Clinical Medicine最新文献_第7页

Severe measles with pneumonitis in an immunocompetent adult. 一名免疫功能正常的成年人患重症麻疹并发肺炎。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-09-01 Epub Date: 2024-08-30 DOI: 10.1016/j.clinme.2024.100239

Danielle Lee, Oliver Mercer, Varsha Halai, Laura Gill, Colin Macleod, Temi Lampejo

引用次数: 0

Improving the systematic screening and documentation of mental capacity for patients with severe brain injury: The Mental Capacity Screening assessment tool (MCScreen). 改善严重脑损伤患者精神能力的系统筛查和记录：精神能力筛查评估工具（MCScreen）。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-09-01 Epub Date: 2024-08-20 DOI: 10.1016/j.clinme.2024.100236

Lynne Turner-Stokes, Karima Benaichouche-Motam, William Goodison, Adam Altaie, Alice Howard, Patrick McKnight, Jessie Alfonso

{"title":"Improving the systematic screening and documentation of mental capacity for patients with severe brain injury: The Mental Capacity Screening assessment tool (MCScreen).","authors":"Lynne Turner-Stokes, Karima Benaichouche-Motam, William Goodison, Adam Altaie, Alice Howard, Patrick McKnight, Jessie Alfonso","doi":"10.1016/j.clinme.2024.100236","DOIUrl":"10.1016/j.clinme.2024.100236","url":null,"abstract":"For patients who may lack capacity, the Mental Capacity Act 2005 requires capacity to be assessed for each decision at the time that treatment is offered, but this is not practical for every element of basic care and intervention delivered to patients undergoing rehabilitation following acquired brain injury, especially if their needs are changing. In this quality improvement project, we introduced a system for screening Mental Capacity and documentation to identify patients with a) largely intact cognition for whom capacity may be reasonably be presumed, and b) those in prolonged disorders of consciousness who clearly lacked capacity for all decisions. This enabled the multidisciplinary team to concentrate on evaluation of capacity in the third group who had more nuanced ability and required detailed assessment or support for decision-making. Two rounds of audit demonstrated that implementation improved the consistency of assessment and documentation. Multicentre roll-out of this approach is now required.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100236"},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11415571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016557","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

Improving quality in adult long covid services: Findings from the LOCOMOTION quality improvement collaborative. 提高成人长期护理服务的质量：LOCOMOTION 质量改进合作组织的研究结果。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-09-01 Epub Date: 2024-08-23 DOI: 10.1016/j.clinme.2024.100237

Julie Darbyshire, Trisha Greenhalgh, Nawar D Bakerly, Kumaran Balasundaram, Sareeta Baley, Megan Ball, Emily Bullock, Rowena Cooper, Helen Davies, Johannes H De Kock, Carlos Echevarria, Sarah Elkin, Rachael Evans, Zacc Falope, Cliodhna Flynn, Emily Fraser, Stephen Halpin, Samantha Jones, Rachel Lardner, Cassie Lee, Ashliegh Lovett, Victoria Masey, Harsha Master, Ghazala Mir, Adam Mosley, Jordan Mullard, Rory J O'Connor, Amy Parkin, Anton Pick, Janet Scott, Nikki Smith, Emma Tucker, Paul Williams, Darren Winch, Conor Wood, Manoj Sivan

{"title":"Improving quality in adult long covid services: Findings from the LOCOMOTION quality improvement collaborative.","authors":"Julie Darbyshire, Trisha Greenhalgh, Nawar D Bakerly, Kumaran Balasundaram, Sareeta Baley, Megan Ball, Emily Bullock, Rowena Cooper, Helen Davies, Johannes H De Kock, Carlos Echevarria, Sarah Elkin, Rachael Evans, Zacc Falope, Cliodhna Flynn, Emily Fraser, Stephen Halpin, Samantha Jones, Rachel Lardner, Cassie Lee, Ashliegh Lovett, Victoria Masey, Harsha Master, Ghazala Mir, Adam Mosley, Jordan Mullard, Rory J O'Connor, Amy Parkin, Anton Pick, Janet Scott, Nikki Smith, Emma Tucker, Paul Williams, Darren Winch, Conor Wood, Manoj Sivan","doi":"10.1016/j.clinme.2024.100237","DOIUrl":"10.1016/j.clinme.2024.100237","url":null,"abstract":"The protracted form of COVID-19 known as 'long covid' was first described in 2020. Its symptoms, course and prognosis vary widely; some patients have a multi-system, disabling and prolonged illness. In 2021, ring-fenced funding was provided to establish 90 long covid clinics in England; some clinics were also established in Scotland and Wales. The NIHR-funded LOCOMOTION project implemented a UK-wide quality improvement collaborative involving ten of these clinics, which ran from 2021 to 2023. At regular online meetings held approximately 8-weekly, participants prioritised topics, discussed research evidence and guidelines, and presented exemplar case histories and clinic audits. A patient advisory group also held a priority-setting exercise, participated in quality meetings and undertook a service evaluation audit. The goal of successive quality improvement cycles aimed at changing practice to align with evidence was sometimes hard to achieve because definitive evidence did not yet exist in this new condition; many patients had comorbidities; and clinics were practically constrained in various ways. Nevertheless, much progress was made and a series of 'best practice' guides was produced, covering general assessment and management; breathing difficulties; orthostatic tachycardia and other autonomic symptoms; fatigue and cognitive impairment; and vocational rehabilitation. This paper summarises key findings with the frontline clinician in mind.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100237"},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055155","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

