British journal of hospital medicine最新文献

{"title":"How to be a Better Doctor: Recognizing How Cognitive Biases Shape-and Distort-Clinical Evidence.","authors":"Sallie Baxendale","doi":"10.12968/hmed.2024.0743","DOIUrl":"https://doi.org/10.12968/hmed.2024.0743","url":null,"abstract":"<p><p>Rather than the absence of any harm, it is the expectation of an overall benefit of a medical treatment that is the foundation of the implicit doctor-patient contract. In the context of an expectation of efficacy, powerful cognitive biases can blind clinicians to obvious signs that a treatment is not helping, or may even be harming their patients. With examples from medical history and current clinical controversies, this paper examines how systematic psychological biases can distort not just individual decision making, but perceptions of the evidence base upon which clinical decisions are built. These distortions can perpetuate harmful practices in medicine long after the objective evidence points in a different direction. By becoming aware of these biases and the way they shape perceptions of the evidence base, doctors can reduce the negative impact they may have on the patients in their care.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-14"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490834","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 COVID-19 on UK Medical Students' Perceptions of Cardiothoracic Surgery-A Comparison of Nationwide Surveys in 2018 and 2022.","authors":"Sathyan Gnanalingham, Raman Gnanalingham, Devan Limbachia","doi":"10.12968/hmed.2024.0285","DOIUrl":"https://doi.org/10.12968/hmed.2024.0285","url":null,"abstract":"<p><p><b>Aims/Background</b> The effects of the coronavirus disease 2019 (COVID-19) pandemic on surgical specialities have been devastating, with more than 1.5 million operations cancelled in 2020, leading to reduced training opportunities and morale. We investigated the impact of COVID-19 pandemic on UK medical students' interest in pursuing a career in cardiothoracic surgery (CTS) and their perceptions of the field, including perceived challenges and opportunities. <b>Methods</b> This study is a comparative cross-sectional study design aiming to assess if there were changes in perceptions amongst UK medical students before and after COVID-19. We distributed the same online survey to all UK medical schools via social media outlets before COVID-19 in 2018 and after in 2022. The Chi-square test was used to analyze differences, with a significance level set a <i>p</i> < 0.05. <b>Results</b> Overall, career intentions of survey respondents towards CTS did not change between 2018 and 2022. However, students' perceptions towards CTS became more negative (<i>p</i> = 0.033). In 2018, for instance, 37% of survey respondents had neutral or negative perceptions of CTS which increased to 59% in 2022. This result was statistically significant, indicating the negative impact of COVID-19 on UK medical students' perceptions of CTS. <b>Conclusion</b> Overall, the effects of COVID-19 did not have a significant impact on medical student interest in a career in CTS. However, negative perceptions associated with a career in CTS persist. A new era of remote, hybrid career events and student modules in CTS could encourage greater interest.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-16"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490425","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 <i>Neisseria sicca</i> Endocarditis in a Patient with Tissue Aortic Valve: Favorable Outcome Following Prompt Multidisciplinary Team Management.","authors":"Husam Jamil, Talal Ezzo, Aymen Doumi, Zeinab Abdallah Elias Diab, Anum Saleem","doi":"10.12968/hmed.2024.0774","DOIUrl":"https://doi.org/10.12968/hmed.2024.0774","url":null,"abstract":"<p><p><i>Neisseria sicca</i> is commonly found in oral flora and is usually deemed harmless. <i>Neisseria sicca</i> is very rarely associated with infective endocarditis and has a high mortality rate with it. We present a case of infective endocarditis in a 57-year-old male who presented with fever, lethargy, and reduced mobility and was admitted to an acute medical unit of a UK district general hospital. Serial blood cultures grew <i>Neisseria sicca</i> and transoesophageal echocardiography confirmed vegetation on the aortic valve. As per microbiology advice, his antibiotic treatment was adjusted to oral ciprofloxacin and intravenous ceftriaxone for 6 weeks given this organism's sensitivity. The cardiology team arranged outpatient appointments for long-term follow-ups. Involving acute medicine, microbiology, and cardiology teams as part of a multidisciplinary team (MDT) led to good clinical outcomes and patients remained alive and well on follow-ups. So far only 27 cases have been documented and we think our work would increase insights into management strategies for this condition particularly the utilization of the MDT approach.