Muhammad Hamza Shah, Salim Usman, Sakshi Roy, Arjun Ahluwalia, Amer Harky
This scholarly inquiry delves into the historical significance of two enduring medical symbols: the Rod of Asclepius and the Caduceus. Tracing their origins back to ancient Greek mythology, we uncover their distinct identities and profound meanings as symbols of healing, unity among medical practitioners, and ethical responsibilities. Beyond aesthetics, these emblems serve as powerful educational tools, fostering universal understanding and connecting modern medicine to its historical heritage. Consequently, embracing their true essence can inspire genuine dedication to the noble mission of caring for others.
{"title":"Caduceus vs. Rod of Asclepius: A Serpentine Dilemma in Medical Iconography.","authors":"Muhammad Hamza Shah, Salim Usman, Sakshi Roy, Arjun Ahluwalia, Amer Harky","doi":"10.1093/postmj/qgad093","DOIUrl":"10.1093/postmj/qgad093","url":null,"abstract":"<p><p>This scholarly inquiry delves into the historical significance of two enduring medical symbols: the Rod of Asclepius and the Caduceus. Tracing their origins back to ancient Greek mythology, we uncover their distinct identities and profound meanings as symbols of healing, unity among medical practitioners, and ethical responsibilities. Beyond aesthetics, these emblems serve as powerful educational tools, fostering universal understanding and connecting modern medicine to its historical heritage. Consequently, embracing their true essence can inspire genuine dedication to the noble mission of caring for others.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41183391","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}
First popularized almost a century ago in epidemiologic research by Ronald Fisher and Jerzy Neyman, the P-value has become perhaps the most misunderstood and even misused statistical value or descriptor. Indeed, modern clinical research has now come to be centered around and guided by an arbitrary P-value of <0.05 as a magical threshold for significance, so much so that experimental design, reporting of experimental findings, and interpretation and adoption of such findings have become largely dependent on this "significant" P-value. This has given rise to multiple biases in the overall body of biomedical literature that threatens the very validity of clinical research. Ultimately, a drive toward reporting a "significant" P-value (by various statistical manipulations) risks creating a falsely positive body of science, leading to (i) wasted resources in pursuing fruitless research and (ii) futile or even harmful policies/therapeutic recommendations. This article reviews the history of the P-value, the conceptual basis of P-value in the context of hypothesis testing and challenges in critically appraising clinical evidence vis-à-vis the P-value. This review is aimed at raising awareness of the pitfalls of this rigid observation of the threshold of statistical significance when evaluating clinical trials and to generate discussion regarding whether the scientific body needs a rethink about how we decide clinical significance.
近一个世纪前,Ronald Fisher 和 Jerzy Neyman 首次在流行病学研究中推广 P 值,它可能已成为最容易被误解甚至滥用的统计值或描述符。事实上,现代临床研究现在已经以任意的 P 值为中心和指导。
{"title":"Evidence-based medicine or statistically manipulated medicine? Are we slaves to the P-value?","authors":"Harsh Goel, Divisha Raheja, Sunil K Nadar","doi":"10.1093/postmj/qgae012","DOIUrl":"10.1093/postmj/qgae012","url":null,"abstract":"<p><p>First popularized almost a century ago in epidemiologic research by Ronald Fisher and Jerzy Neyman, the P-value has become perhaps the most misunderstood and even misused statistical value or descriptor. Indeed, modern clinical research has now come to be centered around and guided by an arbitrary P-value of <0.05 as a magical threshold for significance, so much so that experimental design, reporting of experimental findings, and interpretation and adoption of such findings have become largely dependent on this \"significant\" P-value. This has given rise to multiple biases in the overall body of biomedical literature that threatens the very validity of clinical research. Ultimately, a drive toward reporting a \"significant\" P-value (by various statistical manipulations) risks creating a falsely positive body of science, leading to (i) wasted resources in pursuing fruitless research and (ii) futile or even harmful policies/therapeutic recommendations. This article reviews the history of the P-value, the conceptual basis of P-value in the context of hypothesis testing and challenges in critically appraising clinical evidence vis-à-vis the P-value. This review is aimed at raising awareness of the pitfalls of this rigid observation of the threshold of statistical significance when evaluating clinical trials and to generate discussion regarding whether the scientific body needs a rethink about how we decide clinical significance.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139707634","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}
Sexual harassment (SH) is a particularly harmful type of harassment that can inflict lasting psychological harm on victims. Within the healthcare sector, it negatively impacts teamwork, communication, and potentially compromises patient care. While concerns about workplace SH, including in healthcare, are long-standing, the #MeToo movement has brought renewed scrutiny to this issue since late 2017. Despite increased awareness, evidence suggests that SH remains prevalent in healthcare settings and shows no signs of decline over time. Therefore, there is an urgent need for effective training and intervention measures to enhance the identification of potential sexually offensive behaviors, thus fostering a work environment characterized by respect and inclusivity.
