首页 > 最新文献

Clinical Medicine最新文献

英文 中文
Specialist referrals and diagnostic delays in motor neurone disease: Mapping patients' journey through hoops and hurdles in healthcare. 运动神经元疾病的专科转诊和诊断延误:绘制患者在医疗保健领域的 "圈套 "和 "障碍 "之旅。
IF 3.6 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-01 Epub Date: 2024-07-14 DOI: 10.1016/j.clinme.2024.100228
Samuel James Reynolds, Suresh Kumar Chhetri

Motor neuron disease (MND) is an uncommon but invariably fatal condition, with a median survival of 24-48 months from symptom onset. Although there is no cure at the moment, early diagnosis is crucial to enable timely access to multidisciplinary care, and enrolment in clinical trials utilising investigational therapies. Unfortunately, diagnostic delays remain common, and the average delay between symptom onset and diagnosis is 12 months. Large numbers of specialist referrals have been suggested as a key contributor to diagnostic delays. We conducted a retrospective review of the medical records of patients diagnosed with MND in Lancashire and South Cumbria, to investigate whether large numbers of specialty referrals are a common occurrence in MND. Our review identified that 35% of patients with MND were seen by two or more specialties before being referred to neurology. This rose to 49% when patients with bulbar onset disease were considered. 9% of cases saw three or more specialists. There was a statistically significant correlation between the number of specialist referrals and delays in neurology referral. We hope our findings will increase awareness of the importance of early neurology referral in the diagnosis of MND and promote the use of the MND Red Flag tool as a means of identifying patients in need of prompt neurological evaluation.

运动神经元病(MND)是一种不常见但必然致命的疾病,中位生存期为发病后 24-48 个月。虽然目前尚无根治方法,但早期诊断对于及时获得多学科治疗和参加使用研究疗法的临床试验至关重要。遗憾的是,诊断延误仍很常见,从症状出现到确诊的平均延误时间为 12 个月。大量的专科转诊被认为是导致诊断延误的关键因素。我们对兰开夏郡和南坎布里亚郡确诊为MND患者的医疗记录进行了回顾性审查,以调查大量专科转诊是否是MND的常见现象。我们的审查发现,35% 的 MND 患者在转诊至神经内科之前曾在两个或两个以上专科就诊。如果考虑到球部发病的患者,这一比例上升到49%。9%的病例由三名或三名以上专科医生诊治。专科转诊次数与神经内科转诊延误之间存在统计学意义上的显著相关性。我们希望我们的研究结果能够提高人们对MND早期诊断重要性的认识,并推广使用MND红旗工具,以此来识别需要及时转诊至神经内科的患者。
{"title":"Specialist referrals and diagnostic delays in motor neurone disease: Mapping patients' journey through hoops and hurdles in healthcare.","authors":"Samuel James Reynolds, Suresh Kumar Chhetri","doi":"10.1016/j.clinme.2024.100228","DOIUrl":"10.1016/j.clinme.2024.100228","url":null,"abstract":"<p><p>Motor neuron disease (MND) is an uncommon but invariably fatal condition, with a median survival of 24-48 months from symptom onset. Although there is no cure at the moment, early diagnosis is crucial to enable timely access to multidisciplinary care, and enrolment in clinical trials utilising investigational therapies. Unfortunately, diagnostic delays remain common, and the average delay between symptom onset and diagnosis is 12 months. Large numbers of specialist referrals have been suggested as a key contributor to diagnostic delays. We conducted a retrospective review of the medical records of patients diagnosed with MND in Lancashire and South Cumbria, to investigate whether large numbers of specialty referrals are a common occurrence in MND. Our review identified that 35% of patients with MND were seen by two or more specialties before being referred to neurology. This rose to 49% when patients with bulbar onset disease were considered. 9% of cases saw three or more specialists. There was a statistically significant correlation between the number of specialist referrals and delays in neurology referral. We hope our findings will increase awareness of the importance of early neurology referral in the diagnosis of MND and promote the use of the MND Red Flag tool as a means of identifying patients in need of prompt neurological evaluation.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100228"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Statin-induced, immune-mediated necrotising myopathy triggered by malignancy successfully treated with immunosuppression. 通过免疫抑制成功治疗恶性肿瘤诱发的他汀类药物免疫介导坏死性肌病
IF 3.6 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-01 Epub Date: 2024-05-06 DOI: 10.1016/j.clinme.2024.100217
Ahmed Abouelazm, Kirollos Philops, Amr Amine, Yahia Golam

Statin-induced immune-mediated necrotising myopathy (IMNM) is an inflammatory myopathy that can present as proximal muscle weakness and, in some cases, as dysphagia and respiratory distress. In this report, we present a case of statin-induced IMNM in a 78-year-old male. The patient had significantly high levels of creatinine kinase and myoglobinuria and experienced gradual weakness in the proximal muscles for 1 month after initiating a 20 mg dose of Atorvastatin 10 months before admission. Rapid clinical improvement was observed with the use of high-dose glucocorticoids in conjunction with methotrexate.

