Clinical Medicine最新文献

The WHO has stated that AMR is one of the greatest health threats facing humanity and is responsible for significant morbidity and mortality with a disproportionate impact on vulnerable groups of patients. The WHO set out its global action plan in 2015 and most countries have their own national plans which take a "whole system one health" approach that includes infection prevention and optimising the use of antimicrobials through stewardship programs and diagnostics. In hospitals, antimicrobials are some of the most commonly prescribed medications creating significant selection pressure for emerging resistance. Antimicrobial stewardship (AMS) in hospitals comprises a set of structured interventions that seek to optimise the benefits of treatments whilst limiting the harms. AMS is effective and has proven benefits such as improved outcomes and reduced spread of resistance in hospitals. This paper highlights key principles for antimicrobial prescribing and highlights recent evidence some of which has been practice changing.

Hospital at Home (HaH) provides hospital-level care within patients' homes. With services expanding, a London HaH service embedded new junior doctors posts. Currently, gaps exist in the under- and postgraduate curriculum to develop clinical skills required to deliver care in this context. HaH simulation (HaH-SIM) was developed, through a multi-cycle QIP, to improve early-career doctors' confidence in providing care in this unfamiliar environment. Surveys before and after HaH-SIM assessed confidence in practical, clinical and communication skills; ranked concerns; rated sessions and gained qualitative feedback. 41 doctors participated over two years. It currently includes 6 low-fidelity stations and 3 high-fidelity stations. Confidence improved, particularly in managing end-of-life, decision-making around hospital admission and administering intravenous medications/fluids. High-fidelity scenarios, practical skills and prescribing stations were most highly-rated. As HaH services expand, HaH-SIM is a feasible, effective and transferable way of improving early-career doctors' confidence and skills to provide care in patients' homes.

We report a case of a syndrome first described by French bacteriologist Andre Lemierre nearly one hundred years ago. A young woman presented with fever, chest pain and arthralgia. Admission investigations revealed thrombocytopenia, cavitating pneumonia and an internal jugular vein thrombus. Blood cultures were positive for Fusobacterium necrophorum and Streptococcus constellatus. Respiratory failure developed within 48hrs and was managed with high flow nasal oxygen in a critical care setting. Discussed are the investigation findings leading to diagnosis, as well as the antimicrobial and anticoagulation management strategies. Lemierre's syndrome is rarely encountered by non-specialists but a good outcome can be expected with prompt diagnosis and treatment.

Malaria remains a major global health problem. Transmission occurs in 84 countries across five continents, with almost 250 million cases and over 600,000 deaths each year. Primary and secondary care clinicians in the UK need to be alert to the prospect of malaria presenting in returning travellers. They must be aware of the signs of severe malaria, the need for prompt diagnosis and treatment, and the importance of seeking specialist advice. With emerging resistance, climate change, and the roll-out of the first malaria vaccines, the landscape of malaria is changing. Here we discuss the past, present and future of malaria.

PIVC (peripheral intravenous cannulation) is an essential skill for newly qualified foundation doctors. It has high failure rates, resulting in care delays, pain, and infection. We explored the perceived impact of ultrasound guided PIVC training on confidence when performing difficult access PIVC. We surveyed 88 foundation doctors to evaluate their perceptions on USS-PIVC. Each cohort of participants were given two sessions over a two-month period. Confidence was assessed using electronic questionnaires through 5-point Likert scales and free text responses. Confidence when performing PIVC with difficult access, regardless of USS, increased significantly following the course (p < 0.01). This was also true regarding confidence when performing USS-PIVC (p < 0.01.). Key themes identified included technical skills, confidence, and clinical utility.

