British journal of hospital medicine最新文献

{"title":"Factors Affecting the Occurrence of Arrhythmias Following Pacemaker Implantation.","authors":"Jiafa Jin, Shen Huang, Minsheng An, Xiaoling Tao","doi":"10.12968/hmed.2024.0432","DOIUrl":"10.12968/hmed.2024.0432","url":null,"abstract":"<p><p><b>Aims/Background</b> Pacemakers are essential devices for patients with cardiac rhythm abnormalities. However, the occurrence of arrhythmias after pacemaker implantation remains a clinical challenge. This study aimed to identify and analyze the factors that influence the occurrence of arrhythmias following pacemaker implantation to improve patient outcomes. <b>Methods</b> Clinical data of patients who received pacemaker implantation treatment in the Affiliated Hospital of Chengdu University from January 2021 to December 2022 were retrospectively analyzed. A total of 137 patients were followed up for 12 months and then divided into two groups based on the occurrence of arrhythmias post-implantation: the occurrence group (n = 40) and the non-occurrence group (n = 97). General data, including gender, age, cardiac function indexes, and preoperative anxiety, were collected and compared. Binary logistic regression was used to analyze the influencing factors of arrhythmia occurrence, while Spearman correlation analysis was employed to examine the correlation between cardiac function indexes and arrhythmia occurrence. <b>Results</b> Significant differences were found in age, history of hypertension, preoperative anxiety score, preoperative depression score, preoperative left ventricular end-diastolic diameter (LVEDD), and preoperative left ventricular ejection fraction (LVEF) between the two groups (<i>p</i> < 0.05). There was a positive correlation between arrhythmias occurrence and preoperative LVEDD and LVEF (r = 0.270, 0.329; <i>p</i> < 0.01). Age, history of hypertension, preoperative anxiety score, preoperative depression score, preoperative LVEDD, and preoperative LVEF were identified as risk factors for arrhythmias (odds ratio [OR]) = 2.507, 2.479, 3.012, 2.432, 3.614, 4.525; all <i>p</i> < 0.05). <b>Conclusion</b> Age, history of hypertension, preoperative anxiety score, preoperative depression score, preoperative LVEF, and preoperative LVEDD are important influencing factors for arrhythmias occurrence, which are correlated with preoperative cardiac function indexes. Thus, preoperative observation utilizing these factors can provide a reference for screening high-risk groups.</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":"143490833","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":"How Outcome Prediction Could Aid Clinical Practice.","authors":"Ashley Kieran Clift","doi":"10.12968/hmed.2024.0781","DOIUrl":"10.12968/hmed.2024.0781","url":null,"abstract":"<p><p>Predictive algorithms have myriad potential clinical decision-making implications from prognostic counselling to improving clinical trial efficiency. Large observational (or \"real world\") cohorts are a common data source for the development and evaluation of such tools. There is significant optimism regarding the benefits and use cases for risk-based care, but there is a notable disparity between the volume of clinical prediction models published and implementation into healthcare systems that drive and realise patient benefit. Considering the perspective of a clinician or clinical researcher that may encounter clinical predictive algorithms in the near future as a user or developer, this editorial: (1) discusses the ways in which prediction models built using observational data could inform better clinical decisions; (2) summarises the main steps in producing a model with special focus on key appraisal factors; and (3) highlights recent work driving evolution in the ways that we should conceptualise, build and evaluate these tools.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 1","pages":"1-6"},"PeriodicalIF":1.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037161","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":"Acute Q Fever after Kidney Transplantation: A Case Report.","authors":"Junjie Xie, Gang Li, Fenwang Lin, Zhijie Bai, Lixin Yu, Dongjing Zhang, Bolun Zhang, Junsheng Ye, Ruohan Yu","doi":"10.12968/hmed.2024.0604","DOIUrl":"10.12968/hmed.2024.0604","url":null,"abstract":"<p><p><b>Aims/Background</b> Patients receiving kidney transplant experience immunosuppression, which increases the risk of bacterial, viral, fungal, and parasitic infections. Q fever is a potentially fatal infectious disease that affects immunocompromised renal transplant recipients and has implications in terms of severe consequences for the donor's kidney. <b>Case Presentation</b> A patient with acute Q fever infection following kidney transplantation was admitted to the Tsinghua Changgung Hospital in Beijing, China, in March 2021. Next-generation sequencing (NGS) was used to diagnose Q fever in the patient. Based on the patient's blood test, we detected <i>Rickettsia</i>, the causative agent of Q fever and a zoonotic disease that can manifest in acute or chronic forms in humans. Comprehensive data on clinical symptoms, blood tests, chest computed tomography (CT), NGS, Immunoglobulin G (IgG) antibody titer, and therapeutic efficacy associated with Q fever infection following renal transplantation in this patient were gathered. <b>Conclusion</b> This is the first reported case of acute Q fever occurring in a Chinese renal transplant recipient detected using metagenomic NGS. This case underscores the need to consider acute Q fever as a possible differential diagnosis in kidney transplant recipients with fever of unknown origin.