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Evidence-based appraisal of the role of SJTs in selection. 以证据为基础评估 SJT 在选拔中的作用。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-08 DOI: 10.7861/clinmed.2023-0295
Gurvinder Sahota, John McLachlan, Fiona Patterson, Paul Tiffin

A recent opinion article in Clinical Medicine promoted a new preference-based algorithm to allocate training places for the UK Foundation Programme Office (UKFPO). This replaced the previous process, which ranked candidates based on medical school academic achievement (the educational performance measure; EPM) and the score on a situational judgement test (SJT). Although not without risks, we believe that the new system has positive potential. In presenting their case, Sam et al summarised evidence relating to the UKFPO in an unbalanced way, leading to what we believe are erroneous inferences, particularly with regard to differential attainment. Here, we provide an example of how the general evidence base and conceptual understanding of the validity of SJTs for medical selection is poorly understood. We highlight important research findings that were not cited by Sam et al and provide what we believe is a more balanced and accurate interpretation of the evidence base relating the UKFPO SJT, and SJTs used in medical selection in general. We do this with particular reference to the validity of such tools in this context, as well as their potential impact on under-represented groups in medicine, compared with other selection assessments.

最近,《临床医学》(Clinical Medicine)杂志发表了一篇评论文章,推广了一种基于偏好的新算法,用于分配英国大学预科项目办公室(UKFPO)的培训名额。该算法取代了之前根据医学院学业成绩(教育成绩衡量标准;EPM)和情境判断测试(SJT)得分对候选人进行排名的程序。我们认为,尽管新系统并非没有风险,但它具有积极的潜力。Sam 等人在介绍他们的案例时,以一种不平衡的方式总结了与 UKFPO 有关的证据,导致了我们认为是错误的推论,尤其是关于不同成绩的推论。在此,我们举例说明了对医学选拔中SJT有效性的一般证据基础和概念理解是如何欠缺的。我们强调了萨姆等人没有引用的重要研究成果,并对与UKFPO SJT和一般医学选拔中使用的SJT相关的证据基础进行了我们认为更加平衡和准确的解释。在此过程中,我们特别提到了此类工具在此背景下的有效性,以及与其他遴选评估相比,此类工具对医学领域代表性不足群体的潜在影响。
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引用次数: 0
The importance of integration. 一体化的重要性。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-12-08 DOI: 10.7861/clinmed.2023-23.6.harv
Patrick Vallance
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引用次数: 0
Are we missing pancreatic exocrine insufficiency in 'at-risk' groups? Prospective assessment of the current practice and yield of faecal elastase testing in patients with diabetes mellitus, HIV and/or high alcohol intake. 我们是否遗漏了 "高危 "人群的胰腺外分泌功能不全?对糖尿病、艾滋病和/或酒精摄入量高的患者粪便弹性蛋白酶检测的现行做法和结果进行前瞻性评估。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-01 DOI: 10.7861/clinmed.2023-0185
Mustafa Jalal, John S Leeds, Hey-Long Ching, Andrei Oprescu, Ann Tunbridge, Julia Greig, Solomon Tesfaye, Andrew D Hopper

There is cumulative evidence that pancreatic exocrine insufficiency (PEI) is under-recognised and can occur in patients with 'at-risk' conditions. Thus, we aimed to assess the current practice and yield of requesting faecal elastase (FEL-1), an indicator of PEI, in patients with 'at-risk' conditions. We prospectively recruited patients attending secondary care clinics with diabetes mellitus (DM), people living with HIV (PLHIV) and inpatients admitted to hospital with high alcohol intake (HAI). All patients underwent testing with FEL-1. Those patients with PEI (FEL-1 <200 μg/g) were contacted and offered a follow-up review in gastroenterology clinic. In total, 188 patients were recruited (HAI, n=78; DM, n=64; and PLHIV, n=46). Previous FEL-1 testing had not been performed in any of the patients. The return rate of samples was 67.9% for patients with HAI, 76.6% for those with DM and 56.5% for those with PLHIV. The presence of PEI was shown in 20.4% of patients with DM, 15.4% of patients with PLHIV and 22.6% in those with HAI. Diarrhoea and bloating were the most reported symptoms in followed-up patients with low FEL-1 (31.8% and 22.7% of patients, respectively). Follow-up computed tomography (CT) scans in those patients with PEI identified chronic pancreatitis changes in 13.6% and pancreatic atrophy in 31.8% of patients. These results suggest that there is a lack of testing for PEI in 'at-risk' groups. Our findings also suggest that using FEL-1 to test for PEI in patients with DM, PLHIV and HAI has a significant impact, although further studies are required to validate these findings.

