British journal of hospital medicine最新文献

{"title":"Perioperative Functional Assessment.","authors":"Stephen Richard Waite, Duncan Hargreaves","doi":"10.12968/hmed.2024.0811","DOIUrl":"10.12968/hmed.2024.0811","url":null,"abstract":"<p><p>Perioperative functional assessment is used to inform perioperative risk estimation and to target interventions such as prehabilitation, particularly in higher-risk cohorts. There are a variety of measures used and practice is variable. UK national guidance recommends cardiopulmonary exercise testing (CPET) or alternative objective measures when reduced functional capacity is identified on screening.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 7","pages":"1-4"},"PeriodicalIF":1.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706387","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":"Serum Neuron-Specific Enolase and High-Sensitivity C-Reactive Protein Expression Levels and Their Clinical Significance in Patients With Alzheimer's Disease.","authors":"Zhangning Zhou, Feimin Zhao","doi":"10.12968/hmed.2025.0074","DOIUrl":"https://doi.org/10.12968/hmed.2025.0074","url":null,"abstract":"<p><p><b>Aims/Background</b> Alzheimer's disease (AD) is a degenerative disease of the central nervous system. Identifying effective and highly specific serum biomarkers is crucial for the early diagnosis and therapeutic monitoring of AD. This study aimed to explore the serum levels of neuron-specific enolase (NSE) and high-sensitivity C-reactive protein (hs-CRP) and their clinical significance in AD patients. <b>Methods</b> This retrospective study recruited 112 AD patients hospitalized between June 2021 and June 2023 as an AD group. For comparison, 80 healthy individuals who underwent physical examination during the same period were selected as the control group. The levels of NSE and hs-CRP were assessed using enzyme-linked immunosorbent assay (ELISA). The levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were also determined using ELISA. Furthermore, the severity of cognitive impairment was evaluated using the Mini-mental State Examination (MMSE) score, the Global Deterioration Scale (GDS), and the Clinical Dementia Rating Scale (CDR). Pearson correlation analysis was used to analyze the correlation between serum NSE and hs-CRP levels and disease-related indicators in the AD group, and the receiver operating characteristic (ROC) was used to analyze their diagnostic efficacy. <b>Results</b> The AD group exhibited significantly higher GDS and CDR scores, as well as serum NSE and hs-CRP levels, and significantly lower MMSE scores compared to the control group (<i>p</i> < 0.001). GDS and CDR scores, and serum NSE and hs-CRP levels were significantly higher in the moderate-to-severe group than in the mild group, and significantly lower MMSE scores (<i>p</i> < 0.001). Pearson correlation analysis revealed that serum NSE and hs-CRP levels were negatively correlated with MMSE scores in AD patients (<i>p</i> < 0.05) and were positively correlated with GDS and CDR scores (<i>p</i> < 0.05). ROC curve analysis showed that the serum NSE (area under the curve [AUC]: 0.856, 95% CI 0.787-0.925, <i>p</i> < 0.001) and hs-CRP (AUC: 0.728, 95% CI 0.631-0.825, <i>p</i> < 0.001) levels individually had significant diagnostic efficacy for AD; however, the combined assessment of their levels (AUC: 0.879, 95% CI 0.815-0.943, <i>p</i> < 0.001) demonstrated higher diagnostic efficacy than hs-CRP alone (<i>p</i> < 0.001). <b>Conclusion</b> Serum NSE and hs-CRP levels are closely associated with the cognitive function in AD patients, and their combined evaluation exhibits a higher diagnostic value.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 7","pages":"1-15"},"PeriodicalIF":1.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706392","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":"Reactivation of Epstein-Barr Virus Among Neurointensive Care Patients: A Prospective Observational Study.","authors":"Xiaojiao Xu, Jiahua Zhao, Xiaosa Yang, Rui Liu, Yan Wang, Yubao Ma, Mianwang He, Fei Yang, Jiatang Zhang","doi":"10.12968/hmed.2025.0152","DOIUrl":"10.12968/hmed.2025.0152","url":null,"abstract":"<p><p><b>Aims/Background</b> Approximately 90% of the population is seropositive for Epstein-Barr virus (EBV), and its reactivation has been reported to be associated with increased morbidity and mortality in critically ill patients. However, the clinical significance of EBV reactivation among patients in neurointensive care units (NICU) has rarely been investigated. This study aimed to demonstrate the association between EBV reactivation and clinical outcomes in neurocritically ill patients. <b>Methods</b> Clinical data were collected from 179 patients admitted to the NICU of the Chinese PLA General Hospital between October 2021 and January 2024. These patients were divided into two groups based on EBV infection status: the EBV reactivation group (<i>n</i> = 