British journal of hospital medicine最新文献

{"title":"The 4D Model: Rehabilitating Unrealistic Medicine.","authors":"Edwin C Jesudason","doi":"10.12968/hmed.2024.0845","DOIUrl":"https://doi.org/10.12968/hmed.2024.0845","url":null,"abstract":"<p><p>Managing the symptoms of long-term conditions presents a challenge to patients, clinicians and health systems worldwide. In seeking to explain such symptoms, diagnostic models tend to be 2D, and hence unrealistic if reliant narrowly on just <i>Disease</i> processes or <i>Drug</i> effects. Here, I argue that symptoms which appear refractory to pills or procedures can nonetheless be rehabilitated, if a 2D <i>prognostic</i> model is used in addition. <i>Distress</i> and <i>Discouragement</i> are reproducible syndromes defined as arising from prognostic fears for the proper function and integrity of <i>body</i> and <i>self</i>, respectively. Often, these attract just symptomatic treatment, being medicated as anxiety and depression and/or diverted toward talking therapies. But, when managed in isolation, this is just another unrealistic 2D model, analogous to divorcing nausea from chemotherapy or thromboprophylaxis from surgery. Instead, with changes to our clinical manner, a more realistic medicine can diagnose, for each person, how specific elements from their diagnostic model (<i>Disease</i>, <i>Drugs</i>) drive complications in their prognostic one (<i>Distress</i>, <i>Discouragement</i>). Rather than perpetuate a succession of 2D appointments, a holistic dialogue using the 4D model helps patients to formulate how their symptoms fit together. This can support them to soothe and triage their everyday symptom experience. Confidence with the 4D model can then help patients and clinicians advocate for treatments that are better targeted and integrated. This review facilitates clinical use of the 4D model, with example cases and lay explanations-plus its further theoretical development, using the fit with philosopher Elizabeth Barnes' latest accounts of health.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 4","pages":"1-20"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980364","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":"A Systematic Review of Mortality Risk Prediction Models for Idiopathic Pulmonary Fibrosis.","authors":"Yingxu Wu, Pin Li, Mei Wang, Yongming Liu, Jiapeng Leng, Xuetao Li, Xiaodong Lv, Lijian Pang, Ningzi Zang","doi":"10.12968/hmed.2024.0934","DOIUrl":"https://doi.org/10.12968/hmed.2024.0934","url":null,"abstract":"<p><p><b>Aims/Background</b> Idiopathic pulmonary fibrosis (IPF) is associated with an increased mortality risk. However, the factors that contribute to this risk remain unknown. This study aimed to systematically review existing predictive models for IPF-related mortality and to evaluate prognostic factors associated with patient outcomes. <b>Methods</b> A comprehensive literature search was conducted on PubMed, Cochrane Library, Web of Science, and Embase for studies on IPF mortality risk prediction models published between 1 January 1984 and 15 November 2024. Two independent reviewers screened, extracted, and cross-checked the data. The risk of bias and model applicability were also evaluated. <b>Results</b> A total of 17 risk prediction models were identified. The area under the receiver operating characteristic (ROC) curve (AUC) ranged from 0.728 to 0.907, while the model validation results ranged from 0.750 to 0.920. The concordance index (C-index) of 10 studies was more than 0.7, indicating good predictive performance. This study encompassed a total of 17 risk prediction models incorporating between 3 and 8 combined prognostic variables, with the most frequently included predictors being forced vital capacity as a percentage of the predicted value (FVC%pred), carbon monoxide diffusion capacity as a percentage of the predicted value (DLCO%pred), gender, age, six-minute walk test (6MWT) results, and dyspnea severity. <b>Conclusion</b> Current IPF mortality risk prediction models remain in an exploratory phase, with a generally high risk of bias. Furthermore, the lack of external validation in some models limits their generalizability. Future research should focus on improving the applicability of the model to enhance clinical application.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 4","pages":"1-22"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980376","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":"Innovation Cultivation: When Did We Lose the Art of Innovation and How Can We Get It Back?","authors":"Ffion Byrne, Shantanu Kundu","doi":"10.12968/hmed.2024.0971","DOIUrl":"https://doi.org/10.12968/hmed.2024.0971","url":null,"abstract":"<p><p>The National Health Service (NHS) has a rich history of innovation, producing life-changing advancements such as <i>in vitro</i> fertilisation (IVF) and portable defibrillators. However, recent years have seen a decline in its innovative capacity, hindering the ability to tackle emerging challenges like antimicrobial resistance. This article explores the barriers impeding innovation within the NHS and highlights innovation driving initiatives such as the establishment of innovation hubs. By fostering a culture that embraces creative thinking and collaboration, the NHS can reclaim its innovative spirit and deliver transformative solutions for the future of healthcare.