British journal of hospital medicine最新文献

{"title":"Cauda Equina Syndrome-A 2025 Narrative Review.","authors":"Andreas Conte, Rishabh Jain, Aranghan Lingham, Marion Mueller","doi":"10.31083/BJHM52970","DOIUrl":"https://doi.org/10.31083/BJHM52970","url":null,"abstract":"<p><p>Back pain is a common presentation in healthcare settings. The most serious cause is cauda equina syndrome (CES), a surgical emergency caused by acute compression of the lumbosacral nerve roots. In the UK, diagnosis requires a thorough clinical examination and emergency magnetic resonance imaging (MRI). Once confirmed on imaging, definitive treatment is urgent surgical decompression usually within 24 hours. Delays in diagnosis or treatment can lead to life-changing consequences including bowel and bladder incontinence, sexual dysfunction, lower limb paralysis and chronic pain. This narrative review provides a 2025 update to the 2023 review published in this journal. It covers the anatomy, epidemiology, aetiology, pathophysiology, classification, clinical presentation, examination, investigations, differentials, treatment, and management of CES. Major updates are based on the new UK 2025 Getting It Right First Time (GIRFT) interactive pathway. Important changes include: (1) the standardisation and timing of red flag symptoms, (2) the use of bladder scans as a rule-in rather than rule-out investigation, (3) aim for 24-hour MRI local diagnostic capabilities with standardized imaging sequences and proximal scanning in absence of cauda equina compression, (4) declassification of CES, (5) emphasis on all patients with established CES to receive urgent decompressive surgery as National Confidential Enquiry into Patient Outcome and Death (NCEPOD) level 1/2. This review uses the authors' experience of suspected CES pathway improvement to propose a pathway for the management of suspected CES in the emergency department at district general hospitals without 24-hour MRI capability based on the most recent national GIRFT guidelines.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 4","pages":"52970"},"PeriodicalIF":1.8,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762854","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 Efficacy of Continuous Nursing Plus Shared Outpatient Care on Remission of Type 2 Diabetes Mellitus.","authors":"Chunru Zheng, Xiaohong Chen","doi":"10.31083/BJHM49861","DOIUrl":"https://doi.org/10.31083/BJHM49861","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims/background: &lt;/strong&gt;Type 2 diabetes mellitus (T2DM) is one of the most prevalent chronic metabolic disorders with a gradually increasing global incidence, imposing healthcare burdens on patients. Effective long-term management strategies are crucial for improving patient outcomes and promoting disease remission. Therefore, this study aims to evaluate the efficacy of continuing care services combined with the shared outpatient management model in patients with T2DM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study included 119 patients with T2DM who received treatment and follow-up consultation at Cangnan Hospital of Wenzhou Medical University between January 2024 and December 2024. According to the different nursing methods used, patients were divided into a control group (n = 60, conventional T2DM management) and an observation group (n = 59, conventional T2DM management combined with continuous nursing and shared outpatient management). Continuing care service refers to follow-up and health education that extends from the hospital to the home. At the same time, the shared outpatient management model involves regular group visits that facilitate experience sharing and peer support among patients under multidisciplinary guidance. Clinical indicators, such as fasting blood glucose, 2-hour postprandial blood glucose, fasting C-peptide, 2-hour postprandial C-peptide, body mass index (BMI), glycated hemoglobin A1c (HbA1c), and disease remission rate, were compared between the two groups. Self-management behavior skills were evaluated across five key domains, including exercise, diet, foot care, blood glucose monitoring, and medication adherence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;At 3 and 6 months after intervention, patients in the observation group demonstrated significant improvements in several metabolic indicators compared to those in the control group. Specifically, fasting blood glucose and 2-hour postprandial blood glucose were significantly decreased in the observation group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Furthermore, fasting C-peptide, 2-hour postprandial C-peptide, BMI, and HbA1c were significantly improved in the observation group at 3- and 6-month follow-up time points (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). The self-management behavior assessment revealed that the total median score and scores for exercise, diet, foot care, blood glucose monitoring, and medication compliance were all significantly higher in the observation group than in the control group (all &lt;i&gt;p&lt;/i&gt; &lt; 0.05). The diabetes remission rate was 20.339% (12/59) in the observation group, which was significantly higher than 6.667% (4/60) in the control group (&lt;i&gt;p&lt;/i&gt; = 0.029).