudice, Gulammehdi Haji, Rachel J Davies, Wendy Gin-Sing, Luke S Howard

引用次数: 0

Neurosyphilis: A rare cause of encephalitis in a young male. 神经梅毒：年轻男性脑炎的罕见病因。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-05-01 Epub Date: 2025-04-07 DOI: 10.1016/j.clinme.2025.100312

William Cunningham, Michael Keogh, Nirmalan Arulanantham

引用次数: 0

From eschar to diagnosis: A case report on scrub typhus causing multi-organ failure in a returning traveller. 从感染到诊断：一名返程旅客感染恙虫病致多器官功能衰竭1例报告。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-05-01 Epub Date: 2025-04-01 DOI: 10.1016/j.clinme.2025.100307

Patrick Eaton, Ahmed Ahmed, Emyr Huws

{"title":"From eschar to diagnosis: A case report on scrub typhus causing multi-organ failure in a returning traveller.","authors":"Patrick Eaton, Ahmed Ahmed, Emyr Huws","doi":"10.1016/j.clinme.2025.100307","DOIUrl":"10.1016/j.clinme.2025.100307","url":null,"abstract":"Scrub typhus, caused by Orientia tsutsugamushi, is a rickettsial infection transmitted by mite bites, often underdiagnosed in travellers from endemic regions. This case report describes a 65-year-old female with hypertension who developed severe scrub typhus after a trip to Sri Lanka. She presented with fever, myalgia, headache, fatigue and a scabbed lesion. Initial tests showed neutrophilia, lymphocytopenia and elevated liver enzymes. Malaria was ruled out, and empiric treatment with intravenous Tazocin was initiated. On day 5, she developed Clostridium difficile infection, requiring a switch to oral vancomycin. By day 5, her condition worsened with hypoxia, hypotension, oliguria and renal failure. Chest X-ray revealed bilateral infiltrates and subsequently, she was transferred to critical care. Tests showed positive IgM test for O. tsutsugamushi. Oral doxycycline was started, resulting in rapid improvement. PCR confirmed scrub typhus. This case underscores the importance of early diagnosis and treatment with doxycycline in travellers from endemic areas presenting with febrile illness.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100307"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779343","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

Risk factors and an interpretability tool of in-hospital mortality in critically ill patients with acute myocardial infarction. 危重急性心肌梗死患者住院死亡率的危险因素和可解释性工具。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-05-01 Epub Date: 2025-02-27 DOI: 10.1016/j.clinme.2025.100299

Rui Yang, Tao Huang, Renqi Yao, Di Wang, Yang Hu, Longbing Ren, Shaojie Li, Yali Zhao, Zhijun Dai

{"title":"Risk factors and an interpretability tool of in-hospital mortality in critically ill patients with acute myocardial infarction.","authors":"Rui Yang, Tao Huang, Renqi Yao, Di Wang, Yang Hu, Longbing Ren, Shaojie Li, Yali Zhao, Zhijun Dai","doi":"10.1016/j.clinme.2025.100299","DOIUrl":"10.1016/j.clinme.2025.100299","url":null,"abstract":"Objective: We aim to develop and validate an interpretable machine-learning model that can provide critical information for the clinical treatment of critically ill patients with acute myocardial infarction (AMI).Methods: All data were extracted from the multi-centre database (training and internal validation cohorts: MIMIC-III/-IV, external validation cohort: eICU). After comparing different machine-learning models and several unbalanced data processing methods, the model with the best performance was selected. Lasso regression was used to build a compact model. Seven evaluation methods, PR and ROC curves were used to assess the model. The SHapley Additive exPlanations (SHAP) values were calculated to evaluate the feature's importance. The SHAP plots were adopted to explain and interpret the results. A web-based tool was developed to help application.Results: A total of 12,170 critically ill patients with AMI were included. The balance random forest (BRF) model had the best performance in predicting in-hospital mortality. The compact model did not differ from the full variable model in performance (AUC: 0.891 vs 0.885, P = 0.06). The external validation results also demonstrated the stability of the model (AUC: 0.784). All SHAP plots have shown the contribution ranking of all variables in the model, the relationship trend between variables and outcomes, and the interaction mode between variables. A web-based tool is constructed that can provide individualised risk stratification probabilities (https://github.com/huangtao36/BRF-web-tool).Conclusion: We built the BRF model and the web-based tool by the model algorithm. The model effect has been verified externally. The tool can help clinical decision-making.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100299"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536893","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

Lung transplant: A clinical overview. 肺移植：临床综述。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-05-01 Epub Date: 2025-05-15 DOI: 10.1016/j.clinme.2025.100328

Usman Feroze Khatana, Jasvir Singh Parmar, Caroline M Patterson

引用次数: 0

GLP-1 receptor agonist therapy and pregnancy: Evolving and emerging evidence. GLP-1 受体激动剂疗法与妊娠：不断发展和新出现的证据。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2025-03-01 Epub Date: 2025-02-22 DOI: 10.1016/j.clinme.2025.100298

Maria S Varughese, Fidelma O'Mahony, Lakshminarayanan Varadhan

引用次数: 0