British journal of hospital medicine最新文献

{"title":"Faecal Immunochemical Testing in Secondary Urgent Care Setting: A Feasibility Pilot for Patients Presenting to the Emergency Department With Lower Gastrointestinal Red-Flag Symptoms.","authors":"Amira Babikir, Shravan Reddy Ankilla, Valentin Butnari, Benjamin Seager, Allison Wood, Ahmer Mansuri, Funmi Akinlade, Lance Saker, Michael Machesney, Sandeep Kaul, Saswata Banerjee","doi":"10.31083/BJHM50114","DOIUrl":"https://doi.org/10.31083/BJHM50114","url":null,"abstract":"","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"50114"},"PeriodicalIF":1.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079824","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":"How Can UK Hospitals Transform to Net Zero Carbon Emissions?","authors":"Jasmin Abbott, Petar Tabakov, Susie Vernon, Federica Pascale, Mahmood F Bhutta","doi":"10.31083/BJHM53431","DOIUrl":"https://doi.org/10.31083/BJHM53431","url":null,"abstract":"<p><p>Hospital-based healthcare is the most carbon intensive component of healthcare delivery. Mitigation in the face of the climate and ecological crises is urgent and required under law in England, yet comprehensive guidance is lacking. This review summarizes-by sector of emissions-current evidence on strategies that hospital trust executive boards can take to deliver decarbonisation. We identify variable maturity of evidence available per hospital speciality and emissions sector, limited translation of successful case studies across the sector and a lack of comprehensive guidance or policy to drive large-scale change. Strategies for hospitals to implement change need to be accompanied by cultural shifts in approaches to environmental sustainability backed up by leadership, governance and financial commitments. Crucially, long-term financial savings offered through environmental sustainability investments ought to be a driver, not a barrier, to change.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"53431"},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079762","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":"Study on the Correlation Between Sperm Mitochondrial Membrane Potential, Seminal Plasma Elastase, Seminal Plasma Zinc, and Pregnancy Outcomes of <i>In Vitro</i> Fertilization-Embryo Transfer in Male Infertility Patients.","authors":"Zao Cen, Jie Cai, Yi Zheng","doi":"10.31083/BJHM58284","DOIUrl":"https://doi.org/10.31083/BJHM58284","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims/background: &lt;/strong&gt;Male infertility accounts for 30%-50% of infertility cases. Sperm mitochondrial membrane potential (MMP) and seminal plasma zinc are crucial for sperm motility and function, while seminal elastase reflects infection and inflammation of the reproductive system. This study aimed to explore the roles of sperm MMP, seminal plasma elastase, and seminal plasma zinc in the outcomes of &lt;i&gt;in vitro&lt;/i&gt; fertilization-embryo transfer (IVF-ET) among male infertility patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Clinical data from 179 male infertility patients who visited the hospital between November 2022 and July 2023 were retrospectively analysed. Of these, 85 cases underwent fresh embryo transfer (ET) after &lt;i&gt;in vitro&lt;/i&gt; fertilization (IVF). According to the pregnancy outcomes, the 85 ET cycles were divided into a pregnancy group (n = 42) and a non-pregnancy group (n = 43). Sperm MMP, seminal plasma elastase, and seminal plasma zinc levels were measured. Spearman correlation analysis was used to assess the correlation between fertilization rate and sperm MMP, seminal plasma elastase, and seminal plasma zinc. Binary logistic regression was performed to identify independent factors influencing pregnancy outcomes. Receiver operating characteristic (ROC) curves were constructed to predict diagnostic values of these factors for pregnancy outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The fertilization rate of IVF was positively correlated with sperm MMP (r = 0.362) and seminal plasma zinc (r = 0.415), and negatively correlated with seminal plasma elastase (r = -0.379) (all &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Among the 85 ET cycles, the clinical pregnancy rate and live birth rate were 49.41% (42/85) and 41.18% (35/85), respectively. Compared to the non-pregnancy group, the pregnancy group had significantly higher sperm MMP and seminal plasma zinc levels (&lt;i&gt;p&lt;/i&gt; &lt; 0.001 and &lt;i&gt;p&lt;/i&gt; = 0.009, respectively), and lower seminal plasma elastase levels (&lt;i&gt;p&lt;/i&gt; = 0.002). Multivariate analysis identified sperm non-progressive motility (&lt;i&gt;p&lt;/i&gt; = 0.013, odds ratio [OR] = 0.478, 95% confidence interval [CI] = 0.267-0.856), sperm MMP (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, OR = 1.114, 95% CI = 1.047-1.184), seminal plasma elastase (&lt;i&gt;p&lt;/i&gt; = 0.006, OR = 0.996, 95% CI = 0.993-0.999), and seminal plasma zinc (&lt;i&gt;p&lt;/i&gt; = 0.024, OR = 1.188, 95% CI = 1.023-1.381) as independent factors affecting pregnancy outcome. ROC analysis showed that sperm MMP (area under the