{"title":"Safeguarding healthcare professionals from sexual harassment in the workplace: urgent need for effective training and education.","authors":"Yu Xiao, Liang Liu, Zhou Zhang","doi":"10.1093/postmj/qgae029","DOIUrl":"10.1093/postmj/qgae029","url":null,"abstract":"<p><p>Sexual harassment (SH) is a particularly harmful type of harassment that can inflict lasting psychological harm on victims. Within the healthcare sector, it negatively impacts teamwork, communication, and potentially compromises patient care. While concerns about workplace SH, including in healthcare, are long-standing, the #MeToo movement has brought renewed scrutiny to this issue since late 2017. Despite increased awareness, evidence suggests that SH remains prevalent in healthcare settings and shows no signs of decline over time. Therefore, there is an urgent need for effective training and intervention measures to enhance the identification of potential sexually offensive behaviors, thus fostering a work environment characterized by respect and inclusivity.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140132386","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}
Background: Lack of communication in a family's preferred language is inequitable and results in inferior care. Pediatric residents provide care to many families with non-English or French language preferences (NEFLP). There is no data available about how Canadian pediatric residents use interpreters, making it difficult to develop targeted interventions to improve patient experience.
Objectives: Our purpose was to assess translation services in pediatric training centers and evaluate resident perception of their clinical skills when working with NEFLP patients and families. This survey represents the first collection of data from Canadian pediatric residents about interpreter services.
Results: 122 residents responded. Interpreter services were widely available but underused in a variety of clinical situations. Most (85%) residents felt they provided better care to patients who shared their primary language (English or French), compared with families who preferred other languages-even when an interpreter was present. This finding was consistent across four self-assessed clinical skills.
Conclusions: Residents are more confident in their clinical and communication skills when working with families who share their primary language. Our findings suggest that residents lack the training and confidence to provide equal care to families with varying language preferences. Pediatric training programs should develop curriculum content that targets safe and effective interpreter use while reviewing non-spoken aspects of cultural awareness and safety.
Akiho Araki, Kosuke Ishizuka, Ryuji Uchida, Kenya Ie
{"title":"Mesenteric phlebosclerosis caused by traditional Chinese herbal medicine.","authors":"Akiho Araki, Kosuke Ishizuka, Ryuji Uchida, Kenya Ie","doi":"10.1093/postmj/qgae032","DOIUrl":"10.1093/postmj/qgae032","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140140625","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}
Background: Psoas abscess (PA) is an uncommon disease that has been increasingly reported in the recent years. We reviewed patients with PA and analyzed their clinical characteristics to improve our understanding of this rare disorder.
Methods: We retrospectively reviewed the clinical presentations, microbiology, and outcomes of patients with PA between 2011 and 2022 at the Zhejiang Provincial People's Hospital in China.
Results: There were 40 adult patients identified with the discharge diagnosis of PA. The mean age was 60 years, and 67.5% of the patients were male. Primary symptoms were typically nonspecific. In all, 20 abscesses were considered secondary, and the most common was infective spondylitis. The most common causative organism for primary PA was Staphylococcus aureus, followed by Escherichia coli, whereas multiple bacterial species were found in secondary abscesses. The overall in-hospital mortality rate was 5%. Patients with secondary PA had a longer hospital stay.
