Clinical Medicine最新文献_第7页

'Don't work more than 3 days straight': Working conditions as learning conditions in general practice. “连续工作不超过三天”：工作条件作为一般实践的学习条件。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-07-01 Epub Date: 2026-04-21 DOI: 10.1016/j.clinme.2026.100588

Leonard Grant

{"title":"'Don't work more than 3 days straight': Working conditions as learning conditions in general practice.","authors":"Leonard Grant","doi":"10.1016/j.clinme.2026.100588","DOIUrl":"10.1016/j.clinme.2026.100588","url":null,"abstract":"Objective: To examine how GPs understand their working conditions and to consider what significance this holds for medical education.Design: Data were collected through online interviews with GPs, conducted between April and July 2023. These data were then subjected to thematic analysis.Participants: Fifteen GPs were interviewed, including two practice partners, seven salaried GPs, one locum GP and five GPs in training. Participants were recruited through professional networks using purposive sampling.Results: GPs described intense pressure from increasing demand, large administrative burden and erosion of professional autonomy. Practitioners viewed working full-time as unsustainable, with experienced GPs actively discouraging trainees from taking on such work. The primary coping mechanism that GPs used was reducing their working days, which they considered necessary to continue in practice. The working conditions shape what is understood and transmitted about the profession: that general practice is a fundamentally unsustainable full-time career.Conclusion: GPs understand their working conditions as untenable and that they must be managed at a personal level. However, these conditions are products of specific political and economic arrangements rather than natural features of medical practice. Medical educators should actively consider what the workplace is teaching and what effects this might have on the future workforce.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100588"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13194546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764655","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 global and domestic in policy: Impacts on medical education and migration. 全球和国内政策：对医学教育和移民的影响。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-07-01 Epub Date: 2026-05-22 DOI: 10.1016/j.clinme.2026.100599

Zakia Arfeen, Dawit Wondimagegn, David Rojas, Katherine Woolf, Cynthia Whitehead

引用次数: 0

The global burden of rheumatic heart disease: 1990-2021. 风湿性心脏病的全球负担：1990-2021。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-07-01 Epub Date: 2026-05-05 DOI: 10.1016/j.clinme.2026.100593

Saeid Safiri, Reza Aletaha, Fatemeh Amiri, Mark J M Sullman, Mohammad Rahmanian, Kuljit Singh, Ali-Asghar Kolahi

{"title":"The global burden of rheumatic heart disease: 1990-2021.","authors":"Saeid Safiri, Reza Aletaha, Fatemeh Amiri, Mark J M Sullman, Mohammad Rahmanian, Kuljit Singh, Ali-Asghar Kolahi","doi":"10.1016/j.clinme.2026.100593","DOIUrl":"10.1016/j.clinme.2026.100593","url":null,"abstract":"Introduction: Rheumatic heart disease (RHD) arises from acute rheumatic fever (ARF) following group A streptococcal infection. While its prevalence has declined in high-income regions, it remains a major health burden in low-resource settings.Objective: This research reported the burden of RHD from 1990 to 2021, utilising data from the Global Burden of Disease (GBD) 2021 study.Methods: Publicly available data were analysed to determine absolute counts, age-standardised rates and percentage changes in prevalence, deaths and disability-adjusted life years (DALYs) from 1990 to 2021.Results: In 2021, global RHD cases numbered 54,785,119, with an age-standardised prevalence of 684.2 per 100,000, reflecting a 12.6% increase since 1990. Deaths totalled 373,345, with an age-standardised rate of 4.5 per 100,000, marking a 56.2% decline over the period. In 2021, Eritrea (1,865.4) had the highest prevalence rate and Finland (17.4) the lowest. In 2021, Micronesia reported the highest death rate (9.6 per 100,000), and Guatemala the lowest (0.2). Women exhibited higher prevalence estimates across all ages, peaking in the 25-29 age range. Although prevalence declined with age, it remained higher in females than among males. The relationship between the Socio-demographic Index (SDI) and RHD burden was non-linear, peaking at an SDI of 0.42, before declining sharply.Conclusion: RHD remains a major public health challenge, characterised by rising prevalence and significant health and economic impacts. Despite reductions in mortality and DALY rates, the increasing prevalence underscores the urgent need for improved prevention and management strategies.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100593"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13214522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834634","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

Lipid lowering in coronary artery disease - not just statins. 降低冠状动脉疾病的脂质——不仅仅是他汀类药物。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-07-01 Epub Date: 2026-05-08 DOI: 10.1016/j.clinme.2026.100594