curve [AUC] = 0.748, 95% CI = 0.644-0.851, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), seminal plasma elastase (AUC = 0.698, 95% CI = 0.587-0.809, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), seminal plasma zinc (AUC = 0.664, 95% CI = 0.549-0.779, &lt;i&gt;p&lt;/i&gt; = 0.005), and the combined indicators (AUC = 0.832, 95% CI = 0.747-0.916, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) had good predictive values for pregnancy outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Sperm MMP, seminal plasma elastase, and seminal plasma zinc are significantly correlated with fertilization rates in IVF. Combined detection ","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"58284"},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079857","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":"GLP-1 Receptor Agonists in Diabetic Lower Extremity Peripheral Artery Disease: From Mechanisms to Clinical Practice.","authors":"Jie Pan, Chengnan Guo, Qiuwei Huang, Yikai Zhang, Yimin Shen, Caiyun Guo","doi":"10.31083/BJHM55884","DOIUrl":"https://doi.org/10.31083/BJHM55884","url":null,"abstract":"<p><p>Diabetic lower extremity peripheral artery disease (PAD) is a complex and multifactorial complication of diabetes mellitus, characterized by extensive distal disease burden, accelerated progression, and a markedly elevated risk of major adverse limb events. Despite considerable advances in endovascular and surgical revascularization, limb salvage rates in this population remain suboptimal, largely due to the limited efficacy of current pharmacological options in improving microvascular perfusion, accelerating wound healing, or preventing re-occlusion. In recent years, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a transformative therapeutic class, demonstrating cardiovascular protective effects beyond glycemic control. Large-scale real-world studies have generated encouraging signals regarding their potential to reduce amputation risk and promote wound healing. However, the current evidence base remains limited, and the precise molecular mechanisms by which GLP-1 RAs may protect the diabetic lower extremity require further elucidation. This review systematically examines the epidemiology and pathophysiology of diabetic lower extremity PAD, elucidates the molecular mechanisms of GLP-1 RA-mediated vascular protection, critically evaluates clinical and real-world evidence, and discusses key challenges and future directions for optimizing therapeutic outcomes in this high risk population.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"55884"},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079803","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":"Ten-Year Consecutive Targeted Surveillance of Healthcare-Associated Infections in the Pediatric Intensive Care Unit of a Children's Hospital.","authors":"Yingchun Ran, Qinghua He, Qiong Luo, Xiao Liu, Xuelin Xia, Hongmeng Xie, Jing Zhou, Junhua Chen","doi":"10.31083/BJHM58286","DOIUrl":"https://doi.org/10.31083/BJHM58286","url":null,"abstract":"<p><strong>Aims/background: </strong>Healthcare-associated infections (HAIs) represent a major public health challenge requiring urgent attention. These infections impose substantial burdens on both society and healthcare institutions. Patients in the pediatric intensive care unit (PICU) are at particularly high risk of HAI. This study aimed to analyze the status of targeted HAI surveillance in the PICU over 10 consecutive years and to provide evidence for improving HAI prevention and control strategies.</p><p><strong>Methods: </strong>Data were collected from PICU patients of Children's Hospital of Chongqing Medical University who were monitored through a real-time HAI surveillance system from January 2015 to December 2024. Collected indicators included HAI incidence, infection sites, incidence of device-associated infections, distribution of pathogens, and the detection rates and incidence of multidrug-resistant organisms (MDROs).</p><p><strong>Results: </strong>A total of 20,120 patients were monitored, with an overall HAI incidence of 3.36%. The annual incidence of HAI in the PICU exhibited a significant downward trend over the 10 years (<i>p</i> < 0.001). The respiratory system was the most common site of infection. The incidences of central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI) were 0.70 per 1000 central line-days, 1.84 per 1000 mechanical ventilation-days, and 0.11 per 1000 urinary catheter-days, respectively. A total of 643 pathogenic strains were isolated, predominantly Gram-negative bacteria (73.41%), with <i>Acinetobacter baumannii</i> being the most frequently detected (18.35%). The detection rates of carbapenem-resistant <i>Acinetobacter baumannii</i> (CRAB) and carbapenem-resistant <i>Klebsiella pneumoniae</i> (CRKP) were 67.33% and 31.42%, respectively, both showing significant upward trends over the decade (both <i>p</i> < 0.001). The detection rate of carbapenem-resistant <i>Escherichia coli</i> (CREC) was 16.30% and showed a significant downward trend for 10 consecutive years (<i>p</i> < 0.001). The incidence of MDRO-related HAI was 0.68%, with CRAB (0.32%) and CRKP (0.13%) having the two highest incidence rates.