British journal of hospital medicine最新文献

{"title":"Analysis of Factors Influencing Clinical Inertia in the Treatment of Type 2 Diabetes Mellitus Patients With Metformin.","authors":"Xuan Lu, Fubi Jin","doi":"10.12968/hmed.2024.0645","DOIUrl":"https://doi.org/10.12968/hmed.2024.0645","url":null,"abstract":"<p><p><b>Aims/Background</b> Medication therapy is a crucial measure for type 2 diabetes mellitus (T2DM). However, approximately 50% of diabetes patients in China fail to achieve their blood glucose control targets despite receiving hypoglycemic treatment. Studies have indicated that clinical inertia is often a key factor contributing to poor long-term blood glucose control in most patients. This study aims to investigate the factors influencing clinical inertia in the treatment process of patients using metformin. <b>Methods</b> A retrospective study method was adopted, and 86 T2DM patients treated with metformin who have clinical inertia between June 2021 and June 2023 at Zhejiang Hospital were treated as the inertia group. Additionally, 87 patients who received the same medication treatment and follow-up evaluation without clinical inertia during the same period were selected as the control group. By comparing general data, family and economic situations, lifestyle, and diabetes conditions between the two groups, a logistic multivariate analysis model was used to analyze the factors influencing clinical inertia in the treatment process of T2DM patients using metformin. <b>Results</b> The proportion of male patients and those with an elementary education or below was significantly higher in the inertia group compared to the control group (<i>p</i> < 0.05). Additionally, the proportion of patients without commercial insurance was significantly higher in the inertia group (<i>p</i> < 0.05). The proportion of patients practicing dietary control was lower in the inertia group compared to the control group (<i>p</i> < 0.05). Furthermore, the inertia group had a lower proportion of patients with initial glycated hemoglobin levels ≥8.0%, those conducting home blood glucose monitoring, patients with diabetes-related complications, and those receiving diabetes health education compared to the control group (<i>p</i> < 0.05). Male gender (odds ratio (OR) = 3.487, <i>p</i> = 0.001), elementary education or below (OR = 2.362, <i>p</i> = 0.027), lack of commercial insurance (OR = 3.783, <i>p</i> = 0.005), absence of home blood glucose monitoring (OR = 3.127, <i>p</i> = 0.007), absence of diabetes-related complications (OR = 2.995, <i>p</i> = 0.006), and lack of chronic disease health education (OR = 2.753, <i>p</i> = 0.017) were identified as risk factors for clinical inertia in the treatment of T2DM patients using metformin (<i>p</i> < 0.05). <b>Conclusion</b> The risk of clinical inertia during metformin treatment in T2DM patients is relatively high and is associated with various factors. Targeted intervention measures should be implemented for high-risk populations to reduce the risk of clinical inertia.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 4","pages":"1-13"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982557","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 Impact of the Failure Mode and Effects Analysis Nursing Approach on Complications of Chronic Obstructive Pulmonary Disease Patients With Respiratory Failure.","authors":"Deli Xie, Xiuyun Zheng, Lingcong Peng","doi":"10.12968/hmed.2024.0807","DOIUrl":"https://doi.org/10.12968/hmed.2024.0807","url":null,"abstract":"<p><p><b>Aims/Background</b> Noninvasive intermittent positive pressure ventilation is a widely used approach for managing Chronic obstructive pulmonary disease (COPD) complicated with respiratory failure. Treatment procedures often result in severe complications, requiring the implementation of proactive and effective nursing measures. Therefore, this study investigated the impact of failure mode and effects analysis (FMEA) on preventing complications in COPD patients with respiratory failure and assessed its influence on negative emotions, hope level, and quality of life. <b>Methods</b> This retrospective study included 356 patients with COPD combined with respiratory failure who underwent treatment in the First Affiliated Hospital of Wenzhou Medical University, China, between January 2023 and December 2023. Patients receiving usual care were included in the care-as-usual (CAU) group (n = 204), and those who underwent FMEA were assigned to the FMEA group (n = 152). Baseline characteristics and clinical data were compared between the two groups. Furthermore, the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Herth Hope Index (HHI) and 36-item Short-Form were collected and comparatively analyzed between the two groups. <b>Results</b> The FMEA group exhibited a significantly lower incidence of facial compression injury, dry mouth, phlegm obstruction, flatulence, bronchiectasis, and aspiration pneumonia than the CAU group (<i>p</i> < 0.05). After the intervention, the SAS and