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The continuing care service combined with a shared outpatient management model can effectively improve the blood glucose control, islet function, and metabolic indicators in T2DM patients, and enhance their self-management ability, highlighting a positive clinical value o","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 4","pages":"49861"},"PeriodicalIF":1.8,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147762877","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":"Platelet-To-Lymphocyte Ratio and 28-Day Survival in Critically Ill Patients With Pulmonary Hypertension: Insights From a MIMIC-IV Retrospective Analysis.","authors":"Dedong Ge, Zhengang Zhang","doi":"10.31083/BJHM52966","DOIUrl":"https://doi.org/10.31083/BJHM52966","url":null,"abstract":"<p><strong>Aims/background: </strong>Existing pulmonary arterial hypertension (PAH) risk stratification, based on hemodynamics and functional parameters, is often inadequate in critical illness. The platelet-to-lymphocyte ratio (PLR), reflecting inflammatory and thrombotic pathways, may enhance outcome prediction. This study aimed to determine the prognostic value of PLR for 28-day mortality in critically ill PAH patients, evaluate nonlinear thresholds, and validate predictive performance using machine learning.</p><p><strong>Methods: </strong>A retrospective cohort of 1512 PAH patients was extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) v3.0 database (2008-2022). PLR was derived from admission hematologic parameters. Multivariable Cox regression, restricted cubic spline (RCS) models, and machine learning algorithms were employed to assess associations between PLR and mortality.</p><p><strong>Results: </strong>RCS analysis revealed a U-shaped relationship with mortality, identifying critical thresholds: PLR <67.32 was associated with reduced risk, while PLR >75.92 indicated an abrupt risk escalation (adjusted hazard ratio (HR) = 2.261, 95% confidence interval (CI): 1.053-4.854, <i>p</i> = 0.014). Machine learning models incorporating PLR achieved moderate discrimination (concordance index [C-index] = 0.700). Subgroup analyses confirmed consistent prognostic value across age, sex, chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD) subgroups (all <i>p</i>-interaction > 0.05).</p><p><strong>Conclusion: </strong>PLR represents an independent predictor of short-term mortality in critically ill PAH patients, with nonlinear thresholds offering actionable risk stratification. Integration of PLR into prognostic models may strengthen early risk assessment and guide timely interventions in critical care settings.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 4","pages":"52966"},"PeriodicalIF":1.8,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147763034","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":"Speeding Up Clinical Skills Development in Accelerated Undergraduate Medical Education: Current Insights From Cognitive Science.","authors":"John Sandars, Dario Cecilio-Fernandes","doi":"10.31083/BJHM52967","DOIUrl":"https://doi.org/10.31083/BJHM52967","url":null,"abstract":"<p><p>There is an increasing need to speed up essential clinical skills development in accelerated undergraduate medical education, but there are concerns about developing the required competency in these skills. The aim of this article is to provide insights from cognitive science, with a variety of practical evidence-based strategies for speeding up clinical skills development that have a unique focus on both maximising skill acquisition and retention, with minimisation of their decay over time. These strategies include the need to ensure readiness for training and to provide opportunities for regular practice with assessment and spacing across a variety of situations.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 4","pages":"52967"},"PeriodicalIF":1.8,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147763038","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":"Intelligent Nursing Interventions Guided by the Integrated Theory of Health Behavior Change for Preventing Deep Vein Thrombosis in Critically Ill Patients.","authors":"Chengwei Lv, Mengyang Li, Qian Li, Pan Xu, Yuqian Zheng, Hui Wang, Jing Huang","doi":"10.31083/BJHM52246","DOIUrl":"https://doi.org/10.31083/BJHM52246","url":null,"abstract":"<p><strong>Aims/background: </strong>Deep vein thrombosis (DVT) is a life-threatening complication in critically ill patients, and conventional prevention strategies are often hindered by poor adherence. This study aims to evaluate the clinical effectiveness of intelligent nursing interventions based on the Integrated Theory of Health Behavior Change (ITHBC) in preventing DVT among critically ill patients.