British journal of hospital medicine最新文献

{"title":"Comparison of the Performances of Generalized Linear Model, Decision Tree, Random Forest, Naive Bayes, and Support Vector Machine Models From Machine Learning-Based Classification Algorithms in the Diagnosis of Cushing's Syndrome.","authors":"Mustafa Çakır, Mustafa Aydemir, Okan Oral, Mesut Yılmaz","doi":"10.31083/BJHM57289","DOIUrl":"https://doi.org/10.31083/BJHM57289","url":null,"abstract":"<p><strong>Aims/background: </strong>Various tests are used in the screening and diagnosis of Cushing's syndrome (CS). However, none of the existing approaches provide optimal sensitivity and specificity. This study aimed to analyze the accuracy of various tests used for diagnosing CS, including free cortisol measurements in urine, dexamethasone suppression tests (DSTs; 1, 2, and 8 mg), and nocturnal salivary cortisol measurements. The study aimed to identify the most accurate tests using advanced machine learning (ML) techniques.</p><p><strong>Methods: </strong>We performed binary classifications using data from 278 patients with CS and 220 controls without CS. We developed five ML classification models, namely, a generalized linear model, decision tree, random forest, naive Bayes, and support vector machine, and compared them using standard performance metrics. We employed Boruta feature selection to identify the most informative clinical and biochemical predictors.</p><p><strong>Results: </strong>The naive Bayes model achieved the highest predictive performance, with 100% classification accuracy and a kappa value of 1.0000, followed by the random forest and decision tree models, each with 99.01% accuracy. Boruta feature selection ranked as the most informative predictor post 2-mg DST cortisol, followed by midnight cortisol, post 8-mg DST cortisol, urinary free cortisol, and post 1-mg DST cortisol. The decision tree model identified a cohort-specific post 2-mg DST cortisol threshold of approximately 1.78 µg/dL for distinguishing CS-positive from CS-negative cases.</p><p><strong>Conclusions: </strong>ML models, particularly naive Bayes, exhibited strong internal performance in distinguishing patients with CS from non-CS controls using routinely assessed biochemical parameters. The prominence of the post 2-mg DST cortisol predictor in the Boruta ranking and decision tree analysis indicates that this variable contributed substantially to the model-based classification in this cohort. However, the identified 1.78 µg/dL threshold should be interpreted as a cohort-specific, data-driven finding rather than as a clinical cutoff recommendation, and external validation in larger multicenter cohorts is required before clinical implementation.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 8","pages":"57289"},"PeriodicalIF":1.7,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886521","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":"Impact of Continuing Medical Education on Family Physicians' Knowledge and Clinical Decision-Making Regarding Intermittent Fasting in Type 2 Diabetes.","authors":"Canan Tuz, Tuncay Müge Alvur","doi":"10.31083/BJHM51130","DOIUrl":"https://doi.org/10.31083/BJHM51130","url":null,"abstract":"<p><strong>Aims/background: </strong>Intermittent fasting (IF) is increasingly adopted by patients with type 2 diabetes mellitus (T2DM), often without adequate medical supervision. Despite growing patient demand, family physicians frequently report limited formal training in fasting-related diabetes management. This study aimed to evaluate the efficacy of a structured continuing medical education (CME) intervention in improving family physicians' knowledge, confidence, and clinical decision-making regarding IF in T2DM.</p><p><strong>Methods: </strong>A single-group pre-test and post-test interventional design was employed. Four weekly CME sessions were delivered, with each participant attending one session comprising a didactic lecture. A structured questionnaire was administered before and after each session. A total of 180 participants who completed both assessments and provided informed consent were included in the final analysis.</p><p><strong>Results: </strong>The educational intervention produced a statistically significant increase in total knowledge scores (median [interquartile range, IQR]: 12.0 [10.0-15.25] vs. 18.0 [15.25-19.0], <i>Z</i> = -9.17, <i>p</i> < 0.001, <i>r</i> = 0.68). Significant improvements were also observed in exercise and diet (<i>r</i> = 0.58), diabetes management (<i>r</i> = 0.43), oral antidiabetic drug adjustment (<i>r</i> = 0.64), and insulin management (<i>r</i> = 0.55) (all <i>p</i> < 0.001). Self-perceived competence in managing patients with fasting T2DM increased from 33.3% to 75.6%, and confidence in medication dose and timing adjustment increased from 26.7% to 72.8%. Years in practice were not associated with knowledge gain (Spearman's <i>r_s</i> = -0.058, <i>p</i> = 0.438), and participant characteristics had only limited influence on educational outcomes.