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 4","pages":"1-5"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977300","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":"A Pathological Prediction Model and Scoring System Including Endoscopic Signs for Duodenal Papilla Neoplasms: A Retrospective Study.","authors":"Yuting Qiu, Yi Yang, Xinwei Qiao, Haobo Li, Peng Li, Jing Wu, Shutian Zhang","doi":"10.12968/hmed.2024.0585","DOIUrl":"https://doi.org/10.12968/hmed.2024.0585","url":null,"abstract":"<p><p><b>Aims/Background</b> The application value of endoscopic ultrasound (EUS) in diagnosing duodenal papilla neoplasms (DPNs) remains underexplored. This study aims to evaluate the role of EUS and other clinical indicators in differentiating between benign and malignant DPNs and to establish a pathological prediction model for DPNs. <b>Methods</b> Clinical and imaging data of DPNs patients were collected. Least absolute shrinkage and selection operator (LASSO) regression was employed to screen independent predictors. Patients were divided into training and test cohorts. Univariate and multivariate logistic regression analyses were performed. A nomogram was developed alongside a scoring system, both of which were validated using the test cohort. <b>Results</b> A total of 56 benign and 95 malignant DPNs cases were included. Logistic regression analysis identified age, magnetic resonance imaging (MRI), EUS-measured size, echo intensity and papilla appearance as independent predictors of pathological diagnosis. The nomogram demonstrated a C-index of 0.876, with area under the curve (AUC) values of 0.88 and 0.82 in the training and test cohorts, respectively. The scoring system performed well, with an optimal cutoff value of 14 points. <b>Conclusion</b> Age, MRI, EUS size and papilla appearance are independent risk factors for malignant DPNs. EUS may have extraordinary effects in DPNs differential diagnosis.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 4","pages":"1-18"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060994","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":"Comparison of Direct Aspiration With SOFIA Distal Access Catheter and Solitaire Retrievable Stent-Induced Thrombolysis for the Treatment of Acute Ischemic Stroke.","authors":"Richeng Zhou, Yuqi Su, Yangbo Li, Yunping Li, Rongcai Liu, An Wu, Yongming Xu","doi":"10.12968/hmed.2024.0799","DOIUrl":"https://doi.org/10.12968/hmed.2024.0799","url":null,"abstract":"<p><p><b>Aims/Background</b> Direct aspiration with soft torqueable catheter optimized for intracranial access (SOFIA) distal access catheter and Solitaire retrievable stent-induced thrombolysis are two commonly used interventional therapy methods in acute ischemic stroke (AIS). Despite their distinctive advantages, these surgical methods need to be further studied and compared to help with treatment selection. Therefore, this study aims to analyze the distinct effects of SOFIA distal access catheter direct aspiration and Solitaire retrievable stent-induced thrombolysis in the treatment of AIS. <b>Methods</b> The clinical data of 312 patients with AIS admitted to The Quzhou Affiliated Hospital of Wenzhou Medical University from January 2019 to March 2024 were collected and analyzed retrospectively. All patients were treated with thrombectomy stents. According to different types of stents utilized, 150 patients treated with SOFIA distal access catheter direct aspiration were grouped under the SOFIA group, while 162 patients treated with Solitaire retrievable stent-induced thrombolysis were categorized in the Solitaire group. The success rate and recanalization rate following thrombolysis were compared between the two groups. The scores of National Institutes of Health Stroke Scale (NIHSS), Glasgow Coma Scale (GCS) and modified Barthel Index (MBI) before and 3 months after treatment were compared. The complications, recurrence rate and mortality of the two groups were compared 3 months after operation. <b>Results</b> There was no statistically significant difference in the success rate of mechanical thrombectomy between the two groups after treatment (<i>p</i> > 0.05), while the recanalization rate in the SOFIA group was significantly higher than that in the Solitaire group (<i>p</i> < 0.05). After treatment, the NIHSS scores of the two groups of patients were lower than before treatment, while the scores of GCS and MBI were higher than before treatment (<i>p</i> < 0.05), but there was no significant difference in these scores between the two groups (<i>p</i> > 0.05). Symptomatic intracranial hemorrhage, subarachnoid hemorrhage, arterial perforation, distal thrombosis or emboli occurred in both groups after treatment, without significant differences between the two groups (<i>p</i> > 0.05). The recurrence rate in the SOFIA group was significantly lower than that in the Solitaire group after 3 months of follow-up (<i>p</i> < 0.05), and there was no significant difference in mortality between the two groups (<i>p</i> > 0.05). <b>Conclusion</b> The SOFIA distal access catheter direct aspiration shows significant efficacy in the treatment of AIS by improving the vascular recanalization rate of AIS and reducing the recurrence rate.