Conclusion: PA, as a serious infectious condition, usually presents with nonspecific symptoms and laboratory test results, making early diagnosis difficult. These profiles differed from those reported in the present study. The initial clinical status and subsequent imaging studies can lead to favorable outcomes.
背景:腰大肌脓肿(PA)是一种不常见的疾病,近年来有越来越多的报道。我们回顾性分析了腰大肌脓肿患者的临床特征,以加深我们对这种罕见疾病的了解:方法:我们回顾性研究了中国浙江省人民医院 2011 年至 2022 年期间 PA 患者的临床表现、微生物学和治疗结果:结果:40 名成年患者出院诊断为 PA。平均年龄为 60 岁,67.5% 的患者为男性。主要症状通常为非特异性。共有 20 例脓肿被认为是继发性的,其中最常见的是感染性脊柱炎。原发性脓肿最常见的致病菌是金黄色葡萄球菌,其次是大肠杆菌,而继发性脓肿则有多种细菌。院内总死亡率为 5%。继发性 PA 患者的住院时间较长:结论:PA 作为一种严重的感染性疾病,通常表现为非特异性症状和实验室检查结果,因此很难早期诊断。这些情况与本研究中的报告有所不同。最初的临床状态和随后的影像学检查可带来良好的结果。
{"title":"Psoas abscess: an uncommon disorder.","authors":"Chengan Xu, Zhewen Zhou, Shouhao Wang, Wenya Ren, Xingdi Yang, Hanzhu Chen, Wei Zheng, Qiaoqiao Yin, Hongying Pan","doi":"10.1093/postmj/qgad110","DOIUrl":"10.1093/postmj/qgad110","url":null,"abstract":"<p><strong>Background: </strong>Psoas abscess (PA) is an uncommon disease that has been increasingly reported in the recent years. We reviewed patients with PA and analyzed their clinical characteristics to improve our understanding of this rare disorder.</p><p><strong>Methods: </strong>We retrospectively reviewed the clinical presentations, microbiology, and outcomes of patients with PA between 2011 and 2022 at the Zhejiang Provincial People's Hospital in China.</p><p><strong>Results: </strong>There were 40 adult patients identified with the discharge diagnosis of PA. The mean age was 60 years, and 67.5% of the patients were male. Primary symptoms were typically nonspecific. In all, 20 abscesses were considered secondary, and the most common was infective spondylitis. The most common causative organism for primary PA was Staphylococcus aureus, followed by Escherichia coli, whereas multiple bacterial species were found in secondary abscesses. The overall in-hospital mortality rate was 5%. Patients with secondary PA had a longer hospital stay.</p><p><strong>Conclusion: </strong>PA, as a serious infectious condition, usually presents with nonspecific symptoms and laboratory test results, making early diagnosis difficult. These profiles differed from those reported in the present study. The initial clinical status and subsequent imaging studies can lead to favorable outcomes.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139747225","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}
Background: Multiple displaced rib fractures often result in a poor prognosis. Open reduction and internal fixation has been shown to provide benefits for patients with displaced rib fractures and flail chest. Nevertheless, for patients who are unwilling or unsuitable for surgery, the therapeutic options are limited. We developed a novel plastic vacuum device for rib fractures external stabilization. This study aims to compare the therapeutic efficacy of this device against a traditional chest strap in polytrauma patients with multiple rib fractures.
Methods: A retrospective investigation was conducted on polytrauma patients with multiple rib fractures admitted to our trauma center between March 2020 and March 2023. Patients were categorized into two groups: vacuum external fixation and chest strap. Comparative analysis was conducted on baseline parameters, injury characteristics, and clinical outcomes between the two groups.
Results: In this study, 54 patients were included, with 28 receiving chest strap and 26 undergoing vacuum external fixation. Results showed that, at 3 days and 7 days postintervention, the vacuum external fixation group had significantly lower visual analog scale scores during deep breathing and coughing (P < .05). Vacuum external fixation also reduced pleural drainage duration and volume, as well as lowered the risk of pneumonia and other complications (P < .05). Furthermore, the vacuum external fixation group demonstrated notable improvements in vital capacity, tidal volume, blood-gas test results, and a shorter hospital length of stay.