</p><p><strong>Conclusion: </strong>A structured guideline-based CME programme improved short-term knowledge and self-reported confidence regarding IF in T2DM.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 8","pages":"51130"},"PeriodicalIF":1.7,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886552","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":"Developments in the Treatment of Status Epilepticus in Adults: What Is Established, What Is New and What Is on the Horizon?","authors":"Randeep Mullhi, Thomas Hayton, Shanika Samarasekera, Tonny Veenith","doi":"10.31083/BJHM54046","DOIUrl":"https://doi.org/10.31083/BJHM54046","url":null,"abstract":"","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 8","pages":"54046"},"PeriodicalIF":1.7,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886487","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":"Peritoneal Decompression Can Improve Acute Kidney Injury in Refractory Congestive Heart Failure.","authors":"Emrah Günay, Enver Yüksel","doi":"10.31083/BJHM51353","DOIUrl":"https://doi.org/10.31083/BJHM51353","url":null,"abstract":"","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 8","pages":"51353"},"PeriodicalIF":1.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886488","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 Significance of the Baseline Six-Minute Walk Test in Patients With Early-Stage Lung Cancer and COPD: Correlations With Pulmonary Function, COPD Severity, Cognitive Function, and Quality of Life.","authors":"Shuhui Gao, Guibin Zhang, Deyang Meng, Ke Zhang, Haixiang Gao, Li Yan","doi":"10.31083/BJHM57184","DOIUrl":"https://doi.org/10.31083/BJHM57184","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims/background: &lt;/strong&gt;Driven by global industrialization and a rapidly aging population, lung cancer and chronic obstructive pulmonary disease (COPD) increasingly co-occur, posing complex challenges for clinical management. Although the six-minute walk test (6MWT) is a well-established tool for assessing functional status in each condition, its specific role in patients with early-stage lung cancer and comorbid COPD remains unexplored. This study aimed to explore the correlations between the baseline 6MWT results and pulmonary function, COPD severity, cognitive function, and quality of life (QoL) in patients with early-stage lung cancer and comorbid COPD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective study was conducted, enrolling 215 patients with early-stage lung cancer and COPD admitted to Hebei Provincial People's Hospital between January 2022 and December 2023. Data on patient demographics, baseline 6MWT results (six-minute walk distance [6MWD]), pulmonary function parameters (forced expiratory volume in one second [FEV1], forced vital capacity [FVC], FEV1/FVC ratio), COPD severity grade, cognitive function (Montreal Cognitive Assessment [MoCA] score), and quality of life (St. George's Respiratory Questionnaire [SGRQ] score) were collected from medical records. Patients were dichotomized into High and Low 6MWD groups based on the median 6MWD value. Spearman correlation, univariate analyses, and multivariate logistic regression were used to examine relationships and identify independent factors associated with 6MWD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Logistic regression identified age, FEV1, FVC, FEV1/FVC, COPD severity grade, MoCA score, and the dimensions of respiratory symptoms and activity limitation of the SGRQ scores as independent factors influencing 6MWD. Age demonstrated a significant negative correlation with 6MWD (&lt;i&gt;r&lt;sub&gt;s&lt;/sub&gt;&lt;/i&gt; = -0.666, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). FEV1, FVC, and FEV1/FVC were each significantly positively correlated with 6MWD (&lt;i&gt;r&lt;sub&gt;s&lt;/sub&gt;&lt;/i&gt; = 0.557, &lt;i&gt;p&lt;/i&gt; &lt; 0.001; &lt;i&gt;r&lt;sub&gt;s&lt;/sub&gt;&lt;/i&gt; = 0.139, &lt;i&gt;p&lt;/i&gt; = 0.041; &lt;i&gt;r&lt;sub&gt;s&lt;/sub&gt;&lt;/i&gt; = 0.598, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, respectively). A statistically significant difference in 6MWD was observed among patients with different COPD severity levels (&lt;i&gt;H&lt;/i&gt; = 49.283, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). MoCA scores showed a significant positive correlation with 6MWD (&lt;i&gt;r&lt;sub&gt;s&lt;/sub&gt;&lt;/i&gt; = 0.388, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). The respiratory symptoms, activity limitation, and impact on daily life scores of the SGRQ were each significantly negatively correlated with 6MWD (&lt;i&gt;r&lt;sub&gt;s&lt;/sub&gt;&lt;/i&gt; = -0.766, &lt;i&gt;p&lt;/i&gt; &lt; 0.001; &lt;i&gt;r&lt;sub&gt;s&lt;/sub&gt;&lt;/i&gt; = -0.617, &lt;i&gt;p&lt;/i&gt; &lt; 0.001; &lt;i&gt;r&lt;sub&gt;s&lt;/sub&gt;&lt;/i&gt; = -0.245, &lt;i&gt;p&lt;/i&gt; &lt; 0.001, respectively).