Postgraduate Medical Journal最新文献

Purpose: To investigate Chinese emergency physicians' perceptions of prevalence, associated risk factors, and reported management practices for delirium in critically ill emergency department (ED) patients.

Methods: A cross-sectional survey of 402 physicians from EDs across 18 Chinese provinces.

Results: Physician-estimated delirium prevalence varied widely (median: 15%; interquartile range: 10%-30%), with most perceiving higher incidence during night shifts. Key perceived risk factors included metabolic disorders, pre-existing cognitive impairment, shock, and severe infections. Clinical judgment was the most common assessment method; structured screening tools were reportedly used infrequently. Pharmacological interventions were the preferred management approach for most respondents.

Conclusions: This survey highlights Chinese emergency physicians' varied perceptions of delirium prevalence and reliance on clinical judgment over standardized assessment. Findings suggest a need for enhanced training in standardized screening, greater emphasis on non-pharmacological interventions, and fostering interprofessional collaboration to improve care for ED patients with or at risk of delirium. Key messages What is already known on this topic: Delirium is a serious acute neurocognitive syndrome with high Intensive Care Unit prevalence (31.8%-70%) and significant adverse outcomes. Emergency department delirium remains under recognized despite 6%-38% prevalence in older adults. International guidelines recommend non-pharmacological interventions as first-line management. What this study adds: This survey provides the first assessment of Chinese emergency physicians' delirium perceptions in critically ill patients. Key findings reveal predominant reliance on clinical judgment rather than validated tools and a preference for pharmacological interventions, particularly benzodiazepines, which conflicts with international guidelines. Substantial variation exists in perceived prevalence estimates. How this study might affect research, practice, or policy: Findings inform targeted educational initiatives for Chinese emergency departments, emphasizing the need for standardized screening training and non-pharmacological intervention promotion. Future research should prioritize objective epidemiological studies to validate perceived prevalence rates and evaluate protocol implementation.

Background: Regional anesthetic techniques are applied in cardiac surgery to improve postoperative pain and accelerate recovery. Pecto-intercostal fascial block (PIFB) combined with rectus sheath block (RSB) has been proved to provide ideal analgesia for cardiac surgery, but the effects of combing regional anesthetic techniques on postoperative recovery are uncertain.

Methods: This is a prospective and randomized controlled trial at Fuwai Hospital from 1 June 2024 to 3 July 2024. Eighty patients undergoing elective cardiac surgery via cardiopulmonary bypass were randomized at a 1:1 ratio to be allocated in the intervention group (PIFB combined with RSB) or control group (without regional blocks). The primary outcome was the global score of the 15-item quality of recovery (QoR-15) questionnaire at 24 h after surgery. Secondary outcomes included QoR-15 at 72 h, postoperative pain scores, time to extubation, length of stay, medical expenses in hospital and postoperative morbidities.

Results: The QoR-15 global score at 24 h after cardiac surgery was 122.35 ± 6.71 in the intervention group vs 115.30 ± 5.90 in the control group (P < .001). The proportion of patients experiencing better quality of recovery (Qor-15 ≥ 118) was higher in the intervention group (77.5% vs 55%, P = .033). Postoperative pain scores were 1.90 ± 0.18 in the intervention group compared to 2.95 ± 0.99 in the control group (P = .027) at 24 h. Time to extubation was earlier in the intervention group (274.40 ± 98.36 vs 741.28 ± 93.82 min, P < .001). There were no statistically differences in Qor-15 at 72 h and other recovery outcomes.

Conclusion: The administration of PIFB combined with RSB could improve quality of recovery and relieve postoperative pain for patients following cardiac surgery. Key message What is already known on this topic Previous studies have demonstrated that ultrasound-guided nerve blocks effectively reduce postoperative pain in cardiac surgery patients. However, whether these techniques further enhance overall postoperative recovery remained unclear. What this study adds This trial revealed that ultrasound-guided nerve blocks improved postoperative QoR-15 scores, and combined regional techniques further improved recovery without compromising analgesia. How this study might affect research, practice, or policy The findings support applying combined nerve blocks into enhanced recovery protocols for cardiac surgery, offering evidence to optimize postoperative analgesia strategies.

Background: Thyroid nodules are a widespread disease in endocrine system. While ultrasound is the preferred non-invasive examination, it still has some limitations. The study aims to evaluate the correlation between the location of thyroid nodules and pathological diagnosis of thyroid cancer (TC).

Methods: We retrospectively reviewed data from medical records of patients with thyroid nodules who underwent thyroidectomy