80) and the non-EBV reactivation group (<i>n</i> = 99). Gender, age, laboratory test results, diagnosis and functional prognosis were compared between the two groups to evaluate the clinical significance of EBV reactivation in neurocritically ill patients. <b>Results</b> A total of 179 patients were included in this study, of which 80 (44.69%) had EBV reactivation. Patients with EBV reactivation demonstrated higher levels of serum lactic dehydrogenase (32.50% versus 16.16%, <i>p</i> = 0.010), C-reactive protein (36.25% versus 21.21%, <i>p</i> = 0.026), immunoglobulin G (26.25% versus 12.12%, <i>p</i> = 0.015), cerebrospinal fluid leukocyte counts (67.50% versus 47.47%, <i>p</i> = 0.007), interleukin-6 (68.75% versus 42.42%, <i>p</i> < 0.001), and interleukin-10 (33.75% versus 17.17%, <i>p</i> = 0.010). There was no significant difference in 6-month mortality between patients with and without EBV reactivation (7.50% versus 3.03%, <i>p</i> = 0.302). However, patients with EBV reactivation exhibited poorer functional prognosis compared to those without (42.50% versus 26.26%, <i>p</i> = 0.022). Central nervous system lymphoproliferative disorders are more common in patients with EBV reactivation. <b>Conclusion</b> EBV reactivation is frequent among immunocompetent, neurocritically ill patients and is associated with poorer functional prognosis but not with increased 6-month mortality. Furthermore, EBV reactivation is associated with systemic inflammation.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 7","pages":"1-14"},"PeriodicalIF":1.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706390","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":"Exploration of the Therapeutic Efficacy of Azithromycin Sequential Therapy in Children With Mycoplasma Pneumonia.","authors":"Heng Huang, Fanglu Ji","doi":"10.12968/hmed.2025.0005","DOIUrl":"https://doi.org/10.12968/hmed.2025.0005","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Aims/Background&lt;/b&gt; Mycoplasma pneumonia (MP) is a relatively common infection in children. While sequential treatment with azithromycin is a commonly used regimen, therapeutic response varies substantially among children. This study aims to establish a column chart prediction model based on the clinical characteristics and pathogenic outcomes of Mycoplasma pneumonia in children, enabling accurate decision-making for clinical interventions. &lt;b&gt;Methods&lt;/b&gt; This retrospective study analysed the clinical data of 234 children with Mycoplasma pneumonia admitted to Cangnan Hospital of Wenzhou Medical University between March 2021 and October 2023. The data included general information, clinical symptoms, laboratory examination, and pathogenic profiles. The children were randomly divided into a training set (n = 164) and a validation set (n = 70) in a 7:3 ratio. Based on the efficacy of azithromycin sequential therapy, children in the training set were further divided into a poor efficacy group (n = 36) and a good efficacy group (n = 128). Independent risk factors for Mycoplasma pneumonia in the training set were identified using multiple logistic regression analysis. Furthermore, a column chart prediction model was constructed, and the model's performance was evaluated using receiver operating characteristic (ROC) curve analysis, followed by calibration curves. The predictive model was validated using an independent validation set, and decision curve analysis (DCA) assessed the model's clinical utility. &lt;b&gt;Results&lt;/b&gt; In the training set, 36 cases (21.95%) showed poor therapeutic effects, while 24 cases (34.29%) in the validation set exhibited poor treatment response. There was no significant difference in clinical data between the two groups (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). Univariate analysis showed significant differences (&lt;i&gt;p&lt;/i&gt; &lt; 0.05) across several factors, such as fever duration, cough severity, presence of pulmonary wet rales, white blood cell count, C-reactive protein (CRP) levels, Mycoplasma antibody titers, and Mycoplasma nucleic acid test findings among different treatment groups. Logistic regression analysis revealed prolonged fever duration, severe cough, presence of wet rales in the lungs, high white blood cell count, high CRP levels, high Mycoplasma antibody titers, and positive Mycoplasma nucleic acid test as independent risk factors of poor efficacy for azithromycin sequential treatment (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). The Concordance index (C-index) of the column chart model was 0.804 in the training set and 0.861 in the validation set. The average absolute errors of the predicted and actual values were 0.129 and 0.081, respectively. The Hosmer-Lemeshow test results were χ&lt;sup&gt;2&lt;/sup&gt; = 10.288, &lt;i&gt;p&lt;/i&gt; = 0.245 for the training set and χ&lt;sup&gt;2&lt;/sup&gt; = 7.922, &lt;i&gt;p&lt;/i&gt; = 0.441 for the validation