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The 6MWT results in patients with early-stage lung cancer and COPD demonstrate significant correlations with pulmonary function, COPD severity, cognitive function, and quality of life. Therefore, the 6MWT can be deployed as a ","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 8","pages":"57184"},"PeriodicalIF":1.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886492","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 National Health Service: Where Are We and How Did We Get Here?","authors":"Dinesh Bhugra, Rajiv Wijesuriya","doi":"10.31083/BJHM54477","DOIUrl":"https://doi.org/10.31083/BJHM54477","url":null,"abstract":"","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 8","pages":"54477"},"PeriodicalIF":1.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886308","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 Case Report of Infantile Dopa-Responsive Dystonia Onset With Sleep Disorder Complicated With Autism Spectrum Disorder.","authors":"Li Shao, Jing Zhang, Qi Wang","doi":"10.31083/BJHM49819","DOIUrl":"https://doi.org/10.31083/BJHM49819","url":null,"abstract":"<p><strong>Aims/background: </strong>Dopa-responsive dystonia (DRD) is a rare genetic disorder with complex and diverse clinical manifestations, resulting in a high rate of misdiagnosis. This case report describes an infantile case of DRD complicated by autism spectrum disorder (ASD), initially presenting with a sleep disorder. We aim to summarize its clinical manifestations, diagnostic process, treatment, and follow-up outcomes in order to improve clinical understanding of this disease.</p><p><strong>Case presentation: </strong>A retrospective analysis was performed on a male infant who was treated at Jinhua Maternal and Child Health Care Hospital in 2020. The patient presented at one month of age with sleep disturbances, delayed motor development, and intermittent upward deviation of the eyes. Genetic testing identified two heterozygous pathogenic variants in the tyrosine hydroxylase (<i>TH</i>) gene. Among them, the c.738-2A>G variant was not recorded in the Exome Aggregation Consortium (ExAC), Genome Aggregation Database (gnomAD), or 1000 Genomes Asian population databases. During follow-up, the patient was also found to have comorbid ASD.</p><p><strong>Results: </strong>Genetic testing confirmed biallelic <i>TH</i> mutations, establishing the diagnosis of infantile DRD. The patient exhibited marked clinical response to levodopa/benserazide, though dose titration was required with growth.</p><p><strong>Conclusion: </strong>For infants with unexplained sleep disorder accompanied by delayed motor development, genetic testing should be performed as early as possible to facilitate the identification of the root cause and implement timely treatment. In addition, close follow-up should be conducted to detect comorbid neurodevelopmental disorders.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 8","pages":"49819"},"PeriodicalIF":1.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886447","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":"Rational Medicine: The Culture of Stewardship and the Role of the Physician.","authors":"Rahul Mukherjee","doi":"10.31083/BJHM55476","DOIUrl":"https://doi.org/10.31083/BJHM55476","url":null,"abstract":"","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 8","pages":"55476"},"PeriodicalIF":1.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886026","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":"Impact of Personalized Anemia Management on Quality of Life and Serum Albumin Levels in Maintenance Hemodialysis Patients.","authors":"Kun Yang, Heping Zhang, Wenxu Pan, Imad Ibrahim Ali Al-Sultan","doi":"10.31083/BJHM57141","DOIUrl":"https://doi.org/10.31083/BJHM57141","url":null,"abstract":"<p><strong>Aims/background: </strong>Anemia is a highly prevalent and clinically significant complication in maintenance hemodialysis (MHD) patients, markedly impairing quality of life and being associated with adverse prognosis. Conventional management strategies often lack sufficient individualization, potentially leading to suboptimal therapeutic outcomes. This study aimed to investigate the impact of personalized anemia management on quality of life and albumin levels in maintenance hemodialysis patients through a retrospective analysis.