Pandemics are here to stay: It's time for unity, both nationally and globally, in how we learn and respond. 大流行病将继续存在：现在是全国和全球团结一致，学习和应对的时候了。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-09-01 DOI: 10.1016/j.clinme.2024.100244

Ponnusamy Saravanan

引用次数: 0

Secondary hyperparathyroidism in chronic kidney disease: A narrative review focus on therapeutic strategy. 慢性肾病中的继发性甲状旁腺功能亢进症：以治疗策略为重点的叙述性综述。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-09-01 Epub Date: 2024-08-30 DOI: 10.1016/j.clinme.2024.100238

Shin-Hwa Tsai, Wei-Chih Kan, Rong-Na Jhen, Yu-Ming Chang, Jsun-Liang Kao, Hsien-Yung Lai, Hung-Hsiang Liou, Chih-Chung Shiao

{"title":"Secondary hyperparathyroidism in chronic kidney disease: A narrative review focus on therapeutic strategy.","authors":"Shin-Hwa Tsai, Wei-Chih Kan, Rong-Na Jhen, Yu-Ming Chang, Jsun-Liang Kao, Hsien-Yung Lai, Hung-Hsiang Liou, Chih-Chung Shiao","doi":"10.1016/j.clinme.2024.100238","DOIUrl":"10.1016/j.clinme.2024.100238","url":null,"abstract":"Chronic kidney disease (CKD) affects over 10% of the global population. One crucial complication of CKD is secondary hyperparathyroidism (SHPT), marked by elevated parathyroid hormone levels due to hyperphosphataemia, hypocalcaemia, and low active vitamin D from impaired renal function. SHPT increases risks of bone deformities, vascular calcification, cardiovascular events and mortality. This review examines SHPT treatment strategies in patients with CKD. First-line treatments include phosphate binders, vitamin D receptor activators and calcimimetics. When these fail, invasive options like parathyroidectomy (PTX) and thermal ablation are considered. PTX effectively reduces symptoms and improves radiological outcomes, outperforming medical treatment alone in reducing cardiovascular risk and mortality. Thermal ablation techniques, such as microwave, radiofrequency, laser or high-intensity focused ultrasound, offer less invasive alternatives with promising results. Future research should explore the molecular mechanisms of parathyroid gland hyperplasia and evaluate various treatments' impacts.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100238"},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11414656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105081","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

Gliomas in adults: Guidance on investigations, diagnosis, treatment and surveillance. 成人胶质瘤：调查、诊断、治疗和监测指南》。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-09-01 Epub Date: 2024-09-02 DOI: 10.1016/j.clinme.2024.100240

Anna Lerner, Kieran Palmer, Tom Campion, Thomas O Millner, Emily Scott, Cressida Lorimer, Dimitrios Paraskevopoulos, Grainne McKenna, Silvia Marino, Rachel Lewis, Nick Plowman

