Medicine (Abingdon, England : UK ed.)最新文献_第5页

Drugs for heart failure and arrhythmias 治疗心力衰竭和心律失常的药物

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-08-01 Epub Date: 2026-07-23 DOI: 10.1016/j.mpmed.2026.06.002

James R. Waller, Charles PT. Bowdler

引用次数: 0

Drugs used in the prevention and management of hypertension, hyperlipidaemias and ischaemic heart disease 用于预防和治疗高血压、高脂血症和缺血性心脏病的药物

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-07-01 Epub Date: 2026-06-04 DOI: 10.1016/j.mpmed.2026.04.009

James R Waller, Elizabeth Davis

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Clinical hypertension 临床高血压

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-07-01 Epub Date: 2026-05-26 DOI: 10.1016/j.mpmed.2026.04.008

Ryan McNally, Luca Faconti

{"title":"Clinical hypertension","authors":"Ryan McNally, Luca Faconti","doi":"10.1016/j.mpmed.2026.04.008","DOIUrl":"10.1016/j.mpmed.2026.04.008","url":null,"abstract":"<div><div>Hypertension is one of the most prevalent modifiable contributors to global morbidity and mortality. In high-income countries such as the UK, it affects nearly 1 in 3 adults and disproportionately impacts individuals of ethnic minority backgrounds, particularly those of African or African–Caribbean heritage, who experience earlier onset, poorer blood pressure (BP) control and higher rates of cardiovascular complications. Despite effective therapies, many patients remain undiagnosed or inadequately treated. Accurate BP measurement is essential for diagnosis and requires confirmation with home or ambulatory BP monitoring in most cases. Evaluation for hypertension-mediated organ damage refines risk assessment and guides treatment intensity. Secondary hypertension accounts for 5–10% of cases, and identification of reversible causes is clinically important as targeted therapy can significantly improve BP control. Management is based on BP severity and overall cardiovascular risk. Lifestyle modification is the foundation of care, but most patients require antihypertensive medication, whether monotherapy or combination therapy. Resistant hypertension remains challenging; once pseudo-resistance and secondary causes are excluded, affected individuals may need intensified pharmacotherapy, and in selected cases specialist interventions such as renal denervation can be considered.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 7","pages":"Pages 467-474"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148559473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Coronary artery bypass grafting 冠状动脉旁路移植术

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-07-01 Epub Date: 2026-05-25 DOI: 10.1016/j.mpmed.2026.04.005

Aaina Mittal, Kamran Baig, Christopher Young

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Self-assessment/CPD answers 自我评价/ CPD答案

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-07-01 Epub Date: 2026-05-25 DOI: 10.1016/j.mpmed.2026.04.012

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Ischaemic heart disease: NSTE-ACS 缺血性心脏病：NSTE-ACS

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-07-01 Epub Date: 2026-05-23 DOI: 10.1016/j.mpmed.2026.04.011

Trisha Singh, Peter O'Kane

{"title":"Ischaemic heart disease: NSTE-ACS","authors":"Trisha Singh, Peter O'Kane","doi":"10.1016/j.mpmed.2026.04.011","DOIUrl":"10.1016/j.mpmed.2026.04.011","url":null,"abstract":"<div><div>Non-ST elevation acute coronary syndrome (NSTE-ACS) accounts for a substantial proportion of myocardial infarctions, with increasing incidence over the past two decades; this is partly attributed to the widespread use of high-sensitivity cardiac troponin assays, enabling earlier and more accurate detection of myocardial injury. NSTE-ACS predominantly affects older individuals, with a higher prevalence in those with co-morbid conditions such as hypertension, diabetes mellitus, dyslipidaemia and chronic kidney disease. While the short-term mortality is lower than in ST elevation ACS, individuals with NSTE-ACS exhibit more extensive coronary artery disease and co-morbidities, contributing to higher long-term mortality and recurrent ischaemic events. Diagnosis is primarily based on clinical presentation, electrocardiographic findings and elevated cardiac biomarkers, particularly high-sensitivity troponin, which confirms myocardial necrosis. Initial management involves stabilization with antiplatelet therapy, anticoagulation and prompt risk stratification, followed by invasive strategies such as percutaneous coronary intervention in high-risk patients. Secondary prevention focuses on pharmacological therapies including dual antiplatelet therapy, statins and β-adrenoceptor blockers, alongside lifestyle modifications. Despite favourable short-term outcomes with early intervention, the long-term prognosis remains dependent on effective management of the underlying risk factors and adherence to secondary prevention strategies, as recurrent cardiovascular events remain common.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 7","pages":"Pages 483-490"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148559475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Percutaneous coronary intervention 经皮冠状动脉介入治疗

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-07-01 Epub Date: 2026-05-25 DOI: 10.1016/j.mpmed.2026.04.007

