Pub Date : 2023-11-01DOI: 10.7861/clinmed.23-6-s53
Chinwada Pasca, Chiratidzo Ellen Ndhlovu, Alan Mcgregor, Cynthia Mukwasi-Kahari
{"title":"The prevalence and associated risk factors of osteoporosis in hiv positive postmenopausal women on combined antiretroviral therapy.","authors":"Chinwada Pasca, Chiratidzo Ellen Ndhlovu, Alan Mcgregor, Cynthia Mukwasi-Kahari","doi":"10.7861/clinmed.23-6-s53","DOIUrl":"10.7861/clinmed.23-6-s53","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"23 Suppl 6","pages":"53-54"},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11046635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139105959","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-s21
Adrian McGrath, Hari Pai, Aidan Clack
{"title":"The rapid progression of Creutzfeldt-Jakob disease with concomitant COVID-19 infection: a case report.","authors":"Adrian McGrath, Hari Pai, Aidan Clack","doi":"10.7861/clinmed.23-6-s21","DOIUrl":"10.7861/clinmed.23-6-s21","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"23 Suppl 6","pages":"21-22"},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11046599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139105960","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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140142857","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}
Pub Date : 2023-11-01DOI: 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 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.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"23 6","pages":"641-642"},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140142859","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}
Pub Date : 2023-11-01DOI: 10.7861/clinmed.2023-0391
Mayra Oseguera, Amy A Yau
Lactic acidosis is commonly associated with tissue hypoperfusion and gives rise to concern regarding hypoxia or underlying hypotension. In the cancer patient, especially one undergoing chemotherapy, there is always concern for sepsis; however, in the otherwise clincially stable patient with cancer, type B lactic acidosis can also be related to their underlying malignancy. It is considered a haematological emergency given its high mortality rate. However, despite the urgency to treat type B lactic acidosis in these circumstances, treatment options beyond treatment of the malignancy are limited, and its presence portends a poor prognosis. This case highlights our current understanding of type B lactic acidosis and an approach to lactic acidosis evaluation in the cancer patient.
乳酸酸中毒通常与组织灌注不足有关,会引起对缺氧或潜在低血压的担忧。对于癌症患者,尤其是正在接受化疗的患者来说,脓毒症总是令人担忧的;然而,对于病情稳定的癌症患者来说,B 型乳酸性酸中毒也可能与潜在的恶性肿瘤有关。由于死亡率较高,B 型乳酸酸中毒被视为血液病急症。然而,尽管在这种情况下治疗 B 型乳酸酸中毒迫在眉睫,但除了治疗恶性肿瘤外,其他治疗方法也很有限,而且出现这种情况预示着预后不良。本病例强调了我们目前对 B 型乳酸酸中毒的理解,以及对癌症患者乳酸酸中毒的评估方法。
{"title":"Lactic acidosis in a patient with cancer.","authors":"Mayra Oseguera, Amy A Yau","doi":"10.7861/clinmed.2023-0391","DOIUrl":"10.7861/clinmed.2023-0391","url":null,"abstract":"<p><p>Lactic acidosis is commonly associated with tissue hypoperfusion and gives rise to concern regarding hypoxia or underlying hypotension. In the cancer patient, especially one undergoing chemotherapy, there is always concern for sepsis; however, in the otherwise clincially stable patient with cancer, type B lactic acidosis can also be related to their underlying malignancy. It is considered a haematological emergency given its high mortality rate. However, despite the urgency to treat type B lactic acidosis in these circumstances, treatment options beyond treatment of the malignancy are limited, and its presence portends a poor prognosis. This case highlights our current understanding of type B lactic acidosis and an approach to lactic acidosis evaluation in the cancer patient.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"23 6","pages":"615-617"},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140142863","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}
Pub Date : 2023-11-01DOI: 10.7861/clinmed.2023-0388
Subashini Chandrapalan, Chris Phillips, Nina Newbery, Sarah Logan, Ramesh Arasaradnam
We present the results of the 2022 Census of the Federation of Royal Colleges of Physicians of Edinburgh, Glasgow and London on whether physicians undertake research and the barriers they have encountered. 40% of physicians reported that they undertook research alongside their clinical work. Multivariate analysis of the responses showed that men were 1.6 times more likely to say they undertake research than women. The main barriers to undertaking research were having enough time, organisational factors and a lack of confidence. In this opinion piece we discuss some of the challenges and how they could be addressed.