Conclusions: According to the study findings, vacuum external fixation appears to offer benefits to patients with multiple rib fractures, potentially reducing the risk of complications and improving overall clinical outcomes.
{"title":"The therapeutic value of vacuum external fixation in polytrauma patients with multiple ribs fracture.","authors":"Dongfang Wang, Shuaipeng Gu, Huaqing Shen, Tonghan Li, Enzhi Yin, Xiang Wang, Wei Gao, Yiliu Liao","doi":"10.1093/postmj/qgae020","DOIUrl":"10.1093/postmj/qgae020","url":null,"abstract":"<p><strong>Background: </strong>Multiple displaced rib fractures often result in a poor prognosis. Open reduction and internal fixation has been shown to provide benefits for patients with displaced rib fractures and flail chest. Nevertheless, for patients who are unwilling or unsuitable for surgery, the therapeutic options are limited. We developed a novel plastic vacuum device for rib fractures external stabilization. This study aims to compare the therapeutic efficacy of this device against a traditional chest strap in polytrauma patients with multiple rib fractures.</p><p><strong>Methods: </strong>A retrospective investigation was conducted on polytrauma patients with multiple rib fractures admitted to our trauma center between March 2020 and March 2023. Patients were categorized into two groups: vacuum external fixation and chest strap. Comparative analysis was conducted on baseline parameters, injury characteristics, and clinical outcomes between the two groups.</p><p><strong>Results: </strong>In this study, 54 patients were included, with 28 receiving chest strap and 26 undergoing vacuum external fixation. Results showed that, at 3 days and 7 days postintervention, the vacuum external fixation group had significantly lower visual analog scale scores during deep breathing and coughing (P < .05). Vacuum external fixation also reduced pleural drainage duration and volume, as well as lowered the risk of pneumonia and other complications (P < .05). Furthermore, the vacuum external fixation group demonstrated notable improvements in vital capacity, tidal volume, blood-gas test results, and a shorter hospital length of stay.</p><p><strong>Conclusions: </strong>According to the study findings, vacuum external fixation appears to offer benefits to patients with multiple rib fractures, potentially reducing the risk of complications and improving overall clinical outcomes.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139747226","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}
Background: Tight control of type 2 diabetes (T2DM) in frail older adults has shown to be associated with adverse outcomes. The objective of this study is to determine the prevalence of tight glycemic control based on underlying frailty status and its association with functional and cognitive measures in community-dwelling older adults.
Methodology: Ancillary study of the Singapore Population Health Studies on older adults aged ≥65 years with T2DM. Tight glycemic control cut-offs were based on the 2019 Endocrine Society guideline using HbA1c target range based on a patient's overall health status measured by the FRAIL scale. Data on basic demographics, frailty, cognitive, and functional statuses were collected. Multivariable regression was used to assess potential factors associated with tight glycemic control.
Results: Of 172 community-dwelling older adults with diabetes mellitus and HbA1c done, frail (65%) and pre-frail (64.4%) participants were more likely to have tight glycemic control than robust participants (31.6%, P < 0.001). In multi-variate analysis, frailty (OR 6.43, 95% CI 1.08-38.1, P = 0.041), better cognition (OR 1.15, 95% CI 1.02-1.32, P = 0.028), and multi-morbidity (OR 7.36, 95% CI 1.07-50.4, P = 0.042) were found to be significantly associated with increased odds of tight glycemic control.
Conclusion: Tight glycemic control was highly prevalent in frail and pre-frail older adults, especially in those with multi-morbidity and better cognition. Future prospective longitudinal studies are required to evaluate effectiveness of frailty screening in making treatment decisions and long-term outcomes. Key messages What is already known on this topic: There is growing recognition that glycemic targets should be adjusted based on health or frailty status. However, there is no consensus on how health status or frailty should be defined when determining glycemic control targets. What this study adds: Our study found that tight glycemic control was highly prevalent in frail and pre-frail older adults. Our findings highlight the importance of assessing for tight glycemic control based on frailty status and further work is needed to aid implementation of screening and intervention policies to avoid the attendant harms of tight glycemic control.