他汀类药物诱导的免疫介导坏死性肌病(IMNM)是一种炎症性肌病,可表现为近端肌无力,在某些病例中还可表现为吞咽困难和呼吸窘迫。在本报告中,我们介绍了一例他汀类药物诱发的 IMNM 病例,患者是一名 78 岁的男性。患者入院前 10 个月开始服用 20 毫克剂量的阿托伐他汀,一个月后出现近端肌肉逐渐无力,肌酸激酶和肌红蛋白尿水平明显升高。在使用大剂量糖皮质激素和甲氨蝶呤后,临床症状迅速好转。
{"title":"Statin-induced, immune-mediated necrotising myopathy triggered by malignancy successfully treated with immunosuppression.","authors":"Ahmed Abouelazm, Kirollos Philops, Amr Amine, Yahia Golam","doi":"10.1016/j.clinme.2024.100217","DOIUrl":"10.1016/j.clinme.2024.100217","url":null,"abstract":"<p><p>Statin-induced immune-mediated necrotising myopathy (IMNM) is an inflammatory myopathy that can present as proximal muscle weakness and, in some cases, as dysphagia and respiratory distress. In this report, we present a case of statin-induced IMNM in a 78-year-old male. The patient had significantly high levels of creatinine kinase and myoglobinuria and experienced gradual weakness in the proximal muscles for 1 month after initiating a 20 mg dose of Atorvastatin 10 months before admission. Rapid clinical improvement was observed with the use of high-dose glucocorticoids in conjunction with methotrexate.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100217"},"PeriodicalIF":3.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11108855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A case of spinal epidural abscess concealed by delirium in a young man. 每月一课一例被谵妄掩盖的年轻男子脊髓硬膜外脓肿病例。
IF 3.6 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-01 Epub Date: 2024-05-04 DOI: 10.1016/j.clinme.2024.100214
Benjamin Page, Sam Waddy

Spinal epidural abscess is a rare but serious condition with poor outcomes. It's classic triad of new back pain, neurological deficit and fever is only present in 15% of cases at presentation and is initially misdiagnosed in 75-89%.6,7 Delaying treatment is associated with worse outcomes. Delirium is itself a risk factor for mortality but the disturbance in cognition and memory can also complicate clinical assessment.1-5 We present a case of delirium caused by, and obscuring, a spinal epidural abscess. This case highlights the difficulties in diagnosing spinal epidural abscesses, the need for a high index of suspicion for the condition and timely action to minimise morbidity. In addition, it demonstrates the value of treating unexplained delirium as an emergency and the danger of diagnostic premature closure. Finally, the importance of persistent clinical examination of the confused and non-cooperative patient.