set, suggesting good model calibration. The ROC curve analysis revealed that the area under the ROC curve (AUC) for predicting the poor efficacy of azithromyc","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":"144483189","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":"Improving Understanding, Recognition and Treatment for Men With Anorexia Nervosa.","authors":"James Downs, Clive Kelly","doi":"10.12968/hmed.2024.0643","DOIUrl":"https://doi.org/10.12968/hmed.2024.0643","url":null,"abstract":"<p><p><b>Aims/Background</b> Anorexia Nervosa (AN) in males is often overlooked due to the traditional perception of eating disorders as female concerns. Despite this, there has been an increased focus on male presentations. Research evidence, including concerns from people with lived experience, highlights specific risks and unmet clinical needs as a result of delayed help-seeking, inaccessible services, and treatment that does not account for men's needs. <b>Methods</b> Published research and personal narrative from an author with lived experience are combined to assess (1) existing evidence and gaps in knowledge and treatment for males with AN, and (2) solutions which may address challenges across research, policy, and clinical practice. <b>Results</b> There is an increased prevalence of AN amongst males, with most recent data from National Health Service (NHS) England showing a faster increase in hospitalisations amongst males compared with females. However, the quantity and quality of prevalence data and research into the drivers of this trend are severely lacking. The exclusion of males from clinical research has hindered efforts to assess the efficacy of current AN treatments, despite emerging evidence for males-specific symptoms and health impacts across biopsychosocial domains. These include more frequent use of excessive exercise, feelings of emasculation, neurodivergence, and specific physiological risks occurring at higher weights than females. These factors combine with under-resourced treatment provision which often feels exclusionary to males to create an increased risk of death and significant barriers to recovery. <b>Conclusion</b> Evidenced solutions for providing more timely recognition and effective treatment for males with AN are limited, emphasising the importance of further research. Present-day clinical practice needs to ensure the safe medical management of males with AN, taking an integrated approach to treatment that accounts for co-occurring conditions and minority status identities. Being more responsive to the needs of males with AN and removing the barriers to effective care can be aided by projects that collaborate with men with lived experience.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 6","pages":"1-15"},"PeriodicalIF":1.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483190","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":"Investigation of Knowledge, Attitudes, and Practices Related to Pulmonary Rehabilitation Among AECOPD Patients During the Transitional Period After Discharge and Analysis of Influencing Factors.","authors":"Tingting Zhu, Xiuyun Chen, Fang Li, Xinyu Zhu, Qing Wang, Junjun Yang, Jixiang Bo","doi":"10.12968/hmed.2025.0146","DOIUrl":"https://doi.org/10.12968/hmed.2025.0146","url":null,"abstract":"<p><p><b>Aims/Background</b> Pulmonary rehabilitation is widely recognized as one of the most effective treatment strategies to improve dyspnea, health status, and exercise endurance in patients with chronic obstructive pulmonary disease (COPD). However, participation in pulmonary rehabilitation among patients experiencing acute exacerbation of COPD remains suboptimal. Current research primarily focuses on the knowledge, attitude, and practice (KAP) of pulmonary rehabilitation among COPD patients during hospitalization or at home, with limited studies investigating the transitional period following discharge. This study aimed to investigate the KAP of pulmonary rehabilitation during the discharge transition period and identify the associated influencing factors, providing significant reference and guidance for improving the rehabilitation outcomes in COPD patients. <b>Methods</b> This cross-sectional study employed a convenience sampling method to recruit patients with acute exacerbation of COPD (AECOPD) treated at Jiangsu Subei People's Hospital between June 2023 and May 2024. Data collection instruments included a general data questionnaire, a COPD-specific pulmonary rehabilitation KAP questionnaire, and the Mini Nutrition Assessment-Short Form (MNA-SF). Univariate and multivariate linear regression analyses were conducted to identify factors influencing KAP of pulmonary rehabilitation in AECOPD patients during the discharge transition period. <b>Results</b> A total of 130 questionnaires were distributed, with 128 valid responses collected, yielding an effective response rate of 98.46%. The overall KAP score of