</p><p><strong>Methods: </strong>A retrospective study was conducted on 280 critically ill patients admitted to the intensive care unit of The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University between January 2022 and December 2024. Patients were divided into a control group (n = 138), which received routine care, or an observation group (n = 142), which received additional ITHBC-based intelligent nursing interventions. The incidence of DVT, nursing adherence, hematological parameters (D-dimer, prothrombin time (PT), activated partial thromboplastin time (APTT)), complications, and patient satisfaction were compared between groups.</p><p><strong>Results: </strong>The incidence of DVT was significantly lower in the observation group than in the control group (7.7% vs. 18.1%, <i>p</i> < 0.05). Nursing adherence indicators, including turning frequency, limb exercise compliance, and mechanical prophylaxis use, were markedly higher in the observation group (<i>p</i> < 0.05). After intervention, D-dimer levels decreased significantly in the observation group (<i>p</i> < 0.05), while no significant change was observed in PT or APTT (<i>p</i> > 0.05). No significant differences were found in complication rates (<i>p</i> > 0.05). Patient satisfaction was significantly higher in the observation group (96.5% vs. 87.7%, <i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>ITHBC-guided intelligent nursing interventions effectively reduced the incidence of DVT, improved patient adherence and satisfaction, and demonstrated strong safety and clinical applicability in critically ill patients.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 3","pages":"52246"},"PeriodicalIF":1.8,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580476","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":"Three Decades of Research on Congenital Dermatological Diseases (1995-2024): A Bibliometric Analysis of Global Trends and Insights.","authors":"Ahmad Assiri","doi":"10.31083/BJHM52243","DOIUrl":"https://doi.org/10.31083/BJHM52243","url":null,"abstract":"<p><strong>Aims/background: </strong>Congenital dermatological diseases (CDD), a complex group of inherited or developmental skin disorders, pose challenges in their management owing to their genetic nature, clinical variability, and socioeconomic impact. Despite the growing body of research, gaps remain in our understanding of research trends, collaborative networks, and translational advancements in this field. This bibliometric study evaluates CDD research over the last three decades (1995-2024) to identify its key developments and Emerging Themes.</p><p><strong>Methods: </strong>A comprehensive bibliometric analysis was conducted using the Scopus database (October 2024), owing to its extensive peer-reviewed coverage and reliable citation tracking. A multistep search strategy was used to refine the dataset and ensure its relevance. Bibliometrix and VOSviewer were used for quantitative and network-based analyses, highlighting publication trends, author impacts, and thematic structures.</p><p><strong>Results: </strong>CDD research expanded significantly between 1995 and 2024, with 17,984 publications and the majority being published in the last decade. The average age of the documents was 11.6 years, reflecting sustained engagement. Author metrics (h-index, g-index, and m-index) identified leading contributors, while co-authorship and collaboration networks revealed global research dynamics. The co-word analysis outlined the evolving thematic framework, including trends in diagnostic tools and therapeutic innovations.</p><p><strong>Conclusion: </strong>This study provided a structured overview of CDD research and identified critical gaps in its diagnosis, treatment strategies, and interdisciplinary collaboration. Understanding these trends can inform clinical decision-making, enhance early diagnosis, and support the development of targeted therapies, ultimately improving patient outcomes.