脊髓硬膜外脓肿是一种罕见的严重疾病,治疗效果不佳。新发背痛、神经功能缺损和发热这三个典型症状仅占就诊病例的 15%,75%-89% 的病例最初会被误诊。谵妄本身是导致死亡的一个危险因素,但认知和记忆障碍也会使临床评估复杂化。1,2,3,4,5 我们介绍了一例由脊髓硬膜外脓肿引起并掩盖了谵妄的病例。本病例强调了诊断脊髓硬膜外脓肿的困难、高度怀疑该病的必要性以及及时采取措施将发病率降至最低的必要性。此外,该病例还证明了将不明原因的谵妄作为急症治疗的价值,以及诊断性过早关闭的危险性。最后,对神志不清和不合作的病人进行持续的临床检查非常重要。
{"title":"A case of spinal epidural abscess concealed by delirium in a young man.","authors":"Benjamin Page, Sam Waddy","doi":"10.1016/j.clinme.2024.100214","DOIUrl":"10.1016/j.clinme.2024.100214","url":null,"abstract":"<p><p>Spinal epidural abscess is a rare but serious condition with poor outcomes. It's classic triad of new back pain, neurological deficit and fever is only present in 15% of cases at presentation and is initially misdiagnosed in 75-89%.<sup>6,7</sup> Delaying treatment is associated with worse outcomes. Delirium is itself a risk factor for mortality but the disturbance in cognition and memory can also complicate clinical assessment.<sup>1-5</sup> We present a case of delirium caused by, and obscuring, a spinal epidural abscess. This case highlights the difficulties in diagnosing spinal epidural abscesses, the need for a high index of suspicion for the condition and timely action to minimise morbidity. In addition, it demonstrates the value of treating unexplained delirium as an emergency and the danger of diagnostic premature closure. Finally, the importance of persistent clinical examination of the confused and non-cooperative patient.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100214"},"PeriodicalIF":3.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11108811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Adenosine-sensitive ventricular tachycardia. 腺苷敏感性室性心动过速
IF 3.6 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-01 Epub Date: 2024-05-06 DOI: 10.1016/j.clinme.2024.100216
Rahul K Mukherjee, Magdi M Saba
{"title":"Adenosine-sensitive ventricular tachycardia.","authors":"Rahul K Mukherjee, Magdi M Saba","doi":"10.1016/j.clinme.2024.100216","DOIUrl":"10.1016/j.clinme.2024.100216","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100216"},"PeriodicalIF":3.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11130691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Design, implementation and evaluation of a spiral module combining data science, digital health and evidence-based medicine in the undergraduate medical curriculum: A mixed methods study. 在医学本科课程中结合数据科学、数字健康和循证医学的螺旋模块的设计、实施和评估:一项混合方法研究。
IF 3.6 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-01 Epub Date: 2024-04-20 DOI: 10.1016/j.clinme.2024.100207
Nader Al-Shakarchi, Jaya Upadhyay, Ivan Beckley, Faye Gishen, Anna Di Iorio, Robert Stephens, Sarah Clegg, Fiona C Lampe, Amitava Banerjee

Background: Digital health, data science and health informatics are increasingly important in health and healthcare, but largely ignored in undergraduate medical training.

Methods: In a large UK medical school, with staff and students, we co-designed a new, 'spiral' module (with iterative revisiting of content), covering data science, digital health and evidence-based medicine, implementing in September 2019 in all year groups with continuous evaluation and improvement until 2022.

Results: In 2018/19, a new module, 'Doctor as Data Scientist', was co-designed by academic staff (n = 14), students (n = 23), and doctors (n = 7). The module involves 22 staff, 120 h (43 sessions: 22 lectures, 15 group and six other) over a 5-year curriculum. Since September 2019, 5,200 students have been taught with good attendance. Module student satisfaction ratings were 92%, 84%, 84% and 81% in 2019, 2020, 2021 and 2022 respectively, compared to the overall course (81%).

Conclusions: We designed, implemented and evaluated a new undergraduate medical curriculum that combined data science and digital health with high student satisfaction ratings.