AECOPD patients during the discharge transition period was 57.52 ± 8.92. Among the three dimensions, mean scores from the highest to the lowest were attitude (2.54 ± 0.29), practice (2.39 ± 0.36), and knowledge (2.15 ± 0.36). Univariate analysis revealed significant differences in KAP scores based on age, education level, monthly household income per capita, smoking history, degree of dyspnea, and nutritional status of AECOPD patients during the transitional discharge period (<i>p</i> < 0.05). Multivariate linear regression identified these same factors as significant influencers of KAP levels (<i>p</i> < 0.05). <b>Conclusion</b> The KAP of pulmonary rehabilitation among AECOPD patients during the discharge transition period is at a moderate level and is significantly influenced by age, educational level, monthly household income per capita, smoking history, degree of dyspnea, and nutritional status. Healthcare professionals should design targeted interventions based on these factors to help patients recognize the importance and necessity of pulmonary rehabilitation, establish correct attitudes about it, and improve compliance with it, thereby improving long-term outcomes.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 6","pages":"1-13"},"PeriodicalIF":1.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483192","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 Predictive Value of Serum miR-141-3p, Fibrinogen, and Prostate-Specific Antigen Levels for Bone Metastasis in Prostate Cancer.","authors":"Jianwen Li, Weining Wang","doi":"10.12968/hmed.2024.0881","DOIUrl":"https://doi.org/10.12968/hmed.2024.0881","url":null,"abstract":"<p><p><b>Aims/Background</b> Prostate cancer is a prevalent malignancy among men that frequently progresses to bone metastasis, significantly affecting prognosis and quality of life. Serum biomarkers such as miR-141-3p, fibrinogen (FIB), and prostate-specific antigen (PSA) are emerging as promising tools for early detection and personalised interventions for bone metastasis. This study investigated their predictive value for bone metastasis in prostate cancer. <b>Methods</b> Conducted from March 2018 to March 2023, this study included 100 prostate cancer patients monitored over time. All participants underwent radionuclide bone imaging combined with positron emission tomography-computed tomography (PET-CT). Patients who developed bone metastasis (32 cases) were classified as the metastasis group, while those without (68 cases) were categorised as the non-metastasis group. Additionally, a control group of 50 healthy volunteers was established for comparison. A retrospective analysis assessed serum miR-141-3p, FIB, and PSA levels across the three groups. Clinical data were analysed to identify factors influencing bone metastasis using univariate and multivariate analyses, after which a prediction model was created to evaluate its prognostic value. <b>Results</b> Serum levels of miR-141-3p, FIB, and PSA were significantly different among the three groups, with the highest levels in the metastasis group, followed by the non-metastasis group, and the lowest in the control group (<i>p</i> < 0.05). Both univariate and multivariate analyses confirmed that these serum biomarkers significantly influenced the occurrence of bone metastasis. The combined predictive model demonstrated high clinical value for assessing the risk of bone metastasis in prostate cancer, with an area under the curve (AUC) of 0.923 (95% confidence interval [CI]: 0.868-0.979, <i>p</i> < 0.05). <b>Conclusion</b> Serum levels of miR-141-3p, FIB, and PSA are elevated in prostate cancer patients, particularly those with bone metastasis. The predictive model utilising these biomarkers effectively forecasts the likelihood of bone metastasis.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 6","pages":"1-12"},"PeriodicalIF":1.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483209","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":"Combined Effects of Donepezil and Memantine on Behavioral and Psychological Symptoms, Cognitive Function, and Daily Living Abilities in Patients With Alzheimer's Disease.","authors":"Hongyan Tu, Si Zhou, Jixin Lin","doi":"10.12968/hmed.2024.1037","DOIUrl":"https://doi.org/10.12968/hmed.2024.1037","url":null,"abstract":"<p><p><b>Aims/Background</b> Combined with memantine, donepezil has a beneficial impact on the treatment of moderate to severe Alzheimer's disease (AD), but it can potentially increase the risk of adverse events. The aim of this study is to compare the effects of low-dose and high-dose donepezil combined with memantine on the behavioral and psychological symptoms, cognitive function, and daily living abilities of patients with moderate to severe AD, and to explore their safety. <b>Methods</b> This retrospective study includes 106 AD patients who received treatment in the Third People's Hospital of Fuyang from January 2022 to January 