British journal of hospital medicine最新文献

{"title":"Long-Term Protective Association of Elevated Body Mass Index With Survival in Intracerebral Hemorrhage: A 2-Year Cohort Study Revealing the Obesity Paradox.","authors":"Yu Deng, Yujia Jin, Yutong She, Daiyun Chen, Tianbo Xu, Kefan Qiu, Yingying Cao, Mengsi Wang, Jian Wu","doi":"10.31083/BJHM58250","DOIUrl":"10.31083/BJHM58250","url":null,"abstract":"<p><strong>Aims/background: </strong>The 'obesity paradox' has been reported in intracerebral hemorrhage (ICH), but evidence on long-term mortality remains limited. We investigated the association between body mass index (BMI) and long-term all-cause mortality in a hospital-based ICH cohort.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients with primary ICH admitted within 48 h between 1 November 2016 and 28 February 2021. Patients with secondary ICH, neurosurgical procedures, isolated intraventricular hemorrhage, severe pre-existing disability, or loss to follow-up were excluded. Patients were categorised based on World Health Organization BMI criteria as follows: underweight (<18.5 kg/m²), normal weight (18.5-24.9 kg/m²), overweight (25.0-29.9 kg/m²), and obese (≥30.0 kg/m²). The primary outcome was all-cause mortality. Associations between BMI and mortality were assessed using Cox proportional hazards models, and potential nonlinearity was evaluated by modeling BMI with a spline term within the Cox proportional hazards framework.</p><p><strong>Results: </strong>Of the 947 screened patients, 839 were included (underweight n = 66; normal weight n = 465; overweight n = 261; obese n = 47). Median follow-up time varied across BMI groups (25.5-43.0 months). BMI demonstrated an inverse association with all-cause mortality in an exploratory multivariable model excluding age (hazard ratio (HR): 0.923, 95% confidence interval (CI): 0.864-0.985; <i>p</i> = 0.016). However, this association was attenuated and no longer statistically significant after adjustment for age (HR: 0.958, 95% CI: 0.898-1.022; <i>p</i> = 0.190), suggesting important age-related confounding. Restricted cubic spline analysis showed no evidence of nonlinearity (<i>p</i> = 0.475). Kaplan-Meier curves showed higher survival in overweight and obese groups than in underweight and normal-weight groups. BMI was also negatively associated with hematoma volume; this relationship remained after log transformation.</p><p><strong>Conclusion: </strong>An apparent inverse association between BMI and long-term mortality was observed after primary ICH; however, this association was substantially influenced by age. These findings highlight the complex relationship between BMI, aging, and hemorrhagic stroke characteristics and should be interpreted cautiously given the observational design.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov (NCT04803292).</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"58250"},"PeriodicalIF":1.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079780","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":"<i>Streptococcus pneumoniae</i> Bacteraemia Induced L4/L5 Facet Joint Septic Arthritis.","authors":"Ruman Basra, Maisarah Amran, Marc George","doi":"10.31083/BJHM54784","DOIUrl":"https://doi.org/10.31083/BJHM54784","url":null,"abstract":"","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"54784"},"PeriodicalIF":1.7,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079945","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":"Development and Validation of an Interpretable Machine Learning-Based Prediction Model of Sepsis: A Retrospective Multicenter Cohort Study.","authors":"Zhangcong Lu, Linghan Hu, Pengfei Shui, Binyu Zhao, Shuyu Zhan, Chen Huang, Jiajie Huang, Yang He, Dongpeng Li, Yucai Hong, Ning Liu","doi":"10.31083/BJHM55546","DOIUrl":"10.31083/BJHM55546","url":null,"abstract":"<p><strong>Aims/background: </strong>Sepsis is a leading cause of morbidity and mortality in intensive care units (ICUs). Early identification of patients at high risk of death is essential to guide timely interventions and optimize resource allocation. This study aimed to develop and validate an interpretable machine learning model for predicting 28-day mortality in adult ICU patients.</p><p><strong>Methods: </strong>We retrospectively analyzed data from three independent critical care databases, including 98,233 adult ICU patients. Sixteen routinely collected variables available by the 24-hour prediction landmark-including vital signs and laboratory parameters obtained during the first 24 hours after ICU admission, baseline comorbidities documented at or before ICU admission, and treatments administered during the same 24-hour period-were selected for model development. Nine machine learning algorithms were compared, and model performance was evaluated using both internal and external validation cohorts. Explainable machine learning techniques were applied to identify the most influential predictors.</p><p><strong>Results: </strong>Among the nine algorithms, extreme gradient boosting (XGBoost) demonstrated the highest predictive performance. The model achieved an area under the receiver operating characteristic curve (AUROC) of 0.884 (0.871-0.897) in the internal validation cohort and maintained comparable discrimination in the two external validation cohorts, eICU-Sepsis, derived from the eICU Collaborative Research Database (eICU-CRD), and DRECCv1.0 critical care database (DRECC)-Sepsis, with AUROCs of 0.877 (0.872-0.882) and 0.875 (0.856-0.894), respectively. Mechanical ventilation, comorbidity burden, lactate dehydrogenase, age, respiratory rate, and blood pressure made important contributions to the model's prediction of 28-day mortality.