背景:数字健康、数据科学和健康信息学在健康和医疗保健领域的重要性与日俱增,但在本科医学培训中却被严重忽视:在英国一所大型医学院,我们与教职员工和学生共同设计了一个新的 "螺旋式 "模块(内容迭代重审),涵盖数据科学、数字健康和循证医学,于 2019 年 9 月在所有年级组实施,并在 2022 年之前进行持续评估和改进:2018/19学年,学术人员(14人)、学生(23人)和医生(7人)共同设计了新模块 "医生是数据科学家"。在为期 5 年的课程中,该模块涉及 22 名教职员工、120 个学时(43 节课:22 次讲座、15 次小组讨论和 6 次其他活动)。自 2019 年 9 月以来,已为 5200 名学生授课,出勤率良好。与整体课程(81%)相比,2019 年、2020 年、2021 年和 2022 年的模块学生满意度分别为 92%、84%、84% 和 81%:我们设计、实施并评估了一门新的医学本科课程,该课程结合了数据科学和数字健康,学生满意度很高。
{"title":"Design, implementation and evaluation of a spiral module combining data science, digital health and evidence-based medicine in the undergraduate medical curriculum: A mixed methods study.","authors":"Nader Al-Shakarchi, Jaya Upadhyay, Ivan Beckley, Faye Gishen, Anna Di Iorio, Robert Stephens, Sarah Clegg, Fiona C Lampe, Amitava Banerjee","doi":"10.1016/j.clinme.2024.100207","DOIUrl":"10.1016/j.clinme.2024.100207","url":null,"abstract":"<p><strong>Background: </strong>Digital health, data science and health informatics are increasingly important in health and healthcare, but largely ignored in undergraduate medical training.</p><p><strong>Methods: </strong>In a large UK medical school, with staff and students, we co-designed a new, 'spiral' module (with iterative revisiting of content), covering data science, digital health and evidence-based medicine, implementing in September 2019 in all year groups with continuous evaluation and improvement until 2022.</p><p><strong>Results: </strong>In 2018/19, a new module, 'Doctor as Data Scientist', was co-designed by academic staff (n = 14), students (n = 23), and doctors (n = 7). The module involves 22 staff, 120 h (43 sessions: 22 lectures, 15 group and six other) over a 5-year curriculum. Since September 2019, 5,200 students have been taught with good attendance. Module student satisfaction ratings were 92%, 84%, 84% and 81% in 2019, 2020, 2021 and 2022 respectively, compared to the overall course (81%).</p><p><strong>Conclusions: </strong>We designed, implemented and evaluated a new undergraduate medical curriculum that combined data science and digital health with high student satisfaction ratings.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100207"},"PeriodicalIF":3.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11091512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Doing simple things well can achieve significant benefits. 把简单的事情做好,就能取得显著的效益。
IF 3.6 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-05-01 DOI: 10.1016/j.clinme.2024.100219
Ponnusamy Saravanan
{"title":"Doing simple things well can achieve significant benefits.","authors":"Ponnusamy Saravanan","doi":"10.1016/j.clinme.2024.100219","DOIUrl":"10.1016/j.clinme.2024.100219","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"24 3","pages":"100219"},"PeriodicalIF":3.6,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11258704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141466706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Editorial: Learnings from all walks of medical practice. 社论:从各行各业的医疗实践中学习。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-03-01 DOI: 10.1016/j.clinme.2024.100201
Ponnusamy Saravanan
{"title":"Editorial: Learnings from all walks of medical practice.","authors":"Ponnusamy Saravanan","doi":"10.1016/j.clinme.2024.100201","DOIUrl":"10.1016/j.clinme.2024.100201","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"24 2","pages":"100201"},"PeriodicalIF":4.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11091438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pyroglutamate acidosis 2023. A review of 100 cases. 焦谷氨酸酸中毒 2023。100 例病例回顾。
IF 3.6 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-03-01 Epub Date: 2024-02-29 DOI: 10.1016/j.clinme.2024.100030
Gordon W Stewart

This review concerns the rare, acquired, usually iatrogenic, high-anion-gap metabolic acidosis, pyroglutamic acidosis. Pyroglutamate is a derivative of the amino acid glutamate, and is an intermediate in the 'glutathione cycle', by which glutathione is continuously synthesized and broken down. The vast majority of pyroglutamic acidosis cases occur in patients on regular, therapeutic doses of paracetamol. In about a third of cases, flucloxacillin is co-prescribed. In addition, the patients are almost always seriously unwell in other ways, typically with under-nourishment of some form. Paracetamol, with underlying disorders, conspires to divert the glutathione cycle, leading to the overproduction of pyroglutamate. Hypokalaemia is seen in about a third of cases. Once the diagnosis is suspected, it is simple to stop the paracetamol and change the antibiotic (if flucloxacillin is present), pending biochemistry. N-acetyl-cysteine can be given, but while the biochemical justification is compelling, the clinical evidence base is anecdotal.