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 1","pages":"1-10"},"PeriodicalIF":1.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037037","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":"Predictive Value of Ocular Fundus Hemorrhage for Severe Coronary Artery Disease Assessed via SYNTAX Score.","authors":"Xing Ge, Xiaoli Liu, Tienan Sun, Xinxiao Gao, Hongya Han, Yujie Zhou","doi":"10.12968/hmed.2024.0497","DOIUrl":"10.12968/hmed.2024.0497","url":null,"abstract":"<p><p><b>Aims/Background</b> The relationship between retinal fundus hemorrhage and the severity of coronary artery lesions remains unclear. This study aimed to explore the incidence of fundus hemorrhage in patients at high risk of coronary heart disease (CHD) and to examine its correlation with the SYNTAX score, a tool used to assess the complexity of coronary artery disease. <b>Methods</b> This retrospective study consecutively enrolled patients undergoing coronary angiography (CAG) at Beijing Anzhen Hospital Hospital from June 2019 to January 2020. Bilateral non-mydriatic fundus photography was performed to detect fundus hemorrhages. The SYNTAX score was calculated to quantify the severity of coronary artery lesions, and patients were divided into two groups: a high SYNTAX score (hSS) group (≥23 points) and a low SYNTAX score (lSS) group (≤22 points). Baseline demographic and clinical data were collected, along with relevant laboratory tests. <b>Results</b> A total of 878 patients were included in the study, with 177 in the hSS group and 701 in the lSS group. Fundus hemorrhage was observed in 91 patients (incidence: 10.36%, 95% confidence interval (CI): 8.35%-12.38%). The incidence of fundus hemorrhage was significantly higher in the hSS group compared to the lSS group (21.47% [38/177] vs. 7.56% [53/701], <i>p</i> < 0.001). Multivariate logistic regression analysis identified fundus hemorrhage, body mass index (BMI), and low-density lipoprotein cholesterol (LDL-C) as independent predictors of high SYNTAX scores. <b>Conclusion</b> Fundus hemorrhage is significantly associated with a higher SYNTAX score and may serve as a potential predictor of severe coronary artery lesions in clinical practice.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 1","pages":"1-12"},"PeriodicalIF":1.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037178","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":"Profiling Exosomal Metabolomics as a Means for Diagnosis and Researching Early-Stage Hypertensive Nephropathy.","authors":"Wei Chen, Meng Jia, Rui Yin, Chengwei Zhang, Jinchen He, Hong Yang, Qi Wu","doi":"10.12968/hmed.2024.0568","DOIUrl":"10.12968/hmed.2024.0568","url":null,"abstract":"<p><p><b>Aims/Background</b> Hypertension (HT) is a prevalent medical condition showing an increasing incidence rate in various populations over recent years. Long-term hypertension increases the risk of the occurrence of hypertensive nephropathy (HTN), which is also a health-threatening disorder. Given that very little is known about the pathogenesis of HTN, this study was designed to identify disease biomarkers, which enable early diagnosis of the disease, through the utilization of high-throughput untargeted metabolomics strategies. <b>Methods</b> The participants of this study were patients admitted to The Second Affiliated Hospital of Chengdu Medical College, Nuclear Industry 416 Hospital, who were randomly divided into three groups: Normal group (n = 11), HT group (n = 10), and HTN group (n = 12). Urine exosomes were extracted, purified, and subjected to untargeted metabolomics analysis. Differential metabolites and their significantly enriched Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were identified. The least absolute shrinkage and selection operator (LASSO) regression analysis was then employed to establish a diagnostic model for early-stage HTN. Finally, logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify biomarkers related to early HTN. <b>Results</b> Orthogonal partial least squares-discriminant analysis (OPLS-DA) revealed significant differences in the metabolic profiles of the three patient groups. Compared to subjects of the Normal group, the HT and HTN groups exhibited significantly upregulated and downregulated profiles of differential metabolites, respectively. LASSO regression analysis results indicated that 4-hydroxyphenylacetic acid, bilirubin, uracil, and iminodiacetic acid are potential biomarkers for HTN or HT. <b>Conclusion</b> With untargeted metabolomics analysis, we successfully identified differential metabolites in HTN. A further LASSO regression analysis revealed that four key metabolites, namely 4-hydroxyphenylacetic acid, bilirubin, uracil, and iminodiacetic acid, hold promise for the diagnosis of early-stage HTN.