Thomas R. Gilpin, Peter AJ. Haworth

{"title":"Percutaneous coronary intervention","authors":"Thomas R. Gilpin, Peter AJ. Haworth","doi":"10.1016/j.mpmed.2026.04.007","DOIUrl":"10.1016/j.mpmed.2026.04.007","url":null,"abstract":"<div><div>Percutaneous coronary intervention (PCI) is a cornerstone therapy in the management of coronary artery disease, a condition driven by atherosclerotic plaque formation and inflammation. Since its inception PCI has undergone major technological and procedural evolution, progressing from plain balloon angioplasty to contemporary drug-eluting stents and adjunctive intravascular imaging. PCI aims to restore coronary blood flow safely and effectively while minimizing re-stenosis, stent thrombosis and procedural complications. Indications encompass stable angina refractory to optimal medical therapy, non-ST elevation myocardial infarction where PCI improves symptoms and mortality, and ST elevation myocardial infarction, in which timely PCI is the preferred reperfusion strategy. Advances in pharmacotherapy, including potent P2Y<sub>12</sub> inhibitors and tailored durations of dual antiplatelet therapy, have further optimized outcomes. Pre-procedural computed tomography coronary angiography enables detailed anatomical and physiological assessment, enhancing procedural planning. Contemporary PCI emphasizes meticulous lesion preparation, appropriate calcium modification, and image-guided stent deployment to ensure optimal expansion. New technologies such as intravascular lithotripsy have improved the management of disease with heavily calcification. Continuing refinements are improving precision, safety and long-term clinical outcomes in people undergoing PCI.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 7","pages":"Pages 497-502"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148559477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hidden curriculum of quality improvement: lessons for resident doctors 素质提升的隐性课程：住院医师的经验教训

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-07-01 Epub Date: 2026-05-25 DOI: 10.1016/j.mpmed.2026.03.014

Susy Cook, Julie E Reed, Binoy Perumpalath, Jamie Smyth, Emily Audet

{"title":"Hidden curriculum of quality improvement: lessons for resident doctors","authors":"Susy Cook, Julie E Reed, Binoy Perumpalath, Jamie Smyth, Emily Audet","doi":"10.1016/j.mpmed.2026.03.014","DOIUrl":"10.1016/j.mpmed.2026.03.014","url":null,"abstract":"<div><div>Resident doctors are expected to engage in quality improvement (QI) projects during their training, yet many report feeling unsupported, underprepared or disconnected from meaningful change. This article explores the hidden curriculum of QI – passing on insights into the often-unwritten lessons about improving care in the UK NHS. Here QI is framed not only as a practical activity, but also as a developing science and discipline, one that requires skills in systems thinking, measurement and change management. Drawing on lived experience, supervisor reflections and published research, we offer practical advice for approaching QI projects, with guidance structured in five stages: expectation setting, getting orientated, understanding what matters, making progress and finishing well. Each section includes tips for resident doctors and parallel advice for supervisors and sponsors. The aim is to normalize common challenges, share strategies to navigate them, and support more constructive, confidence-building QI experiences for early-career clinicians. We also include published examples of junior-led QI, stakeholder-mapping guidance, and reflective prompts to support end-of-project learning. This article is for those doing QI – and those who want to help them do it better.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 7","pages":"Pages 523-531"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148559429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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The pathogenesis of atherosclerosis 动脉粥样硬化的发病机制

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-07-01 Epub Date: 2026-05-22 DOI: 10.1016/j.mpmed.2026.04.001

Michael Mahmoudi

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Ischaemic heart disease: ST elevation myocardial infarction 缺血性心脏病：ST段抬高型心肌梗死

Medicine (Abingdon, England : UK ed.) Pub Date : 2026-07-01 Epub Date: 2026-05-23 DOI: 10.1016/j.mpmed.2026.04.003

Clive Lawson

{"title":"Ischaemic heart disease: ST elevation myocardial infarction","authors":"Clive Lawson","doi":"10.1016/j.mpmed.2026.04.003","DOIUrl":"10.1016/j.mpmed.2026.04.003","url":null,"abstract":"<div><div>Acute ST elevation myocardial infarction (STEMI) is most commonly caused by thrombotic occlusion of a major epicardial coronary artery, and initial management is geared towards achieving rapid and effective reperfusion. Most patients present with persistent typical cardiac pain and have either ST elevation or (new) left bundle branch block on their ECG. Where STEMI is diagnosed or suspected, patients should be transferred to the nearest heart attack centre. Primary percutaneous coronary intervention is the acute treatment of choice but thrombolysis should be considered if this cannot be delivered within 120 minutes. Complications of STEMI include a wide range of arrhythmias and heart failure, resulting from either pump failure or major mechanical complications that can require urgent surgical intervention. Post-infarction echocardiography is vital in diagnosing mechanical complications, assessing left ventricular (LV) function and detecting LV thrombus. Longer term outcomes are improved by aggressive secondary prevention with a combination of medication and lifestyle interventions supported by a structured cardiac rehabilitation programme. The appropriate choice and duration of antithrombotic medication requires an appraisal of thrombotic and bleeding risk.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"54 7","pages":"Pages 491-496"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148559476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0