本综述涉及一种罕见的、后天获得的、通常是先天性的高阴离子间隙代谢性酸中毒--焦谷氨酸酸中毒。焦谷氨酸是氨基酸谷氨酸的衍生物,是 "谷胱甘肽循环 "的中间产物,谷胱甘肽通过该循环不断合成和分解。绝大多数焦谷氨酸酸中毒病例都发生在定期服用治疗剂量扑热息痛的患者身上。在大约三分之一的病例中,患者会同时服用氟氯西林。此外,患者几乎都有其他方面的严重不适,通常是某种形式的营养不良。扑热息痛加上潜在的疾病,会改变谷胱甘肽的循环,导致焦谷氨酸的过度产生。约三分之一的病例会出现低钾血症。一旦怀疑确诊,只需停用扑热息痛并更换抗生素(如果使用氟氯西林),然后进行生化检查。可以给予 N-乙酰半胱氨酸,但虽然生化方面的理由很充分,临床方面的证据却只是传闻。
{"title":"Pyroglutamate acidosis 2023. A review of 100 cases.","authors":"Gordon W Stewart","doi":"10.1016/j.clinme.2024.100030","DOIUrl":"10.1016/j.clinme.2024.100030","url":null,"abstract":"<p><p>This review concerns the rare, acquired, usually iatrogenic, high-anion-gap metabolic acidosis, pyroglutamic acidosis. Pyroglutamate is a derivative of the amino acid glutamate, and is an intermediate in the 'glutathione cycle', by which glutathione is continuously synthesized and broken down. The vast majority of pyroglutamic acidosis cases occur in patients on regular, therapeutic doses of paracetamol. In about a third of cases, flucloxacillin is co-prescribed. In addition, the patients are almost always seriously unwell in other ways, typically with under-nourishment of some form. Paracetamol, with underlying disorders, conspires to divert the glutathione cycle, leading to the overproduction of pyroglutamate. Hypokalaemia is seen in about a third of cases. Once the diagnosis is suspected, it is simple to stop the paracetamol and change the antibiotic (if flucloxacillin is present), pending biochemistry. N-acetyl-cysteine can be given, but while the biochemical justification is compelling, the clinical evidence base is anecdotal.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100030"},"PeriodicalIF":3.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11091441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140021087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Optimising renal risk parameters in type 2 diabetes mellitus: Perspectives from a retinal viewpoint. 优化 2 型糖尿病肾脏风险参数:从视网膜角度看问题。
IF 3.6 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-03-01 Epub Date: 2024-02-16 DOI: 10.1016/j.clinme.2024.100031
Sarita Jacob, George I Varughese

Diabetic retinopathy and nephropathy share pathophysiological mechanisms and there is a defined correlation between the severity of both these microvascular complications from suboptimal glycaemic control. The reno-protective properties offered by sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists should be applicable to diabetic retinopathy as well. However, in patients with pre-existing diabetic retinopathy, sudden improvement in glycaemic control is well documented to cause early worsening of the changes in the retina that is usually transient. This paradoxical phenomenon tends to occur with longer duration of diabetes, higher HbA1c at the outset, rapid improvement of glucose levels and the magnitude of HbA1c reduction with addition of more agents to tighten metabolic control. Interestingly, this progression of pre-existing diabetic retinopathy is not quite observed with newer sodium-glucose co-transporter-2 inhibitors. This article discusses potential further areas of future research where mechanisms of renal protection can be translated to the retina.

糖尿病视网膜病变和肾病具有相同的病理生理机制,这两种微血管并发症的严重程度与血糖控制不理想之间存在明确的相关性。钠-葡萄糖共转运体-2 抑制剂和胰高血糖素样肽-1 受体激动剂所提供的肾脏保护特性也应适用于糖尿病视网膜病变。然而,有充分证据表明,对于已经存在糖尿病视网膜病变的患者来说,血糖控制的突然改善会导致视网膜病变的早期恶化,而这种恶化通常是短暂的。这种自相矛盾的现象往往发生在糖尿病病程较长、开始时 HbA1c 较高、血糖水平迅速改善以及在添加更多药物加强代谢控制后 HbA1c 下降幅度较大的情况下。有趣的是,新的钠-葡萄糖共转运体-2 抑制剂并没有观察到原有糖尿病视网膜病变的进展。本文讨论了未来研究的潜在领域,即肾脏保护机制可转化到视网膜。
{"title":"Optimising renal risk parameters in type 2 diabetes mellitus: Perspectives from a retinal viewpoint.","authors":"Sarita Jacob, George I Varughese","doi":"10.1016/j.clinme.2024.100031","DOIUrl":"10.1016/j.clinme.2024.100031","url":null,"abstract":"<p><p>Diabetic retinopathy and nephropathy share pathophysiological mechanisms and there is a defined correlation between the severity of both these microvascular complications from suboptimal glycaemic control. The reno-protective properties offered by sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists should be applicable to diabetic retinopathy as well. However, in patients with pre-existing diabetic retinopathy, sudden improvement in glycaemic control is well documented to cause early worsening of the changes in the retina that is usually transient. This paradoxical phenomenon tends to occur with longer duration of diabetes, higher HbA1c at the outset, rapid improvement of glucose levels and the magnitude of HbA1c reduction with addition of more agents to tighten metabolic control. Interestingly, this progression of pre-existing diabetic retinopathy is not quite observed with newer sodium-glucose co-transporter-2 inhibitors. This article discusses potential further areas of future research where mechanisms of renal protection can be translated to the retina.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100031"},"PeriodicalIF":3.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11091439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predictive value and interrater reliability of mental status and mobility assessment in the emergency department. 急诊科精神状态和行动能力评估的预测价值和相互间可靠性。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-03-01 Epub Date: 2024-02-16 DOI: 10.1016/j.clinme.2024.100027
Tanguy Espejo, Henk B Riedel, Sebastian Messingschlager, Wolfram Sonnleitner, John Kellett, Mikkel Brabrand, Tim Cooksley, Roland Bingisser, Christian H Nickel