</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":"143963269","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":"Adverse Cardiovascular Effects of Psychotropic Medications.","authors":"Vitaliy Androshchuk, Natalie Montarello, Ronak Rajani","doi":"10.12968/hmed.2024.0773","DOIUrl":"https://doi.org/10.12968/hmed.2024.0773","url":null,"abstract":"<p><p>Cardiovascular disease is the leading cause of death in people with serious mental health illnesses, including schizophrenia, major depression and bipolar disorder. The adverse cardiac risk profile of this population is related to the complex interplay between biological, patient-specific and healthcare system factors. A variety of psychotropic medications used to treat these conditions can in themselves produce cardiovascular side effects. This includes autonomic dysfunction, malignant ventricular arrhythmias, heart muscle disorders and vascular thromboembolic events, some of which have been linked with sudden cardiac death. As a result, there is a pressing need for physicians to be aware of the cardio-toxicity associated with psychotropic medication use. In this review, we summarise the main effects of psychotropic drugs on the cardiovascular system and the current recommendations for evaluation and continual monitoring of the many and rapidly increasing number of patients receiving psychotropic pharmacotherapy.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 4","pages":"1-18"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964768","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 Impact of Nurse-Led Motivational Interviewing Based on the Transtheoretical Model on Benign Paroxysmal Positional Vertigo Patients: A Retrospective Study.","authors":"Haiyan Wang, Fang Wang, Liru Ren, Yinghui Li","doi":"10.12968/hmed.2024.0692","DOIUrl":"https://doi.org/10.12968/hmed.2024.0692","url":null,"abstract":"<p><p><b>Aims/Background</b> Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder with a high recurrence rate. Motivational interviewing (MI), a patient-centred communication technique, combined with the transtheoretical model (TTM), may be crucial in promoting behavioural changes and reducing recurrence in BPPV patients. Therefore, this study evaluated the effects of nurse-led MI based on the TTM on rehabilitation outcomes and recurrence rates in BPPV patients. <b>Methods</b> This retrospective cohort study included 1143 BPPV patients treated at Beijing Shijitan Hospital, Capital Medical University, China, between October 2021 and April 2024. The study group (n = 510) received MI based on the TTM in addition to standard BPPV treatment, while the control group (n = 633) received only standard treatment. Data were collected on patients' quality of life (using the Dizziness Handicap Inventory [DHI]), self-care ability (using the Exercise of Self-Care Agency [ESCA] scale), self-efficacy (using the General Self-Efficacy Scale [GSES]), health-promoting lifestyle (using the Health-Promoting Lifestyle Profile [HPLP]), and recurrence rate over the one month of treatment. <b>Results</b> We observed that the study group and the control group were comparable in terms of age, education level, occupational category, underlying chronic diseases other than hyperlipidemia, and there were no significant differences in baseline characteristics (<i>p</i> > 0.05). Post-intervention, the study group demonstrated significantly lower DHI scores, indicating improved quality of life and reduced functional disability (<i>p</i> < 0.001). Self-care ability (<i>p</i> < 0.001) and self-efficacy (<i>p</i> < 0.001) were substantially higher in the study group. HPLP, particularly for physical activity, was significantly enhanced. The recurrence rate was significantly lower in the study group (7.06% vs 12.48%, <i>p</i> = 0.002), with group allocation emerging as an independent predictor of recurrence. Logistic regression analysis confirmed that group allocation was an independent predictor of recurrence (<i>p</i> = 0.002). <b>Conclusion</b> Nurse-led MI based on the TTM significantly improves the quality of life, self-care ability, self-efficacy, and health-promoting lifestyle in BPPV patients while effectively reducing recurrence rates. This approach demonstrates potential clinical significance in the long-term management of BPPV patients.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 4","pages":"1-21"},"PeriodicalIF":1.