British journal of hospital medicine最新文献

{"title":"The Liver Disease-Related Hypoglycemia: An Overview of the Impact, Management Approaches, and Underlying Mechanisms.","authors":"Li-Xiao Shen, Yin-Gui Wu, Mu-Dan Ke","doi":"10.12968/hmed.2025.0028","DOIUrl":"https://doi.org/10.12968/hmed.2025.0028","url":null,"abstract":"<p><p>Hypoglycemia in liver disease is a clinically significant yet underrecognized complication that severely impacts patient health and quality of life. Growing evidence highlights the liver's central role in glucose homeostasis, with dysfunction leading to hypoglycemia through impaired gluconeogenesis, insulin/glucagon dysregulation, and malnutrition. This review compiles disease-specific mechanisms (e.g., cirrhosis vs. acute liver failure) and their clinical implications, revealing that hypoglycemia risk correlates with liver disease severity, comorbidities, and therapeutic regimens. While current strategies emphasize tailored nutrition, careful pharmacotherapy, and continuous glucose monitoring (CGM), critical gaps persist in early diagnosis and personalized management. This work provides clinicians with a practical framework for hypoglycemia risk stratification, integrating (1) liver disease stage-specific monitoring protocols, (2) malnutrition correction strategies, and (3) insulin dose adjustment guidelines to alleviate iatrogenic hypoglycemia. Future directions include validating a liver-specific CGM algorithm optimized for cirrhosis, developing targeted therapies, and conducting multicenter trials to evaluate structured hypoglycemia prevention protocols in advanced liver disease. By bridging mechanistic insights with actionable care pathways, this review aims to reduce hypoglycemia-related morbidity in this vulnerable population.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 6","pages":"1-18"},"PeriodicalIF":1.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483198","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":"Incidence, Severity, and Pain Self-Efficacy of Low Back Pain in the Female Healthcare Professionals and Their Impact on Overall Quality of Life: A Multicenter Retrospective Study.","authors":"Jun Ma, Hong Chen, Jin Ma, Ling Fan, Juan Liang, Jing Tan, Yang Yan, Longfang Huang, Huiping Yang, Lishi Yin","doi":"10.12968/hmed.2024.1042","DOIUrl":"10.12968/hmed.2024.1042","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Aims/Background&lt;/b&gt; Female healthcare professionals are prone to experiencing high rates of non-specific low back pain (LBP), significantly impacting their performance and overall well-being. This multi-center, retrospective study aims to investigate the frequency and severity of non-specific LBP among female healthcare professionals. Additionally, it seeks to assess the relationship among patients' physical condition, self-belief attributes, and quality of life, providing a comprehensive understanding of this crucial occupational health concern. &lt;b&gt;Methods&lt;/b&gt; After propensity score matching (PSM), 1200 female clinical nurses (Study Group 1) and 1200 female doctors (Study Group 2) employed at 6 grade-A tertiary hospitals in Chongqing between November 2021 and January 2024 were included in the study. Additionally, 1200 healthy female volunteers who underwent routine physical examinations during the same period were enrolled as the Control Group. The study assessed the relationship between the incidence of LBP and various factors, such as sociodemographic characteristics, pain intensity, LBP-related disability, pain self-efficacy, and overall quality of life. By comparing these factors, the research sought to investigate their impact on the overall well-being of the subjects. &lt;b&gt;Results&lt;/b&gt; Significant variations were observed in the prevalence of LBP across the three groups, with Study Group 1 and Study Group 2 exhibiting higher rates than the Control Group (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Notable differences were found in the mean Visual Analogue Scale (VAS) and pain self-efficacy questionnaire (psEQ) scores among the three groups (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), with Study Group 1 and Study Group 2 recording higher mean scores than the Control Group (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Furthermore, there were significant differences in the mean subjective symptoms, clinical signs, limitations in daily activities, and total Japanese Orthopedic Association (JOA) LBP scores among the three groups (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), with Study Group 1 and Study Group 2 yielding lower mean scores than the Control Group (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Additionally, significant differences were observed in the mean social function, emotional role, mental health, and total 36-item short-form health survey (SF-36) scores among the three groups (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), with Study Group 1 and Study