Aim: To investigate the predictive value of both mental status, assessed with the AVPUC (Alert, responds to Voice, responds to Pain, Unresponsive, and new Confusion) scale, and mobility assessments, and their interrater reliability (IRR) between triage clinicians and a research team.

Method: Prospective study of consecutive patients who presented to an ED. Mental status and mobility were assessed by triage clinicians and by a dedicated research team.

Results: 4,191 patients were included. After adjustment for age and sex, patients with altered mental status have an odds ratio of 6.55 [4.09-10.24] to be admitted in the ICU and an odds ratio of 21.16 [12.06-37.01] to die within 30 days; patients with impaired mobility have an odds ratio of 7.08 [4.60-11.12] to be admitted in the ICU and an odds ratio of 12.87 [5.93-32.30] to die within 30 days. The kappa coefficient between triage clinicians and the research team for mental status assessment was 0.75, and 0.80 for mobility.

Conclusion: Assessment of mental status by the AVPUC scale, and mobility by a simple dichotomous scale are suitable for ED triage. Both altered mental status and impaired mobility are associated with adverse outcomes. Mental status and mobility assessment have good interrater reliability.

目的:研究用AVPUC(警觉、对声音有反应、对疼痛有反应、无反应和新困惑)量表评估的精神状态和行动能力评估的预测价值,以及分诊临床医生和研究小组之间的相互评分可靠性(IRR):方法:对急诊室连续就诊的患者进行前瞻性研究。结果:共纳入 4,191 名患者:结果:共纳入 4,191 名患者。对年龄和性别进行调整后,精神状态改变的患者入住重症监护室的几率为 6.55 [4.09-10.24],30 天内死亡的几率为 21.16 [12.06-37.01];行动能力受损的患者入住重症监护室的几率为 7.08 [4.60-11.12],30 天内死亡的几率为 12.87 [5.93-32.30]。分诊临床医生和研究小组对精神状态评估的卡帕系数为 0.75,对行动能力评估的卡帕系数为 0.80:结论:使用 AVPUC 量表评估精神状态和使用简单的二分法量表评估行动能力适用于急诊室分诊。精神状态改变和行动能力受损都与不良预后有关。精神状态和行动能力的评估具有良好的互测可靠性。
{"title":"Predictive value and interrater reliability of mental status and mobility assessment in the emergency department.","authors":"Tanguy Espejo, Henk B Riedel, Sebastian Messingschlager, Wolfram Sonnleitner, John Kellett, Mikkel Brabrand, Tim Cooksley, Roland Bingisser, Christian H Nickel","doi":"10.1016/j.clinme.2024.100027","DOIUrl":"10.1016/j.clinme.2024.100027","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the predictive value of both mental status, assessed with the AVPUC (Alert, responds to Voice, responds to Pain, Unresponsive, and new Confusion) scale, and mobility assessments, and their interrater reliability (IRR) between triage clinicians and a research team.</p><p><strong>Method: </strong>Prospective study of consecutive patients who presented to an ED. Mental status and mobility were assessed by triage clinicians and by a dedicated research team.</p><p><strong>Results: </strong>4,191 patients were included. After adjustment for age and sex, patients with altered mental status have an odds ratio of 6.55 [4.09-10.24] to be admitted in the ICU and an odds ratio of 21.16 [12.06-37.01] to die within 30 days; patients with impaired mobility have an odds ratio of 7.08 [4.60-11.12] to be admitted in the ICU and an odds ratio of 12.87 [5.93-32.30] to die within 30 days. The kappa coefficient between triage clinicians and the research team for mental status assessment was 0.75, and 0.80 for mobility.</p><p><strong>Conclusion: </strong>Assessment of mental status by the AVPUC scale, and mobility by a simple dichotomous scale are suitable for ED triage. Both altered mental status and impaired mobility are associated with adverse outcomes. Mental status and mobility assessment have good interrater reliability.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"100027"},"PeriodicalIF":4.4,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11091407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Clinical Medicine
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1