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982645","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":"Construction and Value Analysis of a Prognostic Assessment Model Based on Radiomics and Genetic Data for Colorectal Cancer.","authors":"Yongna Cheng, Ziming Feng, Xiangming Wang","doi":"10.12968/hmed.2024.0620","DOIUrl":"10.12968/hmed.2024.0620","url":null,"abstract":"<p><p><b>Aims/Background</b> Colorectal cancer (CRC) is one of the major global health problems, with high morbidity and mortality, underscoring the need for new diagnostic and prognostic tools. Therefore, this study aims to evaluate the significance of integrating radiomics with genetic data in CRC prognostic assessment and improve the accuracy of prognosis prediction. <b>Methods</b> This study included computed tomography (CT) images from 225 CRC patients and RNA-seq information from 654 patients, obtained from the TICA database. Key radiomics features and genes were identified through radiomics feature extraction, least absolute shrinkage and selection operator (LASSO) regression analysis, and Kaplan-Meier survival analysis. Furthermore, a CRC prognostic model was constructed using these key genes and radiomics features. <b>Results</b> This study identified 170 key radiomics features. Out of them, five were significantly associated with CRC prognosis. Transcriptome data analysis identified 8 key genes, among which the high expressions of Inhibin Subunit Beta B (<i>INHBB</i>), Potassium Voltage-Gated Channel Subfamily Q Member 2 (<i>KCNQ2</i>), and Ubiquilin Like (<i>UBQLNL</i>) were significantly correlated with poor prognosis. Age, tumor stage, pathological T stage, and pathological N stage were determined as independent prognostic factors. Moreover, immune infiltration analysis demonstrated that the immune score of the low-risk group was higher than that of the high-risk group, with significant differences in some immune cells, and key genes were correlated with immune cells. Additionally, the constructed CRC prognostic model incorporating three genes, <i>INHBB</i>, <i>KCNQ2</i>, and <i>UBQLNL</i>, exhibited high prediction accuracy in the validation set, with area under the curve (AUC) values of 0.80, 0.87, and 0.84 at 1-year, 3-year, and 5-year, respectively, indicating good prediction performance and reliability of the model. <b>Conclusion</b> The multimodal data combining radiomics features and gene expression data can improve the accuracy of CRC prognostic assessment, providing a valuable prognostic prediction tool for clinical practice and helping to guide the selection and optimization of treatment regimens.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 3","pages":"1-18"},"PeriodicalIF":1.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708592","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":"Disseminated Tuberculosis Driving Secondary Haemophagocytic Lymphohistiocytosis Following Adalimumab and Treatment for Latent Tuberculosis.","authors":"Timothy Seers, Helen Quah, Dalia Ludwig, Mahdad Noursadeghi, Michael Brown, David Aj Moore, Jessica J Manson","doi":"10.12968/hmed.2024.0462","DOIUrl":"10.12968/hmed.2024.0462","url":null,"abstract":"<p><p>We describe the case of a 63-year-old man presenting with fevers, hyperferrintinaemia and pancytopaenia. He was known to have psoriatic arthritis, managed with adalimumab and methotrexate. Haemophagocytic lymphohistiocytosis (HLH) was diagnosed, and he was treated with intravenous anakinra whilst searching for an aetiology. Despite previous treatment for latent tuberculosis, he developed changes typical for miliary tuberculosis and was started on antituberculosis therapy; whole genome sequencing later demonstrated isoniazid monoresistance. This case demonstrates both the importance of recognising <i>Mycobacterium tuberculosis</i> as a trigger of HLH, and also the risk of latent tuberculosis treatment failure in the setting of monoresistance.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 3","pages":"1-6"},"PeriodicalIF":1.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708595","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":"Low-Dose Dabigatran for Venous Sinus Thromboembolism Associated with Hereditary Dysfibrinogenemia: A Case Report.","authors":"Ying Liu, Jinlong Zhao, Jing Guo, Yu Liu, Chenlu Ma, Yan Zhang","doi":"10.12968/hmed.2024.0426","DOIUrl":"10.12968/hmed.2024.0426","url":null,"abstract":"<p><p>Dabigatran, an anticoagulant, may increase the risk of bleeding in patients with dysfibrinogenemia because of coagulation irregularities, especially at high doses. Cranial Magnetic Resonance Imaging (MRI) and Magnetic Resonance Venography (MRV) were used in the diagnosis of venous sinus thromboembolism in a 42-year-old woman with hereditary dysfibrinogenemia, as documented in our case report. Cranial MRI suggested thrombosis in the venous sinuses, which was confirmed by MRV as thromboses in the superior sagittal, straight, left transverse, and sigmoid sinuses. Instead of the usual fixed-dose, we gave the patient dabigatran based on how the coagulation indicators changed. Forty-six days after treatment, the patient's clinical symptoms had largely resolved. Follow-up cranial MR showed that most of the venous sinus thromboses had disappeared, with some mural thrombi still present in the superior sagittal sinus and left sigmoid sinus. In this report, we optimized the dabigatran regimen adjusted to thrombin time, ensuring efficacy with low bleeding risk.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 3","pages":"1-10"},"PeriodicalIF":1.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708663","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}