Group 2 showing lower mean scores than the Control Group (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). The total JOA LBP scores and total psEQ scores showed positive correlations with the total SF-36 scores in the individual groups and the overall study cohort, while the VAS scores were negatively correlated with the total SF-36 scores (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). &lt;b&gt;Conclusion&lt;/b&gt; LBP occurs more frequently among female healthcare professionals than the general female population. Moreover, they experience more severe pain, greater functional limitations, and a more pronounced decrease in their quality of life. Despite these challenges, the unique occupational ","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 6","pages":"1-20"},"PeriodicalIF":1.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483191","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":"Effect of Hemodialysis Combined With Hemodiafiltration on Cardiac Structure, Function, and Metabolic Indicators in Uremic Patients.","authors":"Haiyun Feng, Jindong Wang, Yuanhua Xiang, Haiyan Lu, Lingjuan Zhou","doi":"10.12968/hmed.2024.0928","DOIUrl":"https://doi.org/10.12968/hmed.2024.0928","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Aims/Background&lt;/b&gt; Uremia is a severe manifestation of end-stage renal failure, with high cardiovascular risk, and current dialysis treatments like hemodialysis (HD) face limitations in toxin clearance, necessitating more effective therapeutic strategies. This study aims to evaluate the clinical efficacy of HD combined with hemodiafiltration (HDF) in treating uremia and its influence on cardiac ultrasound indices. &lt;b&gt;Methods&lt;/b&gt; This study retrospectively analyzed clinical data from 80 uremic patients treated at the Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University between April 2019 and April 2023. Based on different therapeutic regimens, patients were divided into a control group (n = 41) and an observation group (n = 39). The control group received HD, while the observation group underwent HD combined with HDF. The cardiac structure, cardiac function, lipid metabolism, and other biochemical indicators were comparatively assessed between the two groups. &lt;b&gt;Results&lt;/b&gt; There were no significant differences in baseline characteristics between the two groups (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). Before treatment, both groups demonstrated no significant difference in left atrial diameter (LAD), left ventricular posterior wall thickness (LVPWT), interventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVEDD), brain natriuretic peptide (BNP), and troponin T (TnT) (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). However, after 6 months of treatment, these indices were significantly declined in the observation group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Similarly, no significant differences were observed in left ventricular ejection fraction (LVEF), fractional shortening (FS), cardiac output (CO), stroke volume (SV), and peak mitral E-wave velocity/peak mitral A-wave velocity (E/A) before treatment (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). However, a significant improvement was observed in the observation group following 6 months of treatment (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Before treatment, there were no significant differences in serum creatinine (Scr), blood urea nitrogen (BUN), β2-microglobulin (β2-MG), and parathyroid hormone (PTH) between the two groups (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). However, the observation group showed significant improvements in Scr, BUN, β2-MG, and PTH after treatment (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Additionally, the two study groups had no significant differences in total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL) before treatment (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). However, their levels decreased significantly in the observation group after treatment (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Hypertension and hypotension occurred less frequently in the observation group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05), with no significant differences observed in the incidence of arrhythmia and infection between the two groups (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). &lt;b&gt;Conclusion&lt;/b&gt; HD combined with HDF effectively improves cardiac structure and function, reduces metabolic wastes such as Scr, BUN and β2-MG, and decreases blood lipid levels in uremi","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 5","pages":"1-15"},"PeriodicalIF":1.