</p><p><strong>Conclusion: </strong>The incidence of HAI in the PICU significantly decreased over the study period, indicating progress in infection prevention and control. However, CLABSI, VAP, and MDROs remain key priorities in ongoing HAI prevention efforts in the PICU.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"58286"},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079846","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":"Clinical Benefit of the Transthyretin Stabiliser Tafamidis in Hereditary Transthyretin Amyloid Cardiomyopathy: A Case Report.","authors":"Xing Xiao, Mengchen Yang, Ling Ding","doi":"10.31083/BJHM58285","DOIUrl":"https://doi.org/10.31083/BJHM58285","url":null,"abstract":"<p><strong>Aims/background: </strong>This case report aims to illustrate the critical importance of a standardized diagnostic approach and genotype-specific therapy in hereditary transthyretin amyloid cardiomyopathy (ATTR-CM). It highlights the clinical challenge of diagnosing ATTR-CM amidst complex comorbidities and addresses the evidence gap regarding the long-term efficacy of tafamidis for the rare and aggressive p.Val40Ile (protein-level substitution of valine to isoleucine at codon 40) mutation.</p><p><strong>Case presentation: </strong>A 72-year-old East Asian man with multiple comorbidities presented with refractory heart failure. Key clinical clues included the classic \"red flag\" of electrocardiogram (ECG)-echocardiogram discordance (low voltage with ventricular hypertrophy). Genetic testing identified the pathogenic p.Val40Ile transthyretin (<i>TTR</i>) mutation.</p><p><strong>Results: </strong>The diagnosis was confirmed non-invasively via cardiac magnetic resonance (CMR) and technetium-99m pyrophosphate scintigraphy. Following the initiation of tafamidis, the patient's symptoms significantly improved. Over a two-year follow-up period, he sustained clinical stability with a marked reduction in heart failure-related hospitalizations.</p><p><strong>Conclusion: </strong>This report provides detailed case-based evidence supporting the long-term efficacy of tafamidis in stabilizing disease and improving prognosis for patients with ATTR-CM harboring the p.Val40Ile mutation. It underscores the value of timely diagnosis, genetic subtyping, and access to targeted therapy in altering the clinical course of this aggressive genotype.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"58285"},"PeriodicalIF":1.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079558","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":"A SHAP-Based Interpretable Model for MDRO-Infection Risk in Chronically Multimorbid Middle-Aged and Elderly ICU Adults.","authors":"Rong Zhao, Meng Zhao, Yixing Wang, Xianyun Zhang, Jiaoping Zhang, Jun Ge, Jianxing Yue, Yang Xu, Qiankun Liu","doi":"10.31083/BJHM58253","DOIUrl":"https://doi.org/10.31083/BJHM58253","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims/background: &lt;/strong&gt;Multidrug-resistant organism (MDRO) infection poses a significant clinical challenge, resulting in poor outcomes for middle-aged and older intensive care unit (ICU) patients with chronic multimorbidity. While conventional prediction models can identify high-risk patients, they often lack transparency in clinical decision-making. To bridge this gap, we aimed to develop a prediction model that incorporates Shapley Additive Explanations (SHAP)-based explainability analysis. This approach aims to achieve accurate risk prediction while quantitatively assessing the contribution of each risk factor, thereby providing clear guidance for clinical intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We employed a hospital-based consecutive sampling strategy to enroll 314 middle-aged and older patients with chronic multimorbidity admitted to the intensive care units of three Grade A tertiary hospitals and one secondary hospital in Bengbu, Anhui, from May 2024 to May 2025. Based on standard diagnostic criteria for MDROs, patients were categorized into an MDRO infection group and a non-MDRO infection group. Twenty candidate variables potentially associated with MDRO infection were extracted from electronic medical record systems. Univariate analysis, Least Absolute Shrinkage and Selection Operator (LASSO) regression, and multivariable logistic regression were utilized to identify high-risk factors for MDRO infection. The model's discriminative ability and calibration were evaluated using receiver operating characteristic (ROC) analysis and the Hosmer-Lemeshow goodness-of-fit test. Internal validation was performed through bootstrap resampling (1000 iterations). We compared logistic regression, Naive Bayes, support vector machine (SVM), decision tree, linear discriminant analysis (LDA), and quadratic discriminant analysis (QDA) models, selecting the optimal model for SHAP analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;(1) Univariate analysis revealed significant differences between the two groups in age, length of hospital stay, admission diagnosis, history of antibiotic