Jennie Han, Eva Masmanian, Timothy Wang, Tuan Peng Chua

{"title":"Lipid lowering in coronary artery disease - not just statins.","authors":"Jennie Han, Eva Masmanian, Timothy Wang, Tuan Peng Chua","doi":"10.1016/j.clinme.2026.100594","DOIUrl":"10.1016/j.clinme.2026.100594","url":null,"abstract":"Coronary artery disease has a high degree of morbidity and mortality internationally and, after a cardiovascular event, patients require intensified management of modifiable risk factors, with optimal lipid control being an important cornerstone of secondary prevention. This is both a primary and a secondary care responsibility. Familiarity with indications for and prescription of non-statin medications, including injectables, is vital for patient outcomes. Fewer than 30% of patients reach LDL-c targets with statins alone. This is a public health matter, and non-statin therapies that all clinicians need to be aware of are oral therapies such as ezetimibe and bempedoic acid, and injectable therapies such as inclisiran and PCKS9 inhibitors. Icosapent ethyl is also available in those with high fasting triglycerides with specific LDL-c values. Understanding when to refer to the lipid clinic enables patients to be managed appropriately in the correct setting. Future therapies under development include cholesterol ester transfer protein inhibitors, oral PCSK9 inhibitors, and gene editing therapy targeting ANGPTL3 and PCSK9. Lipid optimisation leads to significant reduction in major adverse cardiac events, and familiarity with all available treatment options - including non-statins and injectables - will facilitate best primary and secondary care.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100594"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13199878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147867048","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

When a smartphone-free childhood is not a choice: Recognising smartphones as essential medical devices. 当一个没有智能手机的童年不是一个选择时：认识到智能手机是必不可少的医疗设备。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-07-01 Epub Date: 2026-04-24 DOI: 10.1016/j.clinme.2026.100591

Alice M Gregory, Partha Kar

引用次数: 0

Quality in postgraduate medical education: A contested idea. 研究生医学教育的质量：一个有争议的概念。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-07-01 Epub Date: 2026-04-28 DOI: 10.1016/j.clinme.2026.100590

Janet Grant

引用次数: 0

Metabolic dysfunction-associated steatotic liver disease (MASLD) is under-recognised: Should hepatic elastography be integrated into early risk stratification for people with type 2 diabetes? 代谢功能障碍相关脂肪变性肝病（MASLD）未被充分认识：是否应将肝弹性成像纳入2型糖尿病患者的早期风险分层？

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-07-01 Epub Date: 2026-07-20 DOI: 10.1016/j.clinme.2026.100629

Aftab Ala, Ponnusamy Saravanan

引用次数: 0

Heart failure with preserved ejection fraction (HFpEF): Diagnosis and management for the general physician. 保留射血分数（HFpEF）的心力衰竭：对普通医生的诊断和处理。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-07-01 Epub Date: 2026-06-22 DOI: 10.1016/j.clinme.2026.100608

Rosita Zakeri, Adam A Nabeebaccus

{"title":"Heart failure with preserved ejection fraction (HFpEF): Diagnosis and management for the general physician.","authors":"Rosita Zakeri, Adam A Nabeebaccus","doi":"10.1016/j.clinme.2026.100608","DOIUrl":"10.1016/j.clinme.2026.100608","url":null,"abstract":"Heart failure (HF) with preserved ejection fraction (HFpEF) is becoming the dominant HF phenotype in clinical practice, reflecting population ageing and increasing cardiometabolic disease. Contemporary HFpEF is recognised as a complex, systemic syndrome with heterogeneous pathophysiology and substantial morbidity. It remains underdiagnosed, with many patients detected only during hospitalisation. Diagnosis requires a high index of suspicion and a structured approach integrating clinical assessment, natriuretic peptides and echocardiography to demonstrate elevated left ventricular filling pressures and exclude alternative diagnoses. Recent randomised trials have demonstrated that sodium-glucose cotransporter-2 (SGLT2) inhibitors and non-steroidal mineralocorticoid receptor antagonists reduce HF hospitalisations and improve quality of life. Additional strategies, including obesity-targeted therapies, support phenotype-directed management, alongside core strategies of congestion relief, comorbidity optimisation, and multidisciplinary care. Early recognition and timely initiation of evidence-based therapy are essential to improve outcomes for this population. This review provides a practical, evidence-based framework for the contemporary diagnosis and management of HFpEF.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100608"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301052","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

Integrating MASLD detection into diabetes care in primary care settings in Mexico: A cascade analysis. 将MASLD检测纳入墨西哥初级保健机构的糖尿病护理：级联分析。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-07-01 Epub Date: 2026-04-18 DOI: 10.1016/j.clinme.2026.100585

Rubén Silva-Tinoco, Erick Vladimir Martínez-de la Cruz, Ana Galíndez-Fuentes, Berenice Cabrera-Victoria, Erick Villa-Mejía, Ricardo Ulises Macías-Rodríguez, Alejandro Avalos-Bracho, María Fernanda Bernal-Ceballos