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126369","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":"Evaluating the Effectiveness of Nurse-Led Early Comfort Using Analgesia, Minimal Sedatives, and Maximal Humane Care Sedation in Mechanically Ventilated Patients.","authors":"Hongyu Hui, Xu Fang, Lei Ju, Lingling Tang, Hui Zhang, Miao Wang, Jia Jiang","doi":"10.12968/hmed.2024.0987","DOIUrl":"https://doi.org/10.12968/hmed.2024.0987","url":null,"abstract":"<p><p><b>Aims/Background</b> Early Comfort using Analgesia, minimal Sedatives, and maximal Human care (eCASH) is a patient-centered sedation strategy aimed at reducing the use of sedative drugs and improving patient comfort. Therefore, this study evaluated the effectiveness of a nurse-led eCASH sedation strategy in mechanically ventilated patients. <b>Methods</b> This retrospective cohort study included 149 patients who received mechanical ventilation in the intensive care unit (ICU) of the Second Affiliated Hospital of Harbin Medical University between May 2020 and May 2024. Patients were divided into two groups: the observation group (eCASH sedation group, n = 70), which received nurse-led eCASH sedation, and the control group (traditional sedation group, n = 79), which underwent physician-led traditional sedation strategies. Baseline characteristics, analgesic and sedative use, analgesia and sedation outcomes, duration of mechanical ventilation, ICU stay, length of hospital stay, and incidence of delirium were compared between the two groups. <b>Results</b> The observation group received a significantly higher dose of fentanyl within the first 24 hours of mechanical ventilation compared to the control group (<i>p</i> = 0.001). However, there was no significant difference in fentanyl use at 48 and 72 hours between the two groups (<i>p</i> > 0.05). Dexmedetomidine use in the observation group was significantly lower than in the control group at 24, 48, and 72 hours (<i>p</i> < 0.05). Moreover, no significant difference was observed in the use of propofol between the two groups (<i>p</i> > 0.05). The observation group had a significantly higher analgesia success rate within 72 hours (<i>p</i> = 0.027), although the sedation success rate was not significantly different (<i>p</i> > 0.05). Both groups showed significant improvement over time in Richmond Agitation-Sedation Scale (RASS) and Critical-Care Pain Observation Tool (CPOT) scores (<i>p</i> < 0.001), with the observation group demonstrating a significantly faster improvement in analgesia effectiveness compared to the control group (<i>p</i> = 0.015). The duration of mechanical ventilation was significantly shorter in the observation group (<i>p</i> = 0.011), while the incidence of delirium was lower but not statistically significant (<i>p</i> = 0.519). Additionally, there were no statistically significant differences in ICU stay duration and length of hospital stay between the two groups (<i>p</i> > 0.05). <b>Conclusion</b> The nurse-led eCASH sedation strategy significantly reduces analgesic use, shortens mechanical ventilation duration, and improves analgesia outcomes in mechanically ventilated patients. The effectiveness of sedation and incidence of delirium within the eCASH were comparable to those of traditional sedation.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 5","pages":"1-14"},"PeriodicalIF":1.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126753","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":"Establishment of a Predictive Model for the Efficacy of Vestibular Rehabilitation Therapy in Patients With Vestibular Peripheral Vertigo.","authors":"Shuangzhi Wang, Diwen Zhang, Feihu Cao, Xiyu He, Juan Peng","doi":"10.12968/hmed.2024.0985","DOIUrl":"https://doi.org/10.12968/hmed.2024.0985","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Aims/Background&lt;/b&gt; Vestibular peripheral vertigo, a common condition, is usually managed through vestibular rehabilitation therapy. However, while the current treatment approaches are effective, their efficacy varies among patients. Therefore, establishing a prediction model, evaluating rehabilitation outcomes, and optimizing treatment plans are crucial for patient rehabilitation. Hence, this study aims to explore the factors affecting the clinical efficacy of vestibular rehabilitation in peripheral vestibular vertigo and establish a prediction model based on these factors. &lt;b&gt;Methods&lt;/b&gt; This retrospective study analyzed clinical data from 212 patients with peripheral vestibular vertigo treated at Sichuan Mental Health Center, The Third Hospital of Mianyang, China, between January 2022 and December 2023. Patients were divided into a modeling group (n = 159) and a validation group (n = 53) in a 3:1 ratio. Patients in the modeling group were further divided into two subgroups based on efficacy: a group with good efficacy (n = 108) and a group with poor efficacy (n = 51). Baseline characteristics from the patients were compared between the modeling and validation groups. Furthermore, univariate and multivariate analyses were conducted to identify factors influencing the clinical efficacy of vestibular rehabilitation in peripheral vestibular vertigo. &lt;b&gt;Results&lt;/b&gt; There