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 1","pages":"1-19"},"PeriodicalIF":1.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037182","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":"Should All Doctors Undergo Mandatory Life Support Training?","authors":"Benjamin Stretch, Eng Hong Teh, Matthew Waite, Agnieszka Jakubowska","doi":"10.12968/hmed.2024.0548","DOIUrl":"10.12968/hmed.2024.0548","url":null,"abstract":"<p><p>Advanced life support certification has traditionally been the gold standard of resuscitation training for doctors and has been shown to improve outcomes from cardiac arrest. In 2021, Health Education England removed named courses from mandatory Foundational Programme competencies, which has resulted in capping of reimbursement and reduced access to courses. This represents a drop in educational standards which is particularly concerning when the medical school curriculum has been shown to deliver inconsistent, poor-quality resuscitation training. Here we review the benefits and negatives of life support training, looking at both junior and senior clinicians with differing educational requirements.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 1","pages":"1-6"},"PeriodicalIF":1.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037152","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":"Finerenone: Do We Really Need an Additional Therapy in Type 2 Diabetes Mellitus and Kidney Disease?","authors":"Deepika Manoharan, Nicholas Gangoo, William Hinchliffe","doi":"10.12968/hmed.2024.0715","DOIUrl":"10.12968/hmed.2024.0715","url":null,"abstract":"<p><p>Patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) face considerable cardiorenal morbidity and mortality despite existing therapies. Recent clinical trials demonstrate the efficacy of finerenone, a novel non-steroidal mineralocorticoid receptor antagonist, in reducing adverse renal and cardiovascular outcomes. This editorial briefly reviews the evidence and its implications for clinical practice, advocating the use of finerenone in these high-risk patients in combination with currently established treatment agents.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 1","pages":"1-7"},"PeriodicalIF":1.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037159","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 Different Thromboprophylaxis Regimens in Elderly Patients Following Hip Arthroplasty.","authors":"Qi Zhang, Xuan Sun, Jingbo Pan, Dan Liu","doi":"10.12968/hmed.2024.0538","DOIUrl":"10.12968/hmed.2024.0538","url":null,"abstract":"<p><p><b>Aims/Background</b> Deep venous thrombosis (DVT) represents a significant postoperative complication after artificial femoral head replacement, with the incidence increasing proportionally with patient age. This study aimed to evaluate the effect of early postoperative use of intermittent pneumatic compression devices (IPC), followed by the combined use of low molecular weight heparin (LMWH) after 48 hours, for the prevention of postoperative lower limb DVT in elderly patients undergoing hip arthroplasty. <b>Methods</b> The retrospective study included 100 elderly patients who underwent unilateral femoral head replacement. The control group (n = 55) received combined LMWH initiated 12 hours postoperatively, while the observation group (n = 45) started combined LMWH 48 hours postoperatively. Changes in coagulation parameters, perioperative complications, and the incidence of postoperative lower limb DVT were compared between the two groups. <b>Results</b> Coagulation parameters showed significant changes post-intervention in both groups, with no statistically significant inter-group differences observed post-intervention (<i>p</i> > 0.05). The incidence of postoperative lower limb DVT did not differ significantly between the two groups (<i>p</i> > 0.05). However, the observation group demonstrated significantly lower postoperative blood loss, incidence of periwound hematoma, and transfusion rates compared to the control group (<i>p</i> < 0.05). <b>Conclusion</b> The sequential application of IPC in the early postoperative period, followed by combined LMWH administration after 48 hours, demonstrates comparable efficacy in preventing lower limb DVT formation in elderly patients undergoing hip arthroplasty when compared to the initiation of combined LMWH starting 12 hours postoperatively. In addition, this approach significantly reduces the risk of postoperative bleeding and exhibits a high safety profile.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 1","pages":"1-13"},"PeriodicalIF":1.