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The prevalence and associated risk factors of osteoporosis in hiv positive postmenopausal women on combined antiretroviral therapy. 接受联合抗逆转录病毒疗法的艾滋病毒阳性绝经后妇女骨质疏松症的患病率和相关风险因素。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-01 DOI: 10.7861/clinmed.23-6-s53
Chinwada Pasca, Chiratidzo Ellen Ndhlovu, Alan Mcgregor, Cynthia Mukwasi-Kahari
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引用次数: 0
The rapid progression of Creutzfeldt-Jakob disease with concomitant COVID-19 infection: a case report. 克雅氏病快速进展并伴有 COVID-19 感染:一份病例报告。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-01 DOI: 10.7861/clinmed.23-6-s21
Adrian McGrath, Hari Pai, Aidan Clack
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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
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 : 2023-11-01 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
Lactic acidosis in a patient with cancer. 癌症患者出现乳酸酸中毒。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-01 DOI: 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。
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引用次数: 0
Research activity among physicians in the United Kingdom: results from the Royal College of Physicians Census 2022. 英国医生的研究活动:英国皇家内科学院 2022 年普查结果。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-01 DOI: 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.

我们介绍了爱丁堡、格拉斯哥和伦敦皇家医学院联合会 2022 年的普查结果,内容涉及医生是否从事研究以及他们遇到的障碍。40%的医生表示,他们在从事临床工作的同时还进行研究。对回答进行的多变量分析表明,男性说自己从事研究的可能性是女性的 1.6 倍。开展研究的主要障碍是没有足够的时间、组织因素和缺乏自信。在这篇观点文章中,我们将讨论其中的一些挑战以及如何应对这些挑战。
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引用次数: 0
Supervision, scheduling, satisfaction and shared working: how experiences of junior doctors relate to excess mortality within the NHS. 监督、日程安排、满意度和共同工作:初级医生的经历与国家医疗服务系统内死亡率过高的关系。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-01 DOI: 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.

背景我们试图探索受训医生感知与患者超额死亡率之间的关联:分析了来自两个公开数据库的数据,这些数据反映了 2012 年至 2019 年期间 81 家英国国家医疗服务体系医疗机构的死亡率和受训医生满意度。计算了皮尔逊相关系数:结果:学员感知的所有领域都与超额死亡率相关。非工作时间的临床督导(R=-0.44;p结论:受训医生对临床督导的看法与死亡率相关:受训医生对国家医疗服务系统内临床监督、轮班设计和团队合作的看法与患者死亡率超标始终相关。对这些关联的进一步探讨可以发现干预的机会,从而降低过高的患者死亡率。鉴于我们的研究结果具有重要的临床意义,各机构应考虑迅速实施以证据为基础的干预措施。
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引用次数: 0
A 'catastrophic' fall! 灾难性 "的坠落
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-01 DOI: 10.7861/clinmed.23-6-s25
Farishta Khan, Rona Applewaite, Anthony Abdullah
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引用次数: 0
A case of ANCA-associated vasculitis presenting as a chronic cough with night sweats in an adult male. 一例表现为慢性咳嗽伴盗汗的 ANCA 相关性血管炎成年男性病例。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-01 DOI: 10.7861/clinmed.23-6-s50
Jacob Corum Williams, Ryan Malcolm Hum, Silke Brix, Pauline Ho
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引用次数: 0
A case of HSV2 vasculitis causing multi-territory ischaemic stroke in an immunocompetent man. 一例由 HSV2 型血管炎引起的免疫功能正常男子多区缺血性中风。
IF 4.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-11-01 DOI: 10.7861/clinmed.23-6-s33
Okkar Kyaw, Gagira Mudalige
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引用次数: 0
期刊
Clinical Medicine
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