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-6"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490811","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":"Iron in Chronic Kidney Disease and End-Stage Kidney Disease-Current Trends and Future Direction.","authors":"Thomas McDonnell, Philip A Kalra","doi":"10.12968/hmed.2024.0619","DOIUrl":"https://doi.org/10.12968/hmed.2024.0619","url":null,"abstract":"<p><p>Anaemia is a frequent and serious complication in chronic kidney disease (CKD), affecting both non-dialysis-dependent (NDD) and dialysis-dependent (DD) patients. While erythropoietin (EPO) deficiency is the primary cause, iron deficiency (ID) also plays a crucial role. ID in CKD can be classified as either absolute, resulting from blood loss, or functional, driven by inflammation and elevated hepcidin levels, which trap iron in macrophages and hepatocytes, preventing its use in erythropoiesis. Elevated hepcidin also reduces dietary iron absorption in the gut, making oral iron supplements ineffective, particularly in advanced CKD. This review summarises the available intravenous (IV) iron formulations, discusses diagnostic definitions and treatment thresholds for ID in NDD and DD CKD, and explores potential future therapeutic directions.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-19"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490837","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":"Recent Advances in the Diagnosis and Management of Pulmonary Arterial Hypertension.","authors":"Eamon Mullen, Brian McCullagh, Sean Gaine, Syed Rehan Quadery","doi":"10.12968/hmed.2024.0635","DOIUrl":"https://doi.org/10.12968/hmed.2024.0635","url":null,"abstract":"<p><p>Pulmonary arterial hypertension (PAH) is a rare, progressive, debilitating and life shortening condition characterized by raised pulmonary arterial pressures. PAH includes a group of conditions sharing similar pathophysiology, clinical features and response to therapy. The commonest sub-groups of PAH include idiopathic pulmonary arterial hypertension (IPAH), and PAH associated with connective tissue disease. Recently published international guidelines emphasize the need for disease awareness and early referral to expert centres in suspected cases. Following diagnosis and careful risk stratification, combination therapy is recommended using drugs targeting the nitric oxide, endothelin and prostacyclin signaling pathways. Promising new therapies are on the horizon, however, the survival remains disappointing with a median survival of 7 years. In this review, we focus on the diagnostic evaluation, risk stratification, available treatment options and future directions in PAH.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-13"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490458","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":"Causal Relationship between Branched-Chain Amino Acids and Inflammatory Bowel Disease: A Bidirectional and Multivariable Mendelian Randomization Study.","authors":"Jiaying Zhou, Fengting Zhu, Leimin Sun","doi":"10.12968/hmed.2024.0722","DOIUrl":"https://doi.org/10.12968/hmed.2024.0722","url":null,"abstract":"<p><p><b>Aims/Background</b> The relationship between dysregulated branched-chain amino acid (BCAA) and inflammatory bowel disease (IBD) is not fully understood. This study applied a bidirectional, two-sample Mendelian randomization (MR) approach to explore the potential causal relationship between circulating BCAA levels and IBD. <b>Methods</b> Genome-wide association studies (GWAS) data on total BCAA levels, comprising leucine, valine, and isoleucine, were utilized. Data on IBD and its subtypes were sourced from the FinnGen study. The primary analytical method was the inverse-variance weighted (IVW) MR. To determine the direct causal effect of BCAA levels on IBD risk while accounting for confounders, we employed multivariable Mendelian randomization (MVMR). <b>Results</b> IVW analysis revealed a positive correlation between circulating total BCAA levels, including valine, leucine, and isoleucine, and an increased risk of Crohn's disease (CD). No causal link was detected between BCAA levels and overall IBD or ulcerative colitis (UC). In the MVMR analysis, adjusting for common risk factors further validated a direct causal effect of elevated BCAA levels on CD risk. <b>Conclusion</b> Our findings suggest that elevated circulating BCAA levels are associated with an increased risk of CD. Further research is warranted to explore the potential implications of these findings for CD risk management.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-17"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490823","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":"Combining Circulating Tumour DNA with Clinical Pathological Risk Factors for Developing Peritoneal Metastasis Prediction Model in Patients with Colorectal Cancer.","authors":"Bohan Han, Huabin Hu, Jianwei Zhang, Xiaoyu Xie, Yanhong Deng","doi":"10.12968/hmed.2024.0704","DOIUrl":"https://doi.org/10.12968/hmed.2024.0704","url":null,"abstract":"<p><p><b>Aims/Background</b> Peritoneal metastasis in colorectal cancer (CRC) indicates a poor prognosis for patients. Circulating tumour DNA (ctDNA) effectively predicts recurrence and metastasis. Therefore, this study aims to construct a predictive model for peritoneal metastasis by integrating ctDNA with clinicopathological factors in stage I-III CRC patients. <b>Methods</b> We conducted a retrospective analysis of 299 CRC patients who underwent ctDNA detection at The Sixth Affiliated Hospital, Sun Yat-sen University between January 2010 and December 2022. Patients were randomly divided into training (n = 209) and validation (n = 90) sets in a 7:3 ratio using a random number table method. The least absolute shrinkage and selection operator (LASSO) regression model optimized feature selection, and multivariable logistic regression constructed the predictive model. <b>Results</b> Among the study cohort, 59 patients were ctDNA-positive. Postoperative ctDNA positivity was associated with an 8.522-fold increased risk of peritoneal metastasis (<i>p</i> < 0.001, odds ratio (OR) 8.522, 95% confidence interval (CI) 4.371-16.615). The model included preoperative carbohydrate antigen 125 (CA-125), pathological lymph node staging, perineural invasion, and ctDNA levels, achieving an area under the curve (AUC) of 0.808 (95% CI 0.727-0.888) in the training set and 0.784 (95% CI 0.658-0.910) in the validation set. <b>Conclusion</b> This model can accurately identify high-risk patients for peritoneal metastasis in postoperative CRC, facilitating early detection and timely intervention.