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037127","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":"Diagnostic Value of Neutrophil-to-Lymphocyte Ratio (NLR) in Intrahepatic Cholestasis of Pregnancy.","authors":"Dandan Ji, Mingyan Sheng, Liuyan Zhang, Yonggui Han, Qi Jiang, Qiongxiao Ruan","doi":"10.12968/hmed.2024.0543","DOIUrl":"10.12968/hmed.2024.0543","url":null,"abstract":"<p><p><b>Aims/Background</b> Intrahepatic cholestasis of pregnancy (ICP) is associated with adverse perinatal outcomes, yet the correlation between ICP and the neutrophil-to-lymphocyte ratio (NLR) remains unclear. This study aims to investigate the diagnostic value of NLR in ICP. <b>Methods</b> In this retrospective case-control study, 113 patients with ICP treated in Beilun District People's Hospital from January 2020 to December 2022 were recruited and categorized as the ICP group, and 209 healthy pregnant women treated during the same period were selected as the control group. The levels of NLR and mean platelet volume (MPV) were compared between the two groups. The NLR of patients with different ICP severity were compared. Logistic regression model was used to analyze the relationship between relevant indicators and ICP. The capability of NLR in predicting ICP was evaluated using receiver operating characteristic (ROC) curves. <b>Results</b> There were significant differences in age, neutrophil count, lymphocyte count, platelet count, MPV, alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), NLR, and serum total bile acid (sTBA) among all groups (<i>p</i> < 0.05). The NLR in the severe ICP group was significantly higher than that in the mild ICP group (<i>p</i> < 0.05). Logistic regression analysis showed that MPV (odds ratio [OR] = 1.247) and NLR (OR = 1.885) were independent factors influencing the occurrence of ICP (<i>p</i> < 0.05). ROC curve analysis showed that the area under the curve (AUC) for both mild ICP and severe ICP was 0.679 and 0.869, respectively, substantiating the diagnostic value of NLR. <b>Conclusion</b> NLR can be used as an auxiliary indicator in the diagnosis of ICP and has important clinical value in predicting adverse pregnancy outcomes in ICP patients.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 1","pages":"1-10"},"PeriodicalIF":1.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037071","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 the Omaha System-Based Continuous Care Model in Diabetes Health Management for Outpatients within the Framework of \"Internet +\".","authors":"Ying Chen, Xia Yan, Jianjun Liu, Zhengxia Bian, Li Yan","doi":"10.12968/hmed.2024.0561","DOIUrl":"10.12968/hmed.2024.0561","url":null,"abstract":"<p><p><b>Aims/Background</b> Diabetes is a chronic lifelong condition that requires consistent self-care and daily lifestyle adjustments. Effective disease management involves regular blood glucose monitoring and ongoing nursing support. Inadequate education and poor self-management are key factors contributing to increased mortality among diabetic individuals. Providing personalized guidance and behavioral interventions through continuous nursing care is crucial for achieving optimal glycemic control and fostering positive societal outcomes. This study aimed to evaluate the impact of an Omaha System-based continuous nursing model, implemented through the \"Internet+\" framework, on enhancing self-health management skills, glycemic control, and treatment adherence among patients with type 2 diabetes mellitus (T2DM). <b>Methods</b> This retrospective study analyzed clinical data of T2DM patients who visited the diabetes health management clinic of Zhang Ye People's Hospital affiliated to Hexi University between December 2023 and May 2024. Participants were categorized into intervention and control groups based on whether they received the \"Internet+\"-enabled Omaha System continuous nursing care model. Variables, including demographic characteristics, self-management behaviors, cognitive abilities, environmental factors, glycemic control indicators, and treatment adherence (medication compliance, dietary compliance, lifestyle adherence, and follow-up punctuality), were assessed and compared at baseline, 1 month, and 3 months post-intervention. <b>Results</b> The study included 52 patients in the intervention group and 68 in the control group. Baseline characteristics revealed no significant differences between the two groups (<i>p</i> > 0.05). At 1 and 3 months post-intervention, the intervention group exhibited significant improvements in self-management behaviors, cognitive abilities, environmental factors, and overall scores compared to baseline and the control group (<i>p</i> < 0.05). Fasting plasma glucose (FPG) levels were also significantly reduced in the intervention group compared to baseline and the control group (<i>p</i> < 0.05). 3 months post-intervention, the intervention group demonstrated significantly higher adherence rates to dietary recommendations, healthy lifestyle practices, and treatment compliance compared to the control group (<i>p</i> < 0.05). <b>Conclusion</b> The \"Internet+\"-based Omaha System continuous nursing model significantly enhances self-health management capabilities, stabilizes glycemic control, and promotes adherence to healthy behaviors among patients with T2DM. These findings highlight the potential of the model for broader clinical application in diabetes management.</p>","PeriodicalId":9256,"journal":{"name":"British journal of hospital medicine","volume":"86 1","pages":"1-14"},"PeriodicalIF":1.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036991","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}