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 3","pages":"52243"},"PeriodicalIF":1.8,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580521","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 Update on Therapeutic Strategies for Influenza.","authors":"Nisha Patel, Temi Lampejo","doi":"10.31083/BJHM50146","DOIUrl":"https://doi.org/10.31083/BJHM50146","url":null,"abstract":"","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 3","pages":"50146"},"PeriodicalIF":1.8,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580633","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":"If It Is Not Immunoglobulin E-Mediated Allergy, What Is It?","authors":"Sarah Louise Johnston, Ricardo Madrigal-Burgaleta","doi":"10.31083/BJHM52244","DOIUrl":"https://doi.org/10.31083/BJHM52244","url":null,"abstract":"<p><p>The term \"allergy\" is often used ambiguously, frequently applied to a broad spectrum of immune and non-immune reactions, which can create confusion in clinical practice. Whilst there is some controversy, the term \"allergy\" is now primarily reserved for describing immunoglobulin E (IgE)-mediated (Type I) hypersensitivity. Accurate diagnosis requires distinguishing Type I reactions from their mimics, especially given the clinical overlap with non-IgE-mediated conditions. This review focuses on Type I hypersensitivity, detailing its immunopathogenesis, clinical features, and diagnostic strategies, with particular emphasis on the role of serum tryptase in confirming mast cell activation. A comprehensive clinical history is crucial to distinguishing IgE-mediated allergy from its mimics, focusing on timing, symptom reproducibility, and the identification of potential triggers. Cofactors like non-steroidal anti-inflammatory drugs, alcohol, and exercise may exacerbate reactions, complicating diagnosis. Prompt intramuscular adrenaline administration is essential in cases of anaphylaxis, while patient education and specialist referral are key to long-term management. The review also examines conditions that may mimic Type I reactions, such as chronic spontaneous urticaria or isolated angioedema. In addition to classical allergy, clinicians must consider conditions such as hereditary angioedema, neuroendocrine tumours, and drug-induced pseudoallergic reactions. Recognising these mimics is vital to prevent misdiagnosis, ensuring patient safety, and avoiding unnecessary allergy labels or suboptimal management. This article provides a structured framework for evaluating suspected allergy, enhancing diagnostic accuracy, and guiding appropriate, patient-centred care across allergy and related clinical disciplines.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 3","pages":"52244"},"PeriodicalIF":1.8,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580623","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":"Dermatology Emergencies in Skin of Colour Patients.","authors":"Rosemary Akinbisehin, Chiedu Ufodiama, Mary Sommerlad","doi":"10.31083/BJHM52245","DOIUrl":"https://doi.org/10.31083/BJHM52245","url":null,"abstract":"","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 3","pages":"52245"},"PeriodicalIF":1.8,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580644","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":"Implementation Strategies for Gamification in Pharmacy Clinical Skills Education: A Review and Practical Implications.","authors":"Bo Han, Yulin Zhao, Nur Wahida Zulkifli","doi":"10.31083/BJHM51832","DOIUrl":"https://doi.org/10.31083/BJHM51832","url":null,"abstract":"<p><p>Gamification has emerged as an innovative pedagogical strategy with considerable potential to enhance competency development in health professions education. However, its systematic integration into pharmacy clinical skills training remains underexplored. This review systematically synthesises current evidence on the design principles, theoretical foundations, and educational outcomes of gamified learning in pharmacy curricula. Particular emphasis was placed on its influence on learner motivation, knowledge retention, clinical reasoning, and interprofessional collaboration. A comprehensive literature search encompassing pharmacy, medical, and health sciences education was conducted to identify core components and best practice frameworks for effective gamification. Evidence indicates that well-designed gamification models can significantly improve learner engagement and promote the meaningful integration of theoretical knowledge with authentic clinical practice. Nonetheless, several barriers, including limited instructional resources, inadequate faculty expertise, underdeveloped evaluation tools, and ethical concerns related to data security and digital equity, continue to constrain widespread implementation. This review proposes actionable strategies such as precise alignment of gamification elements with course objectives, structured faculty capacity building, enhancement of technological infrastructure, adoption of multidimensional evaluation systems, and strengthened interprofessional collaboration. Future research should focus on adaptive, artificial intelligence (AI)-driven gamification approaches, evaluate their long-term impacts on clinical competence, and develop standardised, evidence-based guidelines for sustainable integration, as outlined in the proposed frameworks within this review.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 3","pages":"51832"},"PeriodicalIF":1.8,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580638","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}