were statistically significant differences in anxiety, vertigo, concurrent headache, ear symptoms, and lack of sleep in the modeling group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Multivariate logistic regression analysis identified anxiety, severity of dizziness, accompanying headaches, ear symptoms, and inadequate sleep as the independent factors affecting the clinical efficacy of vestibular rehabilitation in treating peripheral vertigo (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Furthermore, a model was established as follows: [Logit (P) = -2.836 + (1.673X&lt;sub&gt;1&lt;/sub&gt;) + (2.220X&lt;sub&gt;2&lt;/sub&gt;) + (0.960X&lt;sub&gt;3&lt;/sub&gt;) + (1.150X&lt;sub&gt;4&lt;/sub&gt;) + (1.202X&lt;sub&gt;5&lt;/sub&gt;)]. The calibration curves of the model in both the training and validation groups were a straight line close to 1, indicating that the predicted efficacy of the model was in agreement with the actual risk. The receiver operating characteristic (ROC) curve analysis revealed that the predicted area under the curve of the model for the clinical efficacy of vestibular rehabilitation in treating vestibular peripheral vertigo was 0.943 (95% confidence interval [CI]: 0.885-0.946, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) in the modeling group and 0.881 (95% CI: 0.796-0.906, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) in the validation group. Decision curve analysis (DCA) evaluated the clinical utility of the model in predicting efficacy, indicating the model's obvious positive net benefits. &lt;b&gt;Conclusion&lt;/b&gt; Anxiety, high vertigo severity, concomitant headache, ear symptoms, and inadequate sleep adversely impact the clinical efficacy of vestibular rehabilitation in peripheral vestibular vertigo. Establishing a predict","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 5","pages":"1-17"},"PeriodicalIF":1.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126737","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":"Relationship Between Neutrophil Extracellular Traps and Venous Thromboembolism: Pathophysiological and Therapeutic Role.","authors":"Rasit Dinc, Nurittin Ardic","doi":"10.12968/hmed.2024.0660","DOIUrl":"https://doi.org/10.12968/hmed.2024.0660","url":null,"abstract":"<p><p>Venous thromboembolism (VTE), which includes pulmonary embolism (PE) and deep vein thrombosis (DVT), is a serious vascular disease that ranks third in cardiovascular-related deaths. Inflammation along with neutrophil extracellular traps (NETs) play a key role in the pathophysiology of VTE. This review focuses on articles that that evaluate the role of NETs in the development of VTE and their potential as therapeutic targets. Research has demonstrated that when NETs become overactivated, they take part in thrombotic activities, which is the opposite of their defensive functions under healthy conditions. When endothelial cells are activated, neutrophils are recruited very early, releasing NETs and initiating a thrombotic process. NETs promote thrombosis by directly activating factor XII (FXII), ultimately triggering platelet recruitment, and initiating the intrinsic coagulant pathway. Subsequently, monocytes and factors such as tissue factor join the process, further increasing NET formation, the inflammatory reactions and progression of venous thrombus. NETs play a crucial part in the intricate interaction between inflammation and thrombosis, where each triggers the other. High levels of NETs also correlate with the severity of VTE. These properties of NETs make them potential therapeutic targets for VTE prevention and treatment. This article aims to describe NETs, their occurrence, and how they relate to VTE. Taking into account what is now known, the function of NETs as targets for treatment in VTE using various approaches, the benefits and drawbacks of these approaches, and suggestions for the future are examined.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 5","pages":"1-15"},"PeriodicalIF":1.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126764","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":"Assessment of the Relationship Between C-Reactive Protein-to-Albumin Ratio and Culprit Lesion Location in Patients With ST-Segment Elevation Myocardial Infarction.","authors":"Yuying Deng, Xiuxian Huang, Jiazhi Pan, Chunyang Wang","doi":"10.12968/hmed.2024.0867","DOIUrl":"https://doi.org/10.12968/hmed.2024.0867","url":null,"abstract":"<p><p><b>Aims/Background</b> The C-reactive protein to albumin ratio (CAR) has traditionally been employed to assess inflammatory status in non-cardiac diseases. Recent clinical studies suggest that CAR is a valuable indicator of inflammation in atherosclerotic coronary artery diseases. However, its relationship with ST-segment elevation myocardial infarction (STEMI) remains unclear. This study aimed to investigate the relationship between CAR and the exact location of the culprit lesion in STEMI patients and its potential clinical implications. <b>Methods</b> A retrospective analysis was conducted on patients who presented with STEMI and were treated with primary percutaneous coronary intervention (PCI) within 12 hours of symptom onset between November 2018 and November 2023. Based on coronary angiography (CAG) findings, patients were categorized into three groups according to the culprit vessel: left anterior descending artery (LAD) (n = 218), left circumflex artery (LCX) (n = 31), and right coronary artery (RCA) (n = 153). Three patients with ramus occlusion were excluded from the subgroup analysis. Furthermore, based on the lesion location within the culprit vessel, patients were divided into proximal (n = 122), middle (n = 222), and distal (n = 61) segment groups. Clinical baseline characteristics and laboratory results were recorded. Statistical analyses, including analysis of variance (ANOVA), the Kruskal-Wallis H-test, Fisher's exact test, and the chi-square test, were performed based on variable types and distribution. Correlation analysis was conducted using Spearman's rank correlation coefficient. The receiver operating characteristic (ROC) curve was applied to determine the optimal cut-off value for CAR. A <i>p</i>-value < 0.05 was considered statistically significant. <b>Results</b> A total of 405 patients were included in the study. CAR and left ventricular ejection fraction (LVEF) showed significant differences across groups stratified by culprit vessels (<i>p</i> = 0.001 for CAR; <i>p</i> < 0.001 for LVEF) and lesion location within the vessels (<i>p</i> < 0.001 for CAR and LVEF). CAR values were higher in more proximally located lesions (r = 0.218, <i>p</i> < 0.001), while LVEF showed an inverse relationship (r = -0.203, <i>p</i> < 0.001). ROC curve analysis showed that CAR could predict proximal- and mid-vessel lesions in STEMI patients, with a cut-off value of 26.16 (area under the curve [AUC]: 0.662, 95% confidence interval [CI]: 0.59-0.74, <i>p</i> < 0.001). <b>Conclusion</b> CAR is an easily calculable and reliable biomarker associated with culprit lesion location in STEMI patients, providing potential clinical utility in risk stratification and disease assessment.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 5","pages":"1-15"},"PeriodicalIF":1.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126289","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":"Knowledge, Attitude, and Practice Levels of Nurses in Primary Hospitals Regarding Elderly Subsyndromal Delirium: Assessment and Development of a Network-Based Tiered Training Program.","authors":"Xiaping Shu, Fang Wang, Jinqiu He, Fang Huang","doi":"10.12968/hmed.2024.1002","DOIUrl":"https://doi.org/10.12968/hmed.2024.1002","url":null,"abstract":"<p><p><b>Aims/Background</b> Subsyndromal delirium (SSD) in elderly patients can lead to prolonged hospital stays, reduced quality of life, and cognitive decline. Evidence suggests that nursing interventions play a key role in mitigating SSD risk by facilitating early identification as well as timely and effective interventions. This study aimed to assess the knowledge, attitude, and practice (KAP) levels of nurses in primary hospitals regarding elderly SSD, identify factors influencing these levels, and construct a network-based tiered training program. <b>Methods</b> A literature review and Delphi expert consultation method, based on the KAP theory, were utilized to develop a questionnaire to assess the KAP levels of nurses regarding elderly SSD in primary hospitals. A pilot study was conducted to determine the reliability and validity of the questionnaire. From January 2024 to June 2024, a stratified cluster sampling method was employed to survey nurses from six secondary or higher-level primary hospitals in Shaoxing, China. The self-developed questionnaire was used to evaluate the KAP levels of primary hospital nurses regarding elderly SSD assessment and analyze factors influencing their scores. Based on the findings, a network-based tiered training program was constructed. <b>Results</b> A total of 615 questionnaires were distributed, of which 600 were valid, with an effective response rate of 97.56%. The mean total KAP score for nurses in primary hospitals regarding elderly SSD assessment was 98.11 ± 12.23, with an overall scoring rate of 61.32%. The mean scoring rates for KAP were 48.35%, 81.29%, and 68.84% respectively. Significant differences in KAP scores regarding elderly SSD for nurses in primary hospitals with different characteristics were observed based on age, educational level, years of experience, and professional title (<i>p</i> < 0.001). Multiple linear regression analysis showed that years of experience and professional title (nurse in charge or deputy senior nurse practitioner and above) were significant predictors of total KAP scores (<i>p</i> < 0.05). <b>Conclusion</b> The overall KAP level of primary hospital nurses regarding elderly SSD assessment was suboptimal. While attitudes towards SSD were generally positive, knowledge and practice levels required considerable improvement. A network-based tiered training program was developed to enhance the capacity of primary hospital nurses for timely and accurate identification of SSD risks in elderly patients.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 5","pages":"1-17"},"PeriodicalIF":1.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126758","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 Causal Relationship Between Serum Metabolites and Sjogren's Syndrome: A Mendelian Randomization Study.","authors":"Yuqiao Li, Li Chen, Xiaohan Huang, Yue Wang","doi":"10.12968/hmed.2024.0968","DOIUrl":"https://doi.org/10.12968/hmed.2024.0968","url":null,"abstract":"<p><p><b>Aims/Background</b> Sjogren's syndrome (SS) is a highly prevalent autoimmune disease with potentially serious consequences if left untreated, but methods for early detection and prevention of SS remain limited. This study aims to investigate the causal relationships between serum metabolites and SS using Mendelian randomization (MR), focusing on identifying key metabolic pathways and biomarkers that contribute to SS pathogenesis. <b>Methods</b> We used a two-sample MR approach to investigate the causal relationships between serum metabolites and SS. The primary method for estimating these causal effects was inverse variance weighting (IVW), with results presented alongside their corresponding 95% confidence intervals (CIs). Sensitivity analyses included the Cochran's Q statistical analysis and MR-Egger method. Furthermore, an enrichment analysis of metabolic pathways was applied to the identified metabolites. <b>Results</b> Thirty-seven serum metabolites that have causal links with SS, encompassing 7 metabolite ratios and 30 single metabolites (4 unknown and 26 known), were identified. Metabolite ratios, reflecting the balance between specific metabolites, were analyzed to identify metabolic shifts that may contribute to SS pathogenesis. Among the 26 known metabolites, 12 are protective factors and 14 are risk factors. The levels of cis-4-decenoate (cDA) (10:1n6) (odds ratio [OR] = 1.125; 95% CI = 1.026-1.233; <i>p</i> = 0.012) is positively correlated with the incidence of SS, whereas the levels of butyrate/isobutyrate (4:0) (OR = 0.822; 95% CI = 0.701-0.963; <i>p</i> = 0.016) are negatively correlated with the SS incidence. Most of these metabolites are associated with lipid and amino acid metabolism. Among lipids, the strongest risk-increasing factor was 2,3-dihydroxy-2-methylbutyrate (OR = 1.307; 95% CI = 1.054-1.621; <i>p</i> = 0.015), while the strongest risk-decreasing factor was hexadecadienoate (16:2n6) (OR = 0.774; 95% CI = 0.635-0.944; <i>p</i> = 0.011). Among amino acids, the strongest risk-increasing factor was N-acetylproline (OR = 1.178; 95% CI = 1.024-1.355; <i>p</i> = 0.022), and the strongest risk-decreasing factor was N-acetylserine (OR = 0.802; 95% CI = 0.694-0.926; <i>p</i> = 0.003). Furthermore, these metabolites are predominantly enriched in the arginine and proline metabolism pathway. <b>Conclusion</b> This study helped enhance our comprehension of the causal relationship between serum metabolites and SS, showing that some metabolites may influence the risk and development of this disease. These insights offer novel perspectives for the development of SS prediction and diagnosis.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 5","pages":"1-18"},"PeriodicalIF":1.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126767","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":"Orthostatic Hypotension-An Approach to Work Up and Management.","authors":"Beth Brailsford, Eleanor Jane East, Jenny Clayton, Abilash Sathyanarayanan","doi":"10.12968/hmed.2024.0602","DOIUrl":"https://doi.org/10.12968/hmed.2024.0602","url":null,"abstract":"<p><p>Orthostatic hypotension (OH) is associated with undesirable impacts on patient quality of life, falls risk and mortality. OH can result from reversible causes such as hypovolaemia. It is more common amongst patients with hypertension and those with uncontrolled hypertension are at higher risk of poorer outcomes. Autonomic neuropathy, which can be secondary to comorbidities including diabetes mellitus and Parkinson's disease, can also lead to treatment refractory OH. Non-pharmacological approaches to management include use of compression garments and rising gradually. A thorough medication review is advocated, with a view to switching to alternative medications that are less likely to exacerbate OH. Midodrine, an alpha-1 adrenergic agonist is licensed for pharmacological management of OH in the UK. Referral to hypertension specialists is recommended by The National Institute for Health and Care Excellence (NICE) if treatment refractory.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 5","pages":"1-9"},"PeriodicalIF":1.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126763","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}