</p><p><strong>Conclusion: </strong>This interpretable machine learning model may facilitate early risk stratification of ICU patients with sepsis. Although the model shows potential for identifying high-risk individuals at the 24-hour prediction landmark, further prospective validation and clinical impact assessment are required before routine clinical implementation.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"55546"},"PeriodicalIF":1.7,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079605","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":"Problem-Based Learning and Simulation-Based Learning in Clinical Endocrinology Education: Applications and Future Directions.","authors":"Yumei Yang","doi":"10.31083/BJHM50409","DOIUrl":"https://doi.org/10.31083/BJHM50409","url":null,"abstract":"<p><p>Diagnosing and treating endocrine diseases is a highly complex endeavor requiring advanced clinical reasoning, decision-making, and practical skills. However, traditional medical teaching approaches are unable to fully cater to the cultivation of these skills among residents. Thus, reforming the current teaching model utilized in clinical endocrinology education by introducing problem-based learning (PBL) and simulation-based learning (SBL) methods is imperative. This article aims to review the current application and research progress of PBL and SBL in clinical endocrinology education and explore their potential for synergistic integration. This narrative review synthesizes findings from peer-reviewed literature identified through searches of PubMed, CNKI, and Web of Science databases. The literature was thematically analyzed to summarize implementation models, educational outcomes, and integration strategies across different training stages. Problem-based learning helps deepen the understanding of disease mechanisms and cultivate systems thinking, while simulation-based learning enables healthcare professionals to develop essential skills through practice in controlled, realistic settings. Both methods, when used individually, demonstrate effectiveness in improving learners' knowledge acquisition, skill confidence, and satisfaction, despite the presence of limitations. Research indicates that combining PBL and SBL may more effectively promote the overall development of clinical competence. In conclusion, PBL and SBL are effective methods for improving clinical endocrinology education, and their complementary advantages suggest that synergistic application represents a promising future direction. However, applying this technique necessitates revision of curriculum, more intense teacher training, and the development of new evaluation systems centered on clinical competence.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"50409"},"PeriodicalIF":1.7,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079827","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":"Predictors of Functional Recovery in Patients With Mild Hemorrhagic Transformation Following Intravenous Thrombolysis for Acute Ischemic Stroke.","authors":"Shengxiong Pu, Zhimin Li, Qian Wang, Yaorong Chen, Hongfeng Liang","doi":"10.31083/BJHM50688","DOIUrl":"10.31083/BJHM50688","url":null,"abstract":"<p><strong>Aims/background: </strong>Patients who develop mild hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) exhibit substantial heterogeneity in functional recovery. However, a systematic evaluation of predictors of functional recovery in this specific population remains lacking. This study aimed to identify the clinical and nutritional factors associated with functional recovery in these patients.</p><p><strong>Methods: </strong>This dual-center retrospective cohort study consecutively enrolled 204 patients with AIS who developed mild HT after IVT between March 2020 and March 2025. Based on the modified Rankin Scale (mRS) score at 3 months, patients were classified into a good functional recovery group (mRS ≤2, n = 153) and a poor functional recovery group (mRS ≥3, n = 51). Demographic, clinical, and laboratory data were collected. Nutritional status was evaluated using the Controlling Nutritional Status (CONUT) score and the Prognostic Nutritional Index (PNI). Univariate and multivariate logistic regression analyses were performed to identify independent predictors. The predictive performance of individual factors and a combined model was assessed using receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>Univariate analysis demonstrated that age, baseline National Institutes of Health Stroke Scale (NIHSS) score, PNI, CONUT score, arrival-to-thrombolysis time, and history of diabetes mellitus (HD) were significantly associated with poor functional recovery (all <i>p</i> < 0.05). Multivariate analysis identified HD, older age, a higher baseline NIHSS score, and a higher CONUT score as independent risk factors for poor functional recovery (all <i>p</i> < 0.05). A combined model incorporating these four variables demonstrated the highest discriminative performance, with an area under the curve (AUC) of 0.840 (95% CI: 0.783-0.897). At the optimal probability cut-off of 0.156, the model achieved a specificity of 92.2% and a sensitivity of 64.5%.