背景:体弱老年人严格控制 2 型糖尿病 (T2DM) 与不良预后有关。本研究的目的是根据潜在的虚弱状况确定严格控制血糖的流行率,以及其与社区老年人的功能和认知指标之间的关系:方法:新加坡人口健康研究(Singapore Population Health Studies)的辅助研究,对象是年龄≥65 岁、患有 T2DM 的老年人。严格的血糖控制临界值以2019年内分泌学会指南为基础,使用基于FRAIL量表测量的患者总体健康状况的HbA1c目标范围。收集了基本人口统计学、虚弱、认知和功能状态的数据。采用多变量回归评估与严格血糖控制相关的潜在因素:结果:在 172 名患有糖尿病且 HbA1c 已测定的社区居住老年人中,体弱者(65%)和体弱前期(64.4%)比强壮者(31.6%,P 结论:体弱者和体弱前期更有可能严格控制血糖:严格控制血糖在体弱和未老先衰的老年人中非常普遍,尤其是在患有多种疾病和认知能力较好的老年人中。今后需要开展前瞻性纵向研究,以评估虚弱筛查在做出治疗决策和长期疗效方面的有效性。关键信息 关于该主题的已知信息: 越来越多的人认识到,应根据健康或虚弱状况调整血糖目标。然而,对于在确定血糖控制目标时应如何定义健康状况或虚弱程度,目前尚未达成共识。本研究的补充: 我们的研究发现,严格控制血糖在虚弱和前期虚弱的老年人中非常普遍。我们的研究结果强调了根据虚弱状况评估严格血糖控制的重要性,还需要进一步的工作来帮助实施筛查和干预政策,以避免严格血糖控制带来的危害。
{"title":"Prevalence of tight glycemic control based on frailty status and associated factors in community-dwelling older adults.","authors":"Li Feng Tan, Reshma Aziz Merchant","doi":"10.1093/postmj/qgae077","DOIUrl":"https://doi.org/10.1093/postmj/qgae077","url":null,"abstract":"<p><strong>Background: </strong>Tight control of type 2 diabetes (T2DM) in frail older adults has shown to be associated with adverse outcomes. The objective of this study is to determine the prevalence of tight glycemic control based on underlying frailty status and its association with functional and cognitive measures in community-dwelling older adults.</p><p><strong>Methodology: </strong>Ancillary study of the Singapore Population Health Studies on older adults aged ≥65 years with T2DM. Tight glycemic control cut-offs were based on the 2019 Endocrine Society guideline using HbA1c target range based on a patient's overall health status measured by the FRAIL scale. Data on basic demographics, frailty, cognitive, and functional statuses were collected. Multivariable regression was used to assess potential factors associated with tight glycemic control.</p><p><strong>Results: </strong>Of 172 community-dwelling older adults with diabetes mellitus and HbA1c done, frail (65%) and pre-frail (64.4%) participants were more likely to have tight glycemic control than robust participants (31.6%, P < 0.001). In multi-variate analysis, frailty (OR 6.43, 95% CI 1.08-38.1, P = 0.041), better cognition (OR 1.15, 95% CI 1.02-1.32, P = 0.028), and multi-morbidity (OR 7.36, 95% CI 1.07-50.4, P = 0.042) were found to be significantly associated with increased odds of tight glycemic control.</p><p><strong>Conclusion: </strong>Tight glycemic control was highly prevalent in frail and pre-frail older adults, especially in those with multi-morbidity and better cognition. Future prospective longitudinal studies are required to evaluate effectiveness of frailty screening in making treatment decisions and long-term outcomes. Key messages What is already known on this topic: There is growing recognition that glycemic targets should be adjusted based on health or frailty status. However, there is no consensus on how health status or frailty should be defined when determining glycemic control targets. What this study adds: Our study found that tight glycemic control was highly prevalent in frail and pre-frail older adults. Our findings highlight the importance of assessing for tight glycemic control based on frailty status and further work is needed to aid implementation of screening and intervention policies to avoid the attendant harms of tight glycemic control.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141458859","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}
