Pub Date : 2023-12-08DOI: 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.
{"title":"Evidence-based appraisal of the role of SJTs in selection.","authors":"Gurvinder Sahota, John McLachlan, Fiona Patterson, Paul Tiffin","doi":"10.7861/clinmed.2023-0295","DOIUrl":"10.7861/clinmed.2023-0295","url":null,"abstract":"<p><p>A recent opinion article in <i>Clinical Medicine</i> 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 <i>et al</i> 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 <i>et al</i> 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.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":" ","pages":"641-642"},"PeriodicalIF":4.4,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11046611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138486856","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}
Pub Date : 2023-11-01DOI: 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.
{"title":"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.","authors":"Mustafa Jalal, John S Leeds, Hey-Long Ching, Andrei Oprescu, Ann Tunbridge, Julia Greig, Solomon Tesfaye, Andrew D Hopper","doi":"10.7861/clinmed.2023-0185","DOIUrl":"10.7861/clinmed.2023-0185","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"23 6","pages":"588-593"},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11046658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138794547","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}
Pub Date : 2023-11-01DOI: 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。
{"title":"Crohn's disease: an update.","authors":"Ella Cockburn, Shahed Kamal, Andrea Chan, Vikram Rao, Tianwei Liu, Joanna Y Huang, Jonathan P Segal","doi":"10.7861/clinmed.2023-0493","DOIUrl":"10.7861/clinmed.2023-0493","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"23 6","pages":"549-557"},"PeriodicalIF":3.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11298500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138794794","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}
Pub Date : 2023-11-01DOI: 10.7861/clinmed.23-6-s86
Koushan Kouranloo, Jennifer Christie
{"title":"Acute hot joints on the medical take: tapping into skills of the workforce.","authors":"Koushan Kouranloo, Jennifer Christie","doi":"10.7861/clinmed.23-6-s86","DOIUrl":"10.7861/clinmed.23-6-s86","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"23 Suppl 6","pages":"86"},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11046624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139105830","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}
Pub Date : 2023-11-01DOI: 10.7861/clinmed.23-6-s51
Keshinie Samarasekara
{"title":"Diagnostic uncertainty and empiric treatment of suspected urinary tract infection in older adults in the emergency department: a retrospective single-centre descriptive study.","authors":"Keshinie Samarasekara","doi":"10.7861/clinmed.23-6-s51","DOIUrl":"10.7861/clinmed.23-6-s51","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"23 Suppl 6","pages":"51-52"},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11046647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139105912","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}
Pub Date : 2023-11-01DOI: 10.7861/clinmed.23-6-s31
Soumi Biswas, Arun Achar
{"title":"Linear IgA bullous dermatoses in an Indian child with IgG predominance: a unique case report from a tertiary care hospital of Eastern India.","authors":"Soumi Biswas, Arun Achar","doi":"10.7861/clinmed.23-6-s31","DOIUrl":"10.7861/clinmed.23-6-s31","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"23 Suppl 6","pages":"31-32"},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11046625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139105938","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}
{"title":"Reliability of BNP to exclude heart failure.","authors":"Myat Lwin, Kyar Chi Kyaw Win, Ben Sieniewicz","doi":"10.7861/clinmed.23-6-s2","DOIUrl":"10.7861/clinmed.23-6-s2","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"23 Suppl 6","pages":"2"},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11046622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139105948","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}