2024. The patients were grouped according to treatment regimen: patients receiving low-dose donepezil (5 mg/day) combined with memantine were included in the low-dose group (<i>n</i> = 45), and those receiving high-dose donepezil (10 mg/day) combined with memantine were included in the high-dose group (<i>n</i> = 61). The assessment results of behavioral and psychological symptoms, cognitive function, daily living ability, quality of life, sleep quality, as well as the occurrence of adverse reactions during treatment were obtained from electronic medical records for the two groups of patients before and after 24 weeks of treatment, and were compared using appropriate statistical tests. <b>Results</b> After 24 weeks of treatment, the scores of neuropsychiatric inventory (NPI) and behavioral pathology in Alzheimer's disease rating scale (BEHAVE-AD) were similar between the two groups (<i>p</i> > 0.05). The scores of Mini-Mental State Examination (MMSE) and Alzheimer's disease assessment scale-cognitive section (ADAS-Cog) were similar between the two groups (<i>p</i> > 0.05). The scores of activities of daily living (ADL) were comparable between the two groups (<i>p</i> > 0.05), and the low-dose group had significantly higher quality of life-Alzheimer's disease (QOL-AD) scores compared to the high-dose group (<i>p</i> < 0.05). The Pittsburgh sleep quality index (PSQI) scores of patients in the high-dose group were significantly higher than those before treatment and those in the low-dose group (<i>p</i> < 0.05). There was no statistically significant difference in PSQI scores between the low-dose group before and after treatment (<i>p</i> > 0.05). During the treatment period, the total incidence of adverse reactions in the low-dose group was significantly lower than that in the high-dose group (11.11% vs. 27.87%, <i>p</i> < 0.05). <b>Conclusion</b> Both 5 mg/day or 10 mg/day donepezil in combination with memantine holds the potential to improve behavioral and psychological symptoms, cognitive function and daily living abilities in patients with moderate-to-severe AD. In addition, high doses of donepezil may lead to decreased sleep quality in patients, increased risk of adverse reactions, and less improvement in quality of life than low doses.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 6","pages":"1-15"},"PeriodicalIF":1.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483183","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":"Anaesthetic Management of Patients With Do-Not-Attempt Resuscitation Orders: A Case for and Against Suspension During Anaesthesia and Surgery.","authors":"Jieling Jacqueline Wu","doi":"10.12968/hmed.2024.0966","DOIUrl":"10.12968/hmed.2024.0966","url":null,"abstract":"<p><p>Managing patients with Do-Not-Attempt Resuscitation (DNAR) orders during anaesthesia and surgery presents an ethical dilemma: should DNAR orders be temporarily suspended or continued to allow for essential, reversible interventions? This paper examines arguments for and against suspension, emphasising the need for preoperative discussions to balance patient autonomy with perioperative safety and delivery of adequate care.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 6","pages":"1-5"},"PeriodicalIF":1.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483088","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 Role of Novel Small Molecule Drugs in the Management of Inflammatory Bowel Disease.","authors":"Nadia Eden, Elizabeth Gaunt, Elaine Ming San Ong, Kassem Sharif, Christian Selinger","doi":"10.12968/hmed.2024.0798","DOIUrl":"https://doi.org/10.12968/hmed.2024.0798","url":null,"abstract":"<p><p>Treatment algorithms have traditionally been based on biological therapy when conventional therapy was not successful in controlling inflammatory bowel disease (IBD). Novel small molecule drugs (SMDs) for IBD include the Janus Kinase (JAK) inhibitors Tofacitinib, Filgotinib and Upadactinib and the sphingosine-1 phosphate (S1P) inhibitors Ozanimod and Etrasimod. SMDs have advantages over biologics, such as oral administration, lack of immunogenicity, and rapid onset of action. All agents are effective in treating ulcerative colitis, while Upadactinib is the only SMD for Crohn's disease. There is growing interest in the use of JAK inhibitors for acute severe colitis. However, safety profiles are distinct from biologics. Clinicians need to be aware of the need for additional lipid monitoring for JAK inhibitors. S1P inhibitors require pre-treatment electrocardiograms to reduce the risk of bradycardia and retinal exams at least in high-risk patients to avoid macular oedema. In this review we highlight the key evidence on efficacy and safety for general hospital physicians.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 6","pages":"1-14"},"PeriodicalIF":1.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483210","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}