use, blood transfusion history, catheter category and number, mechanical ventilation, tracheostomy, white blood cell count, C-reactive protein, and other indices. (2) Variables identified as significant in univariate analysis were further analyzed using LASSO regression, which pinpointed eight predictors with non-zero coefficients; these were included in multivariable logistic regression for refined selection. (3) ROC analysis and the Hosmer-Lemeshow test indicated strong model performance, with an area under the curve (AUC) of 0.906 (95% confidence interval [CI]: 0.896-0.912), sensitivity of 77.92%, and specificity of 88.46%. Bootstrap internal validation confirmed that the model retained satisfactory discriminative ability. (4) Among the models compared, logistic regression demonstrated high predictive accuracy along with superior interpretability and stability, maki","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"58253"},"PeriodicalIF":1.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079573","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":"The Efficacy of Different Exercise Intervention Models and Dosages on Post-Stroke Depression: A Systematic Review and Network Meta-Analysis.","authors":"Xiaolu Fan, Xinyu Dai, Quancheng Peng, Wei Dai, Xiaoqiang Yin, Shuai Hou","doi":"10.31083/BJHM58254","DOIUrl":"https://doi.org/10.31083/BJHM58254","url":null,"abstract":"<p><strong>Aims/background: </strong>Post-stroke depression (PSD) is a prevalent psychological complication among stroke survivors. Exercise intervention, as a non-pharmacological therapeutic approach, plays a crucial role in the rehabilitation of PSD. This study aimed to systematically evaluate the efficacy of various exercise intervention models and exercise doses on PSD through a network meta-analysis. The findings are expected to provide personalized exercise recommendations for patients with PSD and further promote the integration of exercise therapy into stroke rehabilitation.</p><p><strong>Methods: </strong>This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant randomized controlled trials (RCTs) published up to April 2025 were retrieved from PubMed, Cochrane, Embase, Ovid, and Web of Science databases. Data analysis was performed using R statistical software.</p><p><strong>Results: </strong>Exercise interventions lasting less than 8 weeks, performed at least five times per week, and with individual sessions of 30 minutes or less, demonstrated the most significant improvement in PSD symptoms. As the exercise dose increased, the antidepressant effects of mixed aerobic exercise (MAE), combined exercise (CE), resistance training (RT), high-intensity interval training (HIIT), moderate-intensity continuous training (MICT), traditional martial arts (TOMA), and yoga (YOGA) all exhibited a continuous downward trend. Among these, resistance training (RT) showed the most significant decline, with no subsequent rebound effect.</p><p><strong>Conclusion: </strong>All exercise intervention models effectively alleviate PSD symptoms, with resistance training emerging as the most effective single exercise modality. However, the optimal exercise dose for resistance training remains to be established. Further clinical studies are warranted to clarify the dose-response relationship and optimize exercise dose PSD management.</p><p><strong>Systematic review registration: </strong>PROSPERO (CRD420251012962).</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"58254"},"PeriodicalIF":1.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079854","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":"Effects of Pre-MRI Multimodal Psychosocial Nursing Intervention on Anxiety and Examination Compliance in Patients With Optic Neuritis.","authors":"Ning Ma, Bo Feng","doi":"10.31083/BJHM58251","DOIUrl":"https://doi.org/10.31083/BJHM58251","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims/background: &lt;/strong&gt;Magnetic resonance imaging (MRI) is essential for diagnosing and monitoring optic neuritis. However, the procedure itself may induce significant anxiety in patients, potentially compromising examination compliance and image quality. This study retrospectively evaluated the effects of a structured, multimodal pre-MRI psychosocial nursing intervention on anxiety and compliance in patients with optic neuritis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 106 patients diagnosed with optic neuritis who underwent MRI at Jiaozhou Central Hospital of Qingdao between June 2021 and June 2024 were included. Patients were allocated to two groups based on the type of nursing intervention received before the MRI: the control group received routine nursing intervention, while the observation group received a comprehensive intervention comprising four core components: structured health education, individualized psychological support, environmental and emotional support, and family guidance. The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were administered at baseline to assess the comparability of general psychological status between groups. The State-Trait Anxiety Inventory Form-1 (STAI-1) was used