SDS scores were significantly reduced in the FMEA group than in the CAU group (<i>p</i> < 0.001). The temporality and future, positive readiness and expectancy, inter-connectedness, and HHI scale total scores were significantly higher in the FMEA group compared to the CAU group (<i>p</i> < 0.05). The physiological function, role-physical, body pain, general health perceptions, vitality, social functioning, role-emotional, and mental health of patients were significantly higher in the FMEA group than in the CAU group (<i>p</i> < 0.05). <b>Conclusion</b> The application of the FMEA nursing approach helps reduce the risk of complications in patients with COPD combined with respiratory failure, while effectively reducing anxiety and depression, improving their hope level and enhancing their overall quality of life. These observations offer a basis for preventing complications, and provide a reference for the formulation of nursing plans for these patients in clinical practice.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 4","pages":"1-16"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982564","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":"Tips for Trainees & Foundation Doctors in ICU.","authors":"Mark Oakey","doi":"10.12968/hmed.2023.0386","DOIUrl":"https://doi.org/10.12968/hmed.2023.0386","url":null,"abstract":"<p><p>A placement within critical care provides valuable experience for Intensive Care Medicine trainees and those training in other specialties. However, the environment is different from what you have previously experienced on the wards and can initially seem daunting. This guide aims to help demystify some of the critical care jargon so that you can feel more prepared for your time in the intensive care unit (ICU).</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 4","pages":"1-10"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953945","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 the Information Motivation Behavior Combined With Flipped Classroom Teaching Model on the Professional Competence and Creative Thinking of Urological Nursing Interns.","authors":"Shuang Zheng, Haijian Wang, Chunyan Chen","doi":"10.12968/hmed.2024.0739","DOIUrl":"https://doi.org/10.12968/hmed.2024.0739","url":null,"abstract":"<p><p><b>Aims/Background</b> Lack of motivation and poor learning habits lead to ineffective teaching in flipped classrooms. Information Motivation Behavior (IMB) theory facilitates the adaptation and modification of individual behavior through information, motivation, and behavioral intervention. This study aims to explore the effects of a combined IMB and flipped classroom teaching model on the professional competence and creative thinking of urological nursing interns. <b>Methods</b> A total of 85 undergraduate nursing interns who practiced in the Department of Urology from July 2023 to March 2024 were selected for retrospective analysis. The interns were divided into two groups based on the teaching model: the control group (n = 45, flipped classroom) and the study group (n = 40, IMB combined with the flipped classroom). The theoretical and practical scores were detected to assess the professional competence of students. Marmara Creative Thinking Dispositions Scale (MCTDS) scores, and California Critical Thinking Skills Scale-Chinese Version (CTDI-CV) scores were measured before and after training. Students' satisfaction with the teaching format and its effectiveness was compared between the two groups. <b>Results</b> The theoretical and practical scores, as well as the MCTDS and CTDI-CV scores, were significantly increased in both groups after training compared to before training (<i>p</i> < 0.05), with the degree of improvement being higher in the study group than in the control group. After training, the theoretical and practical scores were higher in the study group than in the control group (<i>p</i> < 0.001). The self-discipline, innovation search, courage, inquisitiveness, doubt, flexibility, and total MCTDS scores were also higher in the study group compared to the control group (<i>p</i> < 0.001). Similarly, the truth-seeking, analyticity, open-mindedness, inquisitiveness, maturity in judgment, and total CTDI-CV scores were markedly higher in the study group than in the control group (<i>p</i> < 0.001). Additionally, students' satisfaction with the teaching format and effectiveness was significantly greater in the study group than in the control group (<i>p</i> < 0.001). <b>Conclusion</b> The combination of IMB and the flipped classroom in urological nursing education demonstrated effective teaching outcomes and high satisfaction levels. It enhanced students' professional competence, critical thinking, and creative thinking. However, as this study focused exclusively on urological nursing interns, the results may not be generalizable to the education of other types of nurses.