Carlos González-Muñoza, Margalida Calafat, Javier P Gisbert, Eva Iglesias, Miguel Mínguez, Beatriz Sicilia, Montserrat Aceituno, Fernando Gomollón, Xavier Calvet, Elena Ricart, Luisa De Castro, Montserrat Rivero, Francisco Mesonero, Lucía Márquez, Pilar Nos, Ainhoa Rodríguez-Pescador, Jordi Guardiola, MarianaFe García-Sepulcre, Santiago García-López, Rufo H Lorente-Poyatos, Cristina Alba, Ramon Sánchez-Ocaña, Isabel Vera, Lucía Madero, Sabino Riestra, Mercedes Navarro-Llavat, Jose L Pérez-Calle, Blau Camps, Manuel Van Domselaar, Alfredo J Lucendo, Maria Dolores Martín-Arranz, Miguel A Montoro-Huguet, Mónica Sierra-Ausín, Jordina Llaó, Daniel Carpio, Pilar Varela, Olga Merino, Luis I Fernández-Salazar, Marta Piqueras, Eva Sesé, David Busquets, Carlos Tardillo, Nuria Maroto, Joan Riera, Carlos Martínez-Flores, Fernando Muñoz, Jordi Gordillo-Ábalos, Federico Bertoletti, Esther Garcia-Planella, Eugeni Domènech
Background and aims: Familial inflammatory bowel disease (IBD) history is a controversial prognostic factor in IBD. We aimed to evaluate the impact of a familial history of IBD on the use of medical and surgical treatments in the biological era.
Methods: Patients included in the prospectively maintained ENEIDA database and diagnosed with IBD after 2005 were included. Familial forms were defined as those cases with at least one first-degree relative diagnosed with IBD. Disease phenotype, the use of biological agents, or surgical treatments were the main outcomes.
Results: A total of 5263 patients [2627 Crohn's disease (CD); 2636 ulcerative colitis (UC)] were included, with a median follow-up of 31 months. Of these, 507 (10%) corresponded to familial forms. No clinical differences were observed between familial and sporadic IBD forms except a lower age at IBD diagnosis and a higher rate of males in familial forms of UC. In CD, the proportions of patients treated with thiopurines (54.4% vs 46.7%; P = .015) and survival time free of thiopurines (P = .009) were lower in familial forms. No differences were found regarding the use of biological agents. Concerning surgery, a higher rate of intestinal resections was observed in sporadic CD (14.8% vs 9.9%, P = .027). No differences were observed in UC.
Conclusions: In the era of biological therapies, familial and sporadic forms of IBD show similar phenotypes and are managed medically in a similar way; whether these is due to lack of phenotypical differences or an effect of biological therapies is uncertain. What is already known on this topic: IBD's etiopathogenesis points to an interaction between environmental and genetic factors, being familial history a controversial prognostic factor. Biological agents use and need for surgery regarding familial or sporadic forms of IBDs present conflicting results. What this study adds: Familial and sporadic forms of IBD have similar phenotypes and are managed medically and surgically in a similar way. How this study might affect research, practice or policy: Familial aggregation should not be considered a factor associated with more aggressive disease.