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-18"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490824","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":"Efficacy of Dapagliflozin in the Treatment of Type 2 Diabetes Mellitus Complicated by Coronary Heart Disease: A Meta-Analysis.","authors":"Wenchao Ma, Kun Wang, Leina Sun, Fangcheng Su","doi":"10.12968/hmed.2024.0336","DOIUrl":"https://doi.org/10.12968/hmed.2024.0336","url":null,"abstract":"<p><p><b>Aims/Background</b> Dapagliflozin is a sodium-glucose cotransporter inhibitor that functions to lower blood sugar by promoting glucose excretion. We conducted a meta-analysis to assess the therapeutic efficacy of dapagliflozin in patients with type 2 diabetes mellitus complicated by coronary heart disease. The objective of this analysis is to provide additional clarity on dapagliflozin's effectiveness in this specific patient population. <b>Methods</b> A systematic review of the literature was performed by searching China National Knowledge Infrastructure (CNKI), Wanfang, Wip Chinese Science, Technology Journals, China Biomedicine, Pubmed, Web of Science, and Cochrane Library. Related literature regarding the effectiveness of dapagliflozin, published since the inception of databases until October 2023, was searched and selected. Subsequent to the screening process, the Jadad scale was used to assess the quality of the gathered literature. The NoteExpress3.2 software (Beijing Aegean Music Technology Co., Ltd., Beijing, China) was utilized to manage the literature. Statistical analysis was conducted using RevMan5.4.1 software (The Cochrane Collaboration, London, UK). The <i>p</i>-value of the Q test determined the heterogeneity of the studies, guiding the choice between fixed or random effect models for establishing the combined effect. Forest plots were used to visualize dapagliflozin's efficacy in treating patients with type 2 diabetes mellitus and coronary heart disease. A funnel plot was plotted to assess potential publication bias. <b>Results</b> Twenty-three studies were eligible for inclusion in this meta-analysis. The results revealed that dapagliflozin has better clinical efficacy (odds ratio [OR] = 3.88, 95% confidence interval [CI] 2.59 to 5.82), left ventricular ejection fraction (LVEF) (OR = 5.43, 95% CI 4.02 to 6.84). The values of left ventricular end-diastolic diameter (LVEDD) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were lower in the experimental group (OR: -4.03 and -84.65, 95% CI -5.08 to -2.98 and -127.05 to -42.25, respectively). In addition, further analysis showed that the experimental group experienced a lower incidence of adverse reactions (OR = 0.30, 95% CI 0.16 to 0.57). <b>Conclusion</b> Dapagliflozin is more effective in controlling type 2 diabetes mellitus complicated by coronary heart disease.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-15"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490829","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":"Managing your Palliative Patient.","authors":"Nicholas Herodotou","doi":"10.12968/hmed.2024.0579","DOIUrl":"https://doi.org/10.12968/hmed.2024.0579","url":null,"abstract":"<p><p>Palliative Care is the symptom management of any patient who has an irreversible, progressive, life-limiting condition and is not solely cancer patients. It aims to enhance quality of life, utilizing a holistic, multidisciplinary approach. Good symptom management of palliative patients is what every clinician should be able to deliver. This short article addresses the practical management of how to commence strong opioids, palliative surgical interventions, palliative emergencies and lastly, when do you stop treating a patient who is clinically deteriorating.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-14"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490838","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":"What is the Future of Diagnostics in Heart Failure?","authors":"Aimee McCoubrey, Ross T Campbell","doi":"10.12968/hmed.2024.0797","DOIUrl":"https://doi.org/10.12968/hmed.2024.0797","url":null,"abstract":"<p><p>Heart failure (HF) is a common and malignant condition. Disease-modifying therapies are available, with early diagnosis being crucial as these therapies modify risk within weeks of commencement. A higher proportion of patients are now being diagnosed with HF during a hospital admission, rather than in the community, with an associated poorer prognosis. There is a need to reduce the time spent to diagnosis and treatment in the community. Advances in the diagnostic tools deployed in HF diagnostics, in particular the use of artificial intelligence, hold promise to deliver this.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 2","pages":"1-6"},"PeriodicalIF":1.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490679","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}