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 4","pages":"1-16"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976389","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":"Diagnostic Value of Pericruciate Fat Pad Measurement by MRI in Patients With Knee Articular Cartilage Injury.","authors":"Shaodian Zhang, Tian Zheng, Jialei Jin, Chenyi Ye, Rongxin He","doi":"10.12968/hmed.2024.0824","DOIUrl":"https://doi.org/10.12968/hmed.2024.0824","url":null,"abstract":"<p><p><b>Aims/Background</b> The diagnosis and treatment of knee joint injuries is an important medical topic. Magnetic resonance imaging (MRI) technology can aid in the clear visualization of the knee joint's internal structure. The correlation of pericruciate fat pad (PCFP) grading with cartilage injuries offers guidance in condition assessment and treatment. Therefore, this study aimed to investigate the value of MRI measurement of PCFP in the diagnosis and assessment of patients with knee cartilage injuries. <b>Methods</b> A total of 210 patients who underwent knee MRI examination in our hospital from January 2022 to June 2024 were retrospectively selected. All MRI examinations were conducted in accordance with a set of unified parameter standards, and the general data of patients were collected and analyzed. The relationship between PCFP grading and injury of various parts was analyzed, and the efficacy analysis of PCFP grading in diagnosing injury was analyzed. <b>Results</b> The comparison of the infrapatellar fat pad (IPFP)_Fat Fraction (FF) value, PCFP_FF value, and PCFP_Transverse Relaxation Time (T2) value between the two groups of patients revealed significant differences (<i>p</i> < 0.05). The results of binary logistic regression analysis showed that the FF value and T2 value of PCFP were independent influencing factors for knee cartilage injury (<i>p</i> < 0.05). According to Pearson correlation results, PCFP was positively correlated with injuries to the medial femoral ankle, medial compartment, and lateral femoral ankle (<i>r</i> = 0.293, 0.335, 0.277, <i>p</i> < 0.05). Using arthroscopy results as the gold standard, we found that the PCFP grading-based diagnosis had a sensitivity of 92.86% (130/140), a specificity of 95.71% (67/70), and an accuracy of 93.81% (197/210). In terms of different grades, PCFP grading has an accuracy rate of 95.17% in grade 0 diagnosis, 93.55% in grade 1, 95.71% in grade 2, 90.00% in grade 3, and 77.77% in grade 4. <b>Conclusion</b> MRI measurement of PCFP is highly sensitive, specific and accurate in the diagnosis of patients with knee articular cartilage injury, with a high accuracy in grading injuries, which is helpful for clinical diagnosis.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 4","pages":"1-13"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976810","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 Application of Risdiplam in 5q Spinal Muscular Atrophy: A Narrative Review.","authors":"Tong Zhao, Yang Xue, Miao-Shui Bai, Han-Yu Dong, Fei-Yong Jia","doi":"10.12968/hmed.2024.0808","DOIUrl":"https://doi.org/10.12968/hmed.2024.0808","url":null,"abstract":"<p><p>5q spinal muscular atrophy (SMA) is caused by mutations in the survival motor neuron <i>(SMN)</i> gene located on chromosome 5, leading to insufficient SMN protein levels. Risdiplam is an RNA splicing modifier that modifies pre-mRNA splicing of the <i>SMN2</i> gene, thereby promoting the production of functional survival motor neuron protein (SMN-fl). This article reviews the drug trials of Risdiplam, summarizes the actual clinical data, and systematically evaluates the effectiveness and safety of this drug. By discussing the mechanism of action and economic cost of this drug and comparing it to other SMA drugs, this paper provides a reference for the clinical use of the drug and an idea for future clinical research.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 4","pages":"1-25"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980881","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":"Acute Spinal Problems in the Elderly.","authors":"Joshua Rutnagur, Andrew Frost, Mohit Arora, Jennifer Lowrie, Santosh Baliga","doi":"10.12968/hmed.2024.0545","DOIUrl":"https://doi.org/10.12968/hmed.2024.0545","url":null,"abstract":"<p><p>The human spine has two structural and one main physiological function. The first structural function is to maintain the erect posture to allow a bipedal stance and the second is to protect the neurological elements, namely the spinal cord and the derived nerve roots. Physiologically, the spine is responsible for the majority of haematopoiesis in the skeletally mature adult. Failure of the spine can be observed as a loss of these functions; spinal deformity and neurological deficit. Clinically \"spine failure\" manifests like many other non-spinal pathologies in the elderly such as reduced mobility, falls and loss of independence. The management of these problems poses a challenge in this population. It is anticipated that, with an ageing population, the incidence of these issues will increase across medical specialties and so awareness of their presentation and treatment is significant. In this review, we aim to provide an overview of the diagnosis and current treatment of the most prevalent spine issues in the elderly including osteoporotic fracture, C2 fractures, myelopathy, Metastatic Spinal Cord Compression (MSCC) and lumbar stenosis.