</p><p><strong>Methods: </strong>A retrospective analysis was conducted involving 353 patients who received maintenance hemodialysis at the Affiliated Hospital of North Sichuan Medical College between March 2022 and March 2025. Based on the management approaches documented in their medical records, patients were divided into two groups: Those receiving routine medical care were assigned to the control group (n = 181), while those receiving personalized anemia management strategies were assigned to the observation group (n = 172). The observation group received personalized anemia management in addition to routine dialysis. Specifically, this approach included individualized adjustment of erythropoietin and iron dosages based on a comprehensive evaluation of dynamic hemoglobin and albumin levels, as well as nutritional status. Meanwhile, a multidisciplinary team led by physicians collaboratively formulated nutritional and pharmacological management plans and provided adherence guidance. The study compared changes in hemoglobin levels, hemoglobin target achievement rate, albumin levels, body composition parameters, Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), quality of life scores (assessed using the Kidney Disease Quality of Life 36-Item Short Form Survey, KDQOL-36), and Pittsburgh Sleep Quality Index (PSQI) between the two groups before and after treatment.</p><p><strong>Results: </strong>Following the intervention, depression and anxiety scores in the observation group were significantly lower than those in the control group (<i>p</i> < 0.05). Regarding physiological indicators, albumin levels, body composition parameters, hemoglobin levels, and the hemoglobin target achievement rate, the observation group showed significant improvements compared with the control group (<i>p</i> < 0.05). Additionally, the PSQI score was significantly lower in the observation group, whereas the quality of life scores were significantly higher compared with the control group; all differences were statistically significant (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Personalized anemia management significantly improves quality of life and albumin levels in maintenance hemodialysis patients and demonstrates potential for clinical application.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 8","pages":"57141"},"PeriodicalIF":1.7,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886573","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":"Application of Tiered Training Model in Personnel Management of the Central Sterile Supply Department: A Retrospective Controlled Study.","authors":"Dongyuan Chen, Huali Zhang, Yeyuan Chu, Junhua Shi, Hongying Pan","doi":"10.31083/BJHM57142","DOIUrl":"https://doi.org/10.31083/BJHM57142","url":null,"abstract":"<p><strong>Aims/background: </strong>The Central Sterile Supply Department (CSSD) is a critical component of hospital infection control, and the quality of its work directly impacts patient safety. Given that traditional training models struggle to accommodate differences in staff competency levels, this study aimed to investigate the effectiveness of a tiered training model in CSSD personnel management.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using the same group of staff members. Traditional standardized training was implemented during the control period (2024), while tiered training based on job competency was implemented during the observation period (2025). Based on competency assessments, staff were categorized into basic, proficient, core, and management & guidance levels, and targeted training courses were implemented accordingly. The effectiveness of the tiered training model was evaluated by comparing knowledge levels, core skills, work quality indicators (including process quality, outcome quality, and service efficiency), as well as internal and external satisfaction between the two periods.</p><p><strong>Results: </strong>During the observation period, staff knowledge scores were significantly higher than those in the control period (81.86 ± 5.23 vs. 70.71 ± 8.52, <i>p</i> < 0.001), and scores for various operational skills also improved significantly (<i>p</i> < 0.001). Process and outcome quality indicators, including cleaning qualification rate and sterilization qualification rate, showed significant improvements (<i>p</i> < 0.05). Service efficiency indicators, including retrieval time, preparation, and replenishment times, were also significantly reduced (<i>p</i> < 0.001). Additionally, internal and external training and service satisfaction scores were significantly higher during the observation period (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>The tiered training model can effectively improve the knowledge and technical competencies of CSSD staff, enhance work quality and service efficiency, and increase internal and external satisfaction. This model represents a precise and efficient personnel training and management strategy that accommodates differences in staff capabilities and may have potential for widespread application in the future.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"87 8","pages":"57142"},"PeriodicalIF":1.7,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886473","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}