There are significant variations in discharge post-diabetes-related ketoacidosis (DKA) hospitalisation, yet there is a paucity of research to understand or minimise the reasons. This quality improvement project (QIP) aimed to identify reasons for post-DKA discharge delays and assess intervention efficacy. Utilising the Digital Evaluation of Ketosis and Other Diabetes-related Emergencies (DEKODE) model, data from 177 DKA episodes from January 2021 to September 2023 across three hospitals were analysed. Factors affecting discharge were investigated through a plan, do, study, act (PDSA) methodology. While interventions focused on optimising data collection and refining discharge guidelines, no significant reduction in DKA duration or length of stay was observed. Findings highlight post-DKA hospitalisation's multifaceted nature and the limited impact of simple interventions. Collaborative efforts and further research are necessary to develop effective strategies for expedited discharge and improved patient care. This study's comprehensive tracking and analysis tool offers valuable insights for future interventions in managing DKA-related hospitalisations.

Background: Contemporary observations indicate insufficient quality in the reporting of statistical data. Despite the publication of the SAMPL guidelines in 2015, they have not been widely adopted. The aim of this article is to highlight the incorporation of SAMPL Guidelines in the statistical reviews of articles related to clinical medicine, as well as the changes implemented by authors in revised manuscripts as a result of such guidance. An additional objective is to provide recommendations for biomedical journals regarding the necessity of integrating SAMPL Guidelines into their daily practices.

Methods: The study incorporated 100 selected statistical reviews of original clinical medicine articles from 8 biomedical journals, conducted between 2016 and 2023. Each of these reviews suggested specific SAMPL Guidelines to be implemented in the revised manuscript. It was evaluated which specific SAMPL Guidelines were most frequently enforced and what changes resulted from their implementation.

Results: Seventy-five percent of the manuscripts in question garnered acceptance following a solitary round of statistical evaluation. Among the most frequently recommended and subsequently implemented SAMPL Guidelines by the authors are a more thorough description of the purpose of the applied statistical tests (65%), indication of the practical significance of the obtained results, including calculation of relevant effect size measures (64%), analysis of assumptions necessary for the application of specific statistical tests (58%), and consideration of the impact of outlier values on the obtained results (34%).

Conclusion: To improve the quality of statistical reporting in biomedical journals, greater emphasis should be placed on implementing SAMPL Guidelines.

This case illustrates a rare cause of facial pain due to glossopharyngeal neuralgia in a 66-year-old male patient. Imaging confirmed an aneurysm of the cervical internal carotid artery as the cause; the aneurysm itself, likely secondary to an elongated styloid process (Eagle's syndrome). The imaging findings and management options are discussed below.

Background: The long-COVID syndrome is characterised by a plethora of symptoms. Given its social and economic impact, many studies have stressed the urgency of proposing innovative strategies other than hospital settings. In this double-blind randomised case-control trial, we investigate the effects of sulfur thermal water inhalations, rich in H₂S, compared to distilled water inhalations on symptoms, inflammatory markers, nasal microbiome in long-COVID patients.

Methods: 30 outpatients aged 18-75, with positive diagnosis for long-COVID were randomised in two groups undergoing 12 consecutive days of inhalations. The active Group (STW) received sulfur thermal water inhalations whereas the placebo group received inhalations of sterile distilled non-pyrogenic water (SDW). Each participant was tested prior treatment at day 1 (T0), after the inhalations at day 14 (T1) and at 3 months follow-up (T2). At each time point, blood tests, nasal swabs for microbiome sampling, pulmonary functionality tests (PFTs) and pro-inflammatory marker measure were performed.

Results: The scores obtained in the administered tests (6MWT, Borg score, and SGRQ) at T0, showed a significant variation in STW group, at T1 and T2. Serum cytokine levels and other inflammatory biomarkers reported a statistically significant decrease. Some specific parameters of PFT's showed ameliorations in STW group only. Changes in the STW nasopharyngeal microbiota composition were noticed, especially from T0 to T2.

Conclusions: Inhalations of sulfur thermal water exerted objective and subjective improvements on subjects affected by long-COVID. Significant reduction of inflammatory markers, dyspnea scores and quantitative and qualitative changes in the nasopharyngeal microbiome were also assessed.