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 4","pages":"1-16"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980861","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":"Welcome to the NHS-Evaluating an International Medical Graduate Induction Programme.","authors":"Kwaku Baryeh, Syeda Tasfia Tarannum, Christina Cotzias","doi":"10.12968/hmed.2024.0621","DOIUrl":"https://doi.org/10.12968/hmed.2024.0621","url":null,"abstract":"<p><p><b>Aims/Background</b> International Medical Graduates (IMGs) form a vital part of the United Kingdom (UK) medical workforce. Despite the increasing reliance on IMGs, their experiences of working in the National Health Service (NHS) are poorer than those of UK graduates. We explore whether an induction programme can improve the early experiences of IMGs in the NHS. <b>Methods</b> At our London NHS Trust, we have established an IMG office to bring together the other acute Trusts in our sector to co-ordinate support for IMGs. We conduct a centralized, monthly, weeklong induction programme, based on the national guidance, to help orientate IMGs to working in the NHS. <b>Results</b> From our first 8 months, our workforce reported feeling welcomed, valued, more confident and, understanding the NHS better. <b>Conclusion</b> The initial experiences of IMGs in the NHS can be improved through tailored induction programmes. The longer-term impacts of such interventions require further investigation.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 4","pages":"1-14"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977303","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":"Acute Epstein-Barr Virus Hepatitis With Cholestatic Jaundice and Hyperferritinaemia: A Case Report.","authors":"Paul Njoku, Dorette Ngemoh, Shahriar Amin, Amit K J Mandal, Constantinos G Missouris","doi":"10.12968/hmed.2024.0919","DOIUrl":"https://doi.org/10.12968/hmed.2024.0919","url":null,"abstract":"<p><p>Epstein-Barr virus (EBV) is a common human pathogen often associated with infectious mononucleosis (IM), a typically self-limiting illness. EBV can affect the liver, with manifestations ranging from asymptomatic hepatitis to acute liver failure, particularly in immunocompromised individuals. Cholestatic jaundice and marked hyperferritinaemia are rare in EBV hepatitis, with ferritin levels correlating with disease severity. We report a case of EBV hepatitis in a 50-year-old immunocompetent man presenting with cholestatic jaundice, pharyngitis, cervical lymphadenopathy, and hyperferritinaemia (ferritin 5384 μg/L). Liver biochemistry showed elevated transaminases (alanine transaminase 190 U/L, aspartate transaminase 310 U/L), hyperbilirubinaemia (92 μmol/L), and cholestasis (alkaline phosphatase 902 U/L, gamma-glutamyl transferase 941 U/L). Atypical lymphocytes were seen on peripheral blood smear. Acute EBV infection was confirmed by the presence of EBV Immunoglobulin M (IgM) antibodies, and the patient was successfully managed in an ambulatory care setting with supportive treatment.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 4","pages":"1-11"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954671","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 Evolution of Reverse Shoulder Arthroplasty: A Review of Complications and the Rising Concern of Overuse.","authors":"Praveen Baskaran, Maxwell S Renna, Ashley I Simpson","doi":"10.12968/hmed.2024.0691","DOIUrl":"https://doi.org/10.12968/hmed.2024.0691","url":null,"abstract":"<p><p>Reverse shoulder arthroplasty (RSA) was initially developed to manage cuff tear arthropathy in elderly patients. It has since become increasingly popular due to its ability to provide pain relief, enhance stability, and improve function in various complex shoulder pathologies. This review examines the evolution of RSA, including its expanded indications for use, complications, and the rising concern of potential overuse. While RSA has shown significant benefits in selected cases, its growing application in younger and more active patients raises questions about long-term outcomes and durability. Complications such as instability, infection, baseplate failure, and scapular notching remain substantial challenges, particularly in revision cases. The article emphasises the need for cautious patient selection and evidence-based practice to avoid overuse and ensure optimal patient outcomes. Future high-quality research with extended follow-up is essential to better understand RSA's long-term efficacy and safety, particularly in diverse and younger patient populations.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 4","pages":"1-23"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953749","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}