{"title":"Research activity among physicians in the United Kingdom: results from the Royal College of Physicians Census 2022.","authors":"Subashini Chandrapalan, Chris Phillips, Nina Newbery, Sarah Logan, Ramesh Arasaradnam","doi":"10.7861/clinmed.2023-0388","DOIUrl":"10.7861/clinmed.2023-0388","url":null,"abstract":"<p><p>We present the results of the 2022 Census of the Federation of Royal Colleges of Physicians of Edinburgh, Glasgow and London on whether physicians undertake research and the barriers they have encountered. 40% of physicians reported that they undertook research alongside their clinical work. Multivariate analysis of the responses showed that men were 1.6 times more likely to say they undertake research than women. The main barriers to undertaking research were having enough time, organisational factors and a lack of confidence. In this opinion piece we discuss some of the challenges and how they could be addressed.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"23 6","pages":"637-640"},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140142867","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}
Pub Date : 2023-11-01DOI: 10.7861/clinmed.2023-0129
Jack Charles Barton, Daniel Richardson, Amber Elyse Corrigan, Matthew R Solomons, Ashvin Kuri, Jonathan Round
Background: We sought to explore associations between trainee doctor perception and excess patient mortality.
Methods: Data from two publicly available databases reflecting mortality and components of trainee satisfaction within 81 NHS healthcare institutions between the years 2012 and 2019 were analysed. Pearson's correlation coefficients were calculated.
Results: All domains of trainee perception were correlated with excess mortality. Clinical supervision out of hours (R=-0.44; p<0.0001), teamwork (R=-0.36; p<0.0001) and clinical supervision at any time (R=-0.35; p<0.0001) were most strongly correlated. Most associations remained consistent year on year.
Conclusion: Trainee doctor perceptions of clinical supervision, rota design and teamwork within the NHS are consistently correlated with excess patient mortality. Further exploration of these associations could identify opportunities for interventions to reduce excess patient mortality. Given the clinical significance of our findings, organisations should consider rapid implementation of evidence-based interventions where they exist.
{"title":"Supervision, scheduling, satisfaction and shared working: how experiences of junior doctors relate to excess mortality within the NHS.","authors":"Jack Charles Barton, Daniel Richardson, Amber Elyse Corrigan, Matthew R Solomons, Ashvin Kuri, Jonathan Round","doi":"10.7861/clinmed.2023-0129","DOIUrl":"10.7861/clinmed.2023-0129","url":null,"abstract":"<p><strong>Background: </strong>We sought to explore associations between trainee doctor perception and excess patient mortality.</p><p><strong>Methods: </strong>Data from two publicly available databases reflecting mortality and components of trainee satisfaction within 81 NHS healthcare institutions between the years 2012 and 2019 were analysed. Pearson's correlation coefficients were calculated.</p><p><strong>Results: </strong>All domains of trainee perception were correlated with excess mortality. Clinical supervision out of hours (R=-0.44; p<0.0001), teamwork (R=-0.36; p<0.0001) and clinical supervision at any time (R=-0.35; p<0.0001) were most strongly correlated. Most associations remained consistent year on year.</p><p><strong>Conclusion: </strong>Trainee doctor perceptions of clinical supervision, rota design and teamwork within the NHS are consistently correlated with excess patient mortality. Further exploration of these associations could identify opportunities for interventions to reduce excess patient mortality. Given the clinical significance of our findings, organisations should consider rapid implementation of evidence-based interventions where they exist.</p>","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"23 6","pages":"582-587"},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140142870","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}
Pub Date : 2023-11-01DOI: 10.7861/clinmed.23-6-s50
Jacob Corum Williams, Ryan Malcolm Hum, Silke Brix, Pauline Ho
{"title":"A case of ANCA-associated vasculitis presenting as a chronic cough with night sweats in an adult male.","authors":"Jacob Corum Williams, Ryan Malcolm Hum, Silke Brix, Pauline Ho","doi":"10.7861/clinmed.23-6-s50","DOIUrl":"https://doi.org/10.7861/clinmed.23-6-s50","url":null,"abstract":"","PeriodicalId":10492,"journal":{"name":"Clinical Medicine","volume":"23 Suppl 6 ","pages":"50"},"PeriodicalIF":4.4,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848135","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}