{"title":"Integrating MASLD detection into diabetes care in primary care settings in Mexico: A cascade analysis.","authors":"Rubén Silva-Tinoco, Erick Vladimir Martínez-de la Cruz, Ana Galíndez-Fuentes, Berenice Cabrera-Victoria, Erick Villa-Mejía, Ricardo Ulises Macías-Rodríguez, Alejandro Avalos-Bracho, María Fernanda Bernal-Ceballos","doi":"10.1016/j.clinme.2026.100585","DOIUrl":"10.1016/j.clinme.2026.100585","url":null,"abstract":"Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) remains underrecognised in diabetes care due to the lack of structured detection pathways in primary healthcare.Objective: To evaluate the feasibility and performance of a stepwise diagnostic pathway for identifying the full spectrum of MASLD in adults with type 2 diabetes in primary healthcare settings.Methods: A diagnostic pathway for early detection across the MASLD spectrum, including steatosis, metabolic dysfunction-associated steatohepatitis (MASH), liver fibrosis risk and significant fibrosis, was integrated into a multicomponent diabetes care programme within the public health system. A secondary exploratory analysis used multivariable logistic regression to identify factors independently associated with MASLD.Results: Among 454 adults with type 2 diabetes, MASLD was identified in 51.5% and MASH in 22.2%. Through stepwise assessment, 22.7% showed intermediate-to-high fibrosis risk, and among those who underwent transient elastography, significant fibrosis was confirmed in 27.9% of individuals with increased risk, yielding an estimated prevalence of 10.6% in the MASLD group and 5.9% overall. In multivariable analysis, female sex, elevated liver enzymes and higher body mass index were independently associated with MASLD, with a non-linear association across BMI categories.Conclusion: Implementing structured care pathways for the identification and management of MASLD is feasible and essential to mitigate the burden of diabetes and liver disease. Strengthening primary care capacity remains crucial for systematic integration of MASLD identification in routine care.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100585"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13195615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728841","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 impact of primary percutaneous coronary intervention timing on prognosis in STEMI patients. 原发性经皮冠状动脉介入治疗时机对STEMI患者预后的影响。

IF 3.9 4区医学

Clinical Medicine Pub Date : 2026-07-01 Epub Date: 2026-06-05 DOI: 10.1016/j.clinme.2026.100602

Lihui Zhou, Jin Si, Ming Yi, Keling Xiao, Lijie Sun, Haoyu Zhang, Jinghao Sun, Zhenxing Fan, Zhi Liu, Jing Gao, Lin Pi, Yinghua Zhang, Jing Li

{"title":"The impact of primary percutaneous coronary intervention timing on prognosis in STEMI patients.","authors":"Lihui Zhou, Jin Si, Ming Yi, Keling Xiao, Lijie Sun, Haoyu Zhang, Jinghao Sun, Zhenxing Fan, Zhi Liu, Jing Gao, Lin Pi, Yinghua Zhang, Jing Li","doi":"10.1016/j.clinme.2026.100602","DOIUrl":"10.1016/j.clinme.2026.100602","url":null,"abstract":"Background: The benefit of primary percutaneous coronary intervention (PPCI) performed beyond 6 h after ST-segment elevation myocardial infarction (STEMI) symptom onset remains uncertain.Methods: Patients presenting with STEMI from January 2009 to December 2022 were consecutively enrolled and stratified into three groups: PPCI within 6 h, PPCI beyond 6 h, and no PPCI. Clinical outcomes were compared using Cox multivariable analyses and propensity score matching.Results: A total of 3,720 patients were included (77.4% male, mean age 62.61 ± 12.66 years). Patients were divided into PPCI within 6 h group (n = 1,127, 30.3%), PPCI beyond 6 h group (n = 587, 15.8%), and no PPCI group (n = 2,006, 53.9%). In-hospital mortality rates were 2.8%, 4.1% and 5.2%, respectively (p = 0.006), with pairwise analysis revealing significant differences among the groups. During a median follow-up of 4.96 years, cumulative mortality was 13.1% in PPCI within 6 h group, 16.0% in PPCI beyond 6 h group, and 24.0% in no PPCI group (P < 0.001). PPCI within 6 h was associated with lower mortality (adjusted hazard ratio (HR) 0.565 (0.429-0.744), p < 0.001) or MACCE (adjusted HR 0.765 (0.640-0.914), p = 0.003) while PPCI beyond 6 h showed comparable cumulative mortality (adjusted HR 0.766 (0.575-1.020), p = 0.068) and MACCE (adjusted HR 0.884 (0.721-1.083), p = 0.234) versus no PPCI. Concordant results were observed in propensity score-matched cohorts.Conclusion: While PPCI beyond 6 h of symptom onset may improve in-hospital outcomes in STEMI patients, it is necessary to perform PPCI within 6 h to achieve significant long-term benefits.","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100602"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13315194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148194555","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