{"title":"Gliomas in adults: Guidance on investigations, diagnosis, treatment and surveillance.","authors":"Anna Lerner, Kieran Palmer, Tom Campion, Thomas O Millner, Emily Scott, Cressida Lorimer, Dimitrios Paraskevopoulos, Grainne McKenna, Silvia Marino, Rachel Lewis, Nick Plowman","doi":"10.1016/j.clinme.2024.100240","DOIUrl":"10.1016/j.clinme.2024.100240","url":null,"abstract":"Primary brain tumours are rare but carry a significant morbidity and mortality burden. Malignant gliomas are the most common subtype and their incidence is increasing within our ageing population. The diagnosis and treatment of gliomas involves substantial interplay between multiple specialties, including general medical physicians, radiologists, pathologists, surgeons, oncologists and allied health professionals. At any point along this pathway, patients can present to acute medicine with complications of their cancer or anti-cancer therapy. Increasing the awareness of malignant gliomas among general physicians is paramount to delivering prompt radiological and histopathological diagnoses, facilitating access to earlier and individualised treatment options and allows for effective recognition and management of anticipated complications. This article discusses evidence-based real-world practice for malignant gliomas, encompassing patient presentation, diagnostic pathways, treatments and their complications, and prognosis to guide management outside of specialist centres.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100240"},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132067","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

Utilising accessible and reproducible neurological assessments in clinical studies: Insights from use of the Neurological Impairment Scale in the multi-centre COVID-CNS study. 在临床研究中使用可访问和可重复的神经学评估：多中心 COVID-CNS 研究中使用神经学损伤量表的启示。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-09-01 Epub Date: 2024-09-06 DOI: 10.1016/j.clinme.2024.100241

Ali M Alam, Glynn W Webb, Ceryce Collie, Sashini Mariathasan, Yun Huang, Orla Hilton, Rajish Shil, Katherine C Dodd, James B Lilleker, Craig J Smith, Ava Easton, Arina Tamborska, Rhys H Thomas, Nicholas W S Davies, Thomas M Jenkins, Michael Zandi, Laura Benjamin, Mark A Ellul, Tom Solomon, Thomas A Pollak, Tim Nicholson, Gerome Breen, Daniel J van Wamelen, Nicholas W Wood, Benedict D Michael

{"title":"Utilising accessible and reproducible neurological assessments in clinical studies: Insights from use of the Neurological Impairment Scale in the multi-centre COVID-CNS study.","authors":"Ali M Alam, Glynn W Webb, Ceryce Collie, Sashini Mariathasan, Yun Huang, Orla Hilton, Rajish Shil, Katherine C Dodd, James B Lilleker, Craig J Smith, Ava Easton, Arina Tamborska, Rhys H Thomas, Nicholas W S Davies, Thomas M Jenkins, Michael Zandi, Laura Benjamin, Mark A Ellul, Tom Solomon, Thomas A Pollak, Tim Nicholson, Gerome Breen, Daniel J van Wamelen, Nicholas W Wood, Benedict D Michael","doi":"10.1016/j.clinme.2024.100241","DOIUrl":"10.1016/j.clinme.2024.100241","url":null,"abstract":"Reproducible and standardised neurological assessment scales are important in quantifying research outcomes. These scales are often performed by non-neurologists and/or non-clinicians and must be robust, quantifiable, reproducible and comparable to a neurologist's assessment. COVID-CNS is a multi-centre study which utilised the Neurological Impairment Scale (NIS) as a core assessment tool in studying neurological outcomes following COVID-19 infection. We investigated the strengths and weaknesses of the NIS when used by non-neurology clinicians and non-clinicians, and compared performance to a structured neurological examination performed by a neurology clinician. Through our findings, we provide practical advice on how non-clinicians can be readily trained in conducting reproducible and standardised neurological assessments in a multi-centre study, as well as illustrating potential pitfalls of these tools.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100241"},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145332","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

Pure red cell aplasia secondary to erythropoietin therapy. 继发于促红细胞生成素疗法的纯红细胞再生不良。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-07-01 Epub Date: 2024-07-17 DOI: 10.1016/j.clinme.2024.100229

Gwenno Mair Edwards, Abdulfattah A Alejmi

引用次数: 0

Reducing the harm associated in treating hyperkalaemia with insulin and dextrose. 减少使用胰岛素和葡萄糖治疗高钾血症的危害。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-07-01 Epub Date: 2024-06-12 DOI: 10.1016/j.clinme.2024.100222

Sara Abou Sherif, Irene Katsaiti, Hannah Jebb, Serena Banh, Rachna Bedi, Jeremy Levy, David Thomas, Damien Ashby, Richard Corbett

引用次数: 0

Vertebral body and spinal cord infarction in a pile-driver operator with fibrocartilaginous disc embolism. 一名患有纤维软骨椎间盘栓塞的打桩机操作员的椎体和脊髓梗塞。

IF 3.6 4区医学

Clinical Medicine Pub Date : 2024-07-01 Epub Date: 2024-07-05 DOI: 10.1016/j.clinme.2024.100226

Sjx Murphy, Djh McCabe, R L O Donohoe, A J McCarthy

引用次数: 0