{"title":"Influence of familial forms of inflammatory bowel disease on the use of immunosuppressants, biological agents, and surgery in the era of biological therapies. Results from the ENEIDA project.","authors":"Carlos González-Muñoza, Margalida Calafat, Javier P Gisbert, Eva Iglesias, Miguel Mínguez, Beatriz Sicilia, Montserrat Aceituno, Fernando Gomollón, Xavier Calvet, Elena Ricart, Luisa De Castro, Montserrat Rivero, Francisco Mesonero, Lucía Márquez, Pilar Nos, Ainhoa Rodríguez-Pescador, Jordi Guardiola, MarianaFe García-Sepulcre, Santiago García-López, Rufo H Lorente-Poyatos, Cristina Alba, Ramon Sánchez-Ocaña, Isabel Vera, Lucía Madero, Sabino Riestra, Mercedes Navarro-Llavat, Jose L Pérez-Calle, Blau Camps, Manuel Van Domselaar, Alfredo J Lucendo, Maria Dolores Martín-Arranz, Miguel A Montoro-Huguet, Mónica Sierra-Ausín, Jordina Llaó, Daniel Carpio, Pilar Varela, Olga Merino, Luis I Fernández-Salazar, Marta Piqueras, Eva Sesé, David Busquets, Carlos Tardillo, Nuria Maroto, Joan Riera, Carlos Martínez-Flores, Fernando Muñoz, Jordi Gordillo-Ábalos, Federico Bertoletti, Esther Garcia-Planella, Eugeni Domènech","doi":"10.1093/postmj/qgae076","DOIUrl":"https://doi.org/10.1093/postmj/qgae076","url":null,"abstract":"<p><strong>Background and aims: </strong>Familial inflammatory bowel disease (IBD) history is a controversial prognostic factor in IBD. We aimed to evaluate the impact of a familial history of IBD on the use of medical and surgical treatments in the biological era.</p><p><strong>Methods: </strong>Patients included in the prospectively maintained ENEIDA database and diagnosed with IBD after 2005 were included. Familial forms were defined as those cases with at least one first-degree relative diagnosed with IBD. Disease phenotype, the use of biological agents, or surgical treatments were the main outcomes.</p><p><strong>Results: </strong>A total of 5263 patients [2627 Crohn's disease (CD); 2636 ulcerative colitis (UC)] were included, with a median follow-up of 31 months. Of these, 507 (10%) corresponded to familial forms. No clinical differences were observed between familial and sporadic IBD forms except a lower age at IBD diagnosis and a higher rate of males in familial forms of UC. In CD, the proportions of patients treated with thiopurines (54.4% vs 46.7%; P = .015) and survival time free of thiopurines (P = .009) were lower in familial forms. No differences were found regarding the use of biological agents. Concerning surgery, a higher rate of intestinal resections was observed in sporadic CD (14.8% vs 9.9%, P = .027). No differences were observed in UC.</p><p><strong>Conclusions: </strong>In the era of biological therapies, familial and sporadic forms of IBD show similar phenotypes and are managed medically in a similar way; whether these is due to lack of phenotypical differences or an effect of biological therapies is uncertain. What is already known on this topic: IBD's etiopathogenesis points to an interaction between environmental and genetic factors, being familial history a controversial prognostic factor. Biological agents use and need for surgery regarding familial or sporadic forms of IBDs present conflicting results. What this study adds: Familial and sporadic forms of IBD have similar phenotypes and are managed medically and surgically in a similar way. How this study might affect research, practice or policy: Familial aggregation should not be considered a factor associated with more aggressive disease.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443268","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}
In this paper, we highlight the prevalent misconception among patients regarding the normal value of left ventricular ejection fraction in cardiac function assessment. This misconception arises from the proportion dominance effect, wherein individuals tend to judge based on proportions rather than absolute values. We explain how this misunderstanding impacts patient demoralization and medical adherence, leading to worse clinical outcomes. To address this, the concept of "Left Ventricular Ejection Fraction - Proportion of Normal" is introduced, which adjusts left ventricular ejection fraction to a patient-specific normal range. This patient-centric approach aims to enhance comprehension, engagement, and adherence by conveying accurate information through the lens of proportions, thereby potentially improving clinical outcomes.
{"title":"Left ventricular ejection fraction: time to revise the metric?","authors":"Avik Ray, Dan Zlotoff, Ichiro Kawachi","doi":"10.1093/postmj/qgae074","DOIUrl":"https://doi.org/10.1093/postmj/qgae074","url":null,"abstract":"<p><p>In this paper, we highlight the prevalent misconception among patients regarding the normal value of left ventricular ejection fraction in cardiac function assessment. This misconception arises from the proportion dominance effect, wherein individuals tend to judge based on proportions rather than absolute values. We explain how this misunderstanding impacts patient demoralization and medical adherence, leading to worse clinical outcomes. To address this, the concept of \"Left Ventricular Ejection Fraction - Proportion of Normal\" is introduced, which adjusts left ventricular ejection fraction to a patient-specific normal range. This patient-centric approach aims to enhance comprehension, engagement, and adherence by conveying accurate information through the lens of proportions, thereby potentially improving clinical outcomes.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427429","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}