to evaluate periprocedural state anxiety before and after the intervention. Physiological indicators, including heart rate and blood pressure as anxiety-related stress indicators, and oxygen saturation as a safety parameter, as well as examination compliance, were compared between the two groups. Compliance was assessed by MRI technicians using a 5-point scale based on image clarity and motion artifacts, with higher scores indicating better cooperation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Baseline SAS, SDS, and STAI-1 scores did not differ significantly between the two groups (&lt;i&gt;p&lt;/i&gt; &gt; 0.05), indicating comparability in general psychological status and pre-intervention anxiety levels. Following the intervention, the STAI-1 score (43.16 ± 2.85) in the observation group was significantly lower than in the control group (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Additionally, the observation group exhibited significantly lower post-intervention heart rate and blood pressure compared with the control group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). The compliance score in the controlgroup was 4.00 (2.00, 5.00), while that in the observation group was 5.00 (4.00, 5.00); compliance in the observation group was significantly higher than that in the control group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Furthermore, the observation group demonstrated a higher first-attempt success rate and a shorter mean examination time compared with the control group, with statistically significant differences (&lt;i&gt;p&lt;/i&gt; &lt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;A multimodal psychosocial nursing intervention administered before MRI examination effectively reduces periprocedural state anxiety and physiological stress responses in patients with optic neuritis. This approach may have broader applicab","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"58251"},"PeriodicalIF":1.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079729","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":"A Multidisciplinary Perioperative Diabetes Optimisation Pathway: Glycaemic and Hospital Pathway Outcomes in a Prospective Cohort.","authors":"Kavitha Dhevi Krishnasamy Ganapathy, Samiul Mostafa, Brighid Lane, Manju Kurian, Feaz Babwah","doi":"10.31083/BJHM55387","DOIUrl":"https://doi.org/10.31083/BJHM55387","url":null,"abstract":"<p><strong>Aims/background: </strong>Suboptimal glycaemic control may delay surgery and increase perioperative risk, yet national guidance provides limited detail on how preoperative diabetes optimisation should be organised. This study evaluated a multidisciplinary perioperative diabetes optimisation pathway in a tertiary hospital.</p><p><strong>Methods: </strong>This prospective single-centre cohort included 174 consecutive adults referred to The Queen Elizabeth Hospital Birmingham, United Kingdom, between 1 January and 31 December 2024, with glycated haemoglobin (HbA1c) >69 mmol/mol (>8.5%) before elective surgery. The pathway comprised diabetologist assessment, individualised treatment adjustment, diabetes specialist nurse follow-up, education, repeat HbA1c measurement and communication with surgical teams. Primary outcomes were change in HbA1c and achievement of HbA1c ≤69 mmol/mol (≤8.5%). Secondary outcomes included progression to surgery and factors associated with target achievement and follow-up HbA1c. Multivariable logistic and linear regression examined target achievement and follow-up HbA1c, respectively.</p><p><strong>Results: </strong>Paired data were available for 149/174 patients (85.6%). Mean HbA1c decreased from 96.2 ± 14.0 to 73.1 ± 14.1 mmol/mol, a reduction of 23.1 mmol/mol (2.1 percentage points; <i>p</i> < 0.001); 77/149 patients (51.7%) achieved the target. Higher baseline HbA1c was associated with lower odds of target achievement (odds ratio 0.96 per mmol/mol, 95% confidence interval 0.94-0.99; <i>p</i> = 0.006), although patients with the highest baseline values achieved the largest absolute reductions. After adjustment for baseline HbA1c and other covariates, each additional diabetes-team appointment was associated with a 0.58 mmol/mol lower follow-up HbA1c (95% confidence interval -0.98 to -0.18; <i>p</i> = 0.005). Overall, 124/174 patients (71.3%) proceeded to surgery.</p><p><strong>Conclusion: </strong>Referral to the pathway was associated with substantial improvement in preoperative HbA1c; just over half of patients achieved the preoperative target and most proceeded to surgery. Baseline HbA1c identified patients less likely to reach the fixed target despite larger absolute reductions, while more frequent specialist contact was modestly associated with lower follow-up HbA1c. Coordinated specialist follow-up, including pragmatic basal insulin initiation and titration where clinically indicated, provides a reproducible hospital-based model for preoperative diabetes optimisation.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"55387"},"PeriodicalIF":1.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080009","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}