越来越多的证据表明,胰腺外分泌功能不全(PEI)未得到充分认识,而且可能发生在 "高危 "患者身上。因此,我们旨在评估目前在 "高危 "患者中检测粪便弹性蛋白酶(FEL-1)的方法和结果。我们前瞻性地招募了在二级医疗诊所就诊的糖尿病(DM)患者、艾滋病病毒感染者(PLHIV)和高酒精摄入量(HAI)住院患者。所有患者都接受了 FEL-1 检测。患有 PEI 的患者(FEL-1
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引用次数: 0
Crohn's disease: an update. 克罗恩病:最新进展。
IF 3.6 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-01 DOI: 10.7861/clinmed.2023-0493
Ella Cockburn, Shahed Kamal, Andrea Chan, Vikram Rao, Tianwei Liu, Joanna Y Huang, Jonathan P Segal

Crohn's disease (CD) is a chronic, relapsing and remitting inflammatory bowel disease (IBD) that is increasing in incidence and prevalence globally. Management aims to achieve endoscopic healing, symptom resolution and improvement in quality of life. Therapeutic approaches in CD vary depending on disease phenotype. Thiopurines are important in steroid-sparing maintenance therapy, while anti-tumour necrosis factor agents play a fundamental role, especially in fistulising CD. Suboptimal response to these medications may require escalation to other immunosuppressive and biologic therapies, and surgical intervention is still required in a proportion of patients. Tailoring treatment to target specific patient phenotypes, disease severity and patient wishes is becoming more feasible with the growing array of therapeutic options in CD.

克罗恩病(Crohn's disease,CD)是一种慢性、复发性和缓解性炎症性肠病(IBD),在全球的发病率和流行率都在不断上升。治疗的目的是实现内镜下痊愈、症状缓解和改善生活质量。CD 的治疗方法因疾病表型而异。硫嘌呤类药物在节省类固醇的维持治疗中非常重要,而抗肿瘤坏死因子药物则发挥着重要作用,尤其是在瘘管型 CD 中。如果对这些药物的反应不理想,可能需要升级到其他免疫抑制和生物疗法,一部分患者仍需要手术治疗。随着 CD 治疗方案的不断增加,针对特定患者表型、疾病严重程度和患者意愿进行定制治疗变得越来越可行。
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引用次数: 0
Acute hot joints on the medical take: tapping into skills of the workforce. 医疗服务中的急诊热点:利用劳动力的技能。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-01 DOI: 10.7861/clinmed.23-6-s86
Koushan Kouranloo, Jennifer Christie
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引用次数: 0
Diagnostic uncertainty and empiric treatment of suspected urinary tract infection in older adults in the emergency department: a retrospective single-centre descriptive study. 急诊科中老年人疑似尿路感染的诊断不确定性和经验性治疗:一项回顾性单中心描述性研究。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-01 DOI: 10.7861/clinmed.23-6-s51
Keshinie Samarasekara
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引用次数: 0
Diffusion of responsibility: a clinical audit. 责任分散:临床审计。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-01 DOI: 10.7861/clinmed.23-6-s109
Sian Harkin
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引用次数: 0
Janus kinase inhibitor audit. Janus 激酶抑制剂审计。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-01 DOI: 10.7861/clinmed.23-6-s114
Jenni Beck, Samantha Banford
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引用次数: 0
Linear IgA bullous dermatoses in an Indian child with IgG predominance: a unique case report from a tertiary care hospital of Eastern India. 印度儿童以 IgG 为主的线性 IgA 大疱性皮肤病:印度东部一家三级医院的独特病例报告。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-01 DOI: 10.7861/clinmed.23-6-s31
Soumi Biswas, Arun Achar
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引用次数: 0
Reliability of BNP to exclude heart failure. BNP 排除心力衰竭的可靠性。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-01 DOI: 10.7861/clinmed.23-6-s2
Myat Lwin, Kyar Chi Kyaw Win, Ben Sieniewicz
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引用次数: 0
期刊
Clinical Medicine
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