</p><p><strong>Conclusion: </strong>In patients with AIS who develop mild HT after IVT, baseline neurological deficit severity, nutritional status, HD, and age are independent determinants of functional recovery. A model integrating these factors demonstrates superior discriminative potential and may facilitate early risk stratification and personalized management in this patient population.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"50688"},"PeriodicalIF":1.7,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079747","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":"Artificial Intelligence and Health Misinformation in Healthcare: Opportunities, Limitations and Future Directions.","authors":"Hasan H Alsararatee, Ahmad Abu Allam","doi":"10.31083/BJHM51991","DOIUrl":"https://doi.org/10.31083/BJHM51991","url":null,"abstract":"<p><p>The rapid digitalisation of health information has transformed how individuals access medical knowledge but has also facilitated the widespread dissemination of health misinformation. The World Health Organization describes this phenomenon as an infodemic, characterised by an overabundance of information that includes both accurate and misleading content, making it difficult for individuals to identify reliable sources of health advice. Exposure to misinformation has been linked to vaccine hesitancy, reduced adherence to public health guidance and increased engagement with unverified treatments. Artificial intelligence (AI) technologies are increasingly being explored as tools to detect, monitor and counter misleading health narratives across digital platforms. This article critically explores current evidence on AI-based approaches to health misinformation governance, including machine learning, natural language processing, deep learning, large language models, multimodal systems and social media surveillance. Evidence suggests that AI can help identify misleading narratives and emerging public concerns, but current studies rarely distinguish intentional disinformation from unintentional misinformation when reporting model performance. Significant challenges include dataset bias, restricted generalisability across linguistic and cultural contexts, platform-specific model development, limited external validation, privacy concerns, uncertain clinical relevance and amplification through engagement-driven recommendation systems. The article argues that AI should be understood as one component within an iterative, risk-stratified governance framework that combines healthcare expertise, public health interpretation, transparent oversight, platform accountability, tailored digital health literacy interventions and evaluation of real-world public health outcomes.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"51991"},"PeriodicalIF":1.7,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079581","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":"Risk Factor Analysis of Cardiovascular Events in Patients With Diabetic Kidney Disease and Hypertension: A Retrospective Study.","authors":"Xiaofen Sun, Junhan Zhu, Duoqiao Li, Fang Jiang","doi":"10.31083/BJHM49746","DOIUrl":"https://doi.org/10.31083/BJHM49746","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims/background: &lt;/strong&gt;Diabetic kidney disease (DKD) is among the most prevalent complications of diabetes and is commonly accompanied by hypertension as a comorbid condition. The coexistence of these two conditions markedly augments the risk of cardiovascular disease. Although traditional risk factors such as dyslipidemia, smoking, and decreased renal function have been shown to be associated with increased cardiovascular events, evidence for the higher-risk subgroup of \"DKD with hypertension\" remains relatively limited. This study aimed to retrospectively analyze the influencing factors of adverse cardiovascular events in this population and assess the independent predictive value of different clinical indicators.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this single-center retrospective cohort study, 204 patients diagnosed with DKD and hypertension were enrolled between January 2021 and January 2024. Baseline data, including patient demographics and clinical indicators, were collected. Patients were divided into an event group and a non-event group based on whether they experienced cardiovascular events during the 12-month follow-up period. Independent risk factors were screened using univariate and multivariate logistic regression, and the effects of prior hyperlipidemia and smoking on event-free survival were assessed using Kaplan-Meier curves.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Compared with the non-event group, patients in the event group had significantly higher levels of low-density lipoprotein (LDL), urinary protein, and kidney injury molecule-1 (KIM-1), and significantly lower levels of high-density lipoprotein (HDL), along with a greater prevalence of prior hyperlipidemia and smoking (all &lt;i&gt;p&lt;/i&gt; &lt; 0.05). Univariate analysis showed that prior hyperlipidemia, smoking, elevated LDL, reduced HDL, and increased KIM-1 were all associated with cardiovascular events. Further multivariate analysis confirmed that prior hyperlipidemia, smoking, HDL, LDL, and KIM-1 were all independent predictors of cardiovascular events (all &lt;i&gt;p&lt;/i&gt; &lt; 0.05). According to Kaplan-Meier curve analysis, patients with a history of hyperlipidemia and a smoking habit had significantly lower event-free survival than those without these characteristics (&lt;i&gt;p&lt;/i&gt; = 0.034 and &lt;i&gt;p&lt;/i&gt; = 0.024).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In DKD patients with hypertension, prior hyperlipidemia, smoking, elevated LDL, reduced HDL, and increased KIM-1 were key independent risk factors for cardiovascular events. The adverse association of dyslipidemia and smoking with event-free survival was evident early in the follow-up period. These results suggest that this high-risk population should receive enhanced lipid management and smoking cessation interventions, and the potential value of renal tubular injury markers (such as KIM-1) in cardiovascular risk assessment should be investigated to facilitate early identification of high-risk individuals and the development of individualiz","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"49746"},"PeriodicalIF":1.7,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079778","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 Effect of Electromyographic Biofeedback Relaxation Training on Pain Catastrophizing and Fatigue Levels in Lung Cancer Patients Undergoing Combined Chemoradiotherapy.","authors":"Xiaoling Fu, Huiwei Wang, Xiaoni Lin, Liying Chen, Jingjing Hu, Yeling Wang, Fang Yin, Weiying Wu","doi":"10.31083/BJHM50603","DOIUrl":"https://doi.org/10.31083/BJHM50603","url":null,"abstract":"<p><strong>Aims/background: </strong>Lung cancer patients undergoing combined chemoradiotherapy often experience pain, fatigue, sleep disturbances, and decreased quality of life. Among these, pain catastrophizing, as a negative cognitive pattern, can exacerbate symptom experience. Similarly, fatigue and sleep disturbances are also influenced by psychological and cognitive factors, yet conventional supportive care provides limited intervention at the psychological and cognitive levels. This study aims to investigate the impact of electromyographic biofeedback relaxation training on pain catastrophizing and fatigue levels in lung cancer patients undergoing combined chemoradiotherapy.</p><p><strong>Methods: </strong>This study employed a single-center, retrospective cohort design. Through a review of medical records from March 2020 to March 2022, patients who had received structured electromyographic biofeedback relaxation training undergoing chemoradiotherapy were assigned to an observation group (<i>n</i> = 78). Patients without such records, receiving only routine supportive care, were classified as a control group (<i>n</i> = 109). The training consisted of six sessions over two weeks. Outcomes, including pain catastrophizing (Pain Catastrophizing Scale), pain intensity (Visual Analogue Scale), sleep quality (European Organisation for Research and Treatment of Cancer), and quality of life (Functional Assessment of Chronic Illness Therapy-Fatigue), were assessed before and after the intervention period.</p><p><strong>Results: </strong>After the intervention, the pain catastrophism scores, pain intensity scores, and sleep disturbance scores of the observation group were significantly lower than those of the control group, while the fatigue score was significantly higher than that of the control group (all <i>p</i> < 0.05). Furthermore, the observation group also showed significantly better scores and total scores on multiple dimensions of quality of life (including physical well-being, social/family well-being, emotional health, functional well-being, and fatigue subscales) than the control group (<i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>Supplementing routine combined chemoradiotherapy management with electromyographic biofeedback relaxation training was associated with lower levels of pain catastrophizing and fatigue, improved sleep quality, and enhanced overall quality of life in lung cancer patients. This intervention may represent a safe and feasible non-pharmacological support strategy for symptom management in lung cancer patients undergoing combined chemoradiotherapy.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"50603"},"PeriodicalIF":1.7,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079912","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":"ERCP Knowledge, Practical Skills, and Training Needs of Endoscopic Nurses: A Cross-Sectional Study Based on Miller's Pyramid Theory.","authors":"Lingyun Liu, Jiajie Hu, Ling Tong, Qinyan Wang","doi":"10.31083/BJHM53861","DOIUrl":"https://doi.org/10.31083/BJHM53861","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims/background: &lt;/strong&gt;Endoscopic retrograde cholangiopancreatography (ERCP) is a high-risk invasive procedure that requires close cooperation between physicians and specialized nurses. Standardized systematic training for endoscopic nurses remains insufficient in many clinical settings in China. We aimed to investigate current levels of specialized knowledge and practical skills among endoscopic nurses in Zhejiang Province, China regarding ERCP, based on Miller's pyramid theory of abilities, and analyze their training willingness and needs, thereby providing a theoretical basis for establishing a systematic and standardized ERCP training system for acquiring specialized knowledge and operational skills.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We designed a questionnaire based on Miller's Pyramid of Clinical Competence and conducted a cross-sectional survey from August 2025 to September 2025 using convenience sampling among 230 endoscopy center nurses from 18 hospitals in Zhejiang. The questionnaire comprised three sections: general information, self-assessment of ERCP basic knowledge and practical skills, and training willingness and needs. The total survey score was 40 points, with 8-24 points indicating a low level, 25-34 points indicating a moderate level, and &gt;34 points indicating a high level.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 230 valid questionnaires were returned. The overall score for endoscopic nurses' ERCP knowledge level was 23.55 ± 5.81 points and that for practical skills was 23.77 ± 6.98 points; thus, nurses' knowledge and practical skill scores were both at a low level. Male nurses, nurses in tertiary A hospitals, nurses aged &gt;40 years, those with intermediate-level professional titles or above, and nurses with &gt;10 years' working experience achieved higher scores in theoretical knowledge and practical abilities. Analysis of endoscopic nurses' training needs revealed that 99.57% of nurses were willing to participate in training. Regarding the most common responses, these were \"once per quarter\" for training frequency, \"Monday to Friday noon\" for training time, \"31-45 minutes\" for training duration, \"learning new techniques\" for training content, and \"hands-on practice in the operating room\" for training methods; and the most common responses regarding training resources were \"operation video library\".&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The present findings indicated that endoscopic nurses' specialized knowledge and practical skills regarding ERCP require further improvement, and a clear demand for training exists. It is recommended that hospital administrators and nursing educators identify practical problems according to nurses' core demands and develop individualized hierarchical and staged training programs, with equal emphasis on theoretical knowledge and clinical practice. Teaching modalities including simulation training devices and hands-on workshops should be provided to foster professional specialization amon","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"53861"},"PeriodicalIF":1.7,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079796","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":"An Algorithm for Inferior Vena Cava Filter Placement in Severely Injured Patients: A Systematic Review-Based Consensus and Guidelines by SMA-VS.","authors":"Biyu Rui, Haisheng Wu, Ming Qi, Kangkang Zhi, Ye Pan","doi":"10.31083/BJHM55548","DOIUrl":"10.31083/BJHM55548","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims/background: &lt;/strong&gt;Venous thromboembolism is a major complication of severe injury, and the role of inferior vena cava (IVC) filters in patients suffering from this condition remains controversial. The current clinical practice guideline, developed by the Shanghai Medical Association Vascular Surgery Branch, aims to clarify the role of IVC filters in severely injured patients based on evidence and consensus-derived recommendations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a systematic review and random-effects meta-analysis of randomized controlled trials and observational cohort studies, reported in accordance with PRISMA 2020, followed by a two-round Delphi consensus process involving 21 experts from five specialties. Because the included studies spanned clinically heterogeneous populations and combined prophylactic with therapeutic filter placement, a post hoc sensitivity analysis restricted to trauma and fracture populations was performed. Pooled estimates were derived using the DerSimonian-Laird random-effects estimator in Review Manager (RevMan) 5.4. Certainty of evidence was not formally graded; reported agreement percentages denote the strength of expert consensus rather than Grading of Recommendations Assessment Development and Evaluation (GRADE) or equivalent formal ratings. Because each outcome was informed by only two to five studies, pooled estimates should be interpreted with caution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Six studies were included. In the principal analysis, which pooled studies of both prophylactic and therapeutic filter placement, IVC filters were associated with a lower incidence of symptomatic pulmonary embolism (five studies; risk ratio [RR] 0.22, 95% confidence interval [CI] 0.08-0.66), an association informed by four observational studies and one randomized trial. Filters were not associated with reduced all-cause mortality (RR 0.88, 95% CI 0.41-1.89) or with a difference in bleeding (RR 1.08, 95% CI 0.91-1.28), and were associated with a higher incidence of deep vein thrombosis (RR 1.38, 95% CI 1.02-1.87), although this finding was not robust in leave-one-out analysis. When the analysis was restricted to trauma and fracture populations, the reduction in symptomatic pulmonary embolism persisted (RR 0.15, 95% CI 0.04-0.59), whereas the association with deep vein thrombosis was no longer evident (RR 1.31, 95% CI 0.68-2.50). Fifteen recommendations were formulated, of which fourteen achieved consensus. These recommendations include: (i) pharmacologic thromboprophylaxis is the mainstay of prevention; (ii) IVC filters are reserved for defined indications; and (iii) availability of institutional retrieval infrastructure is a prerequisite for IVC placement. A clinical decision algorithm was developed to integrate the recommendations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The certainty of evidence was low for most components, although substantial agreement was achieved among expert clinicians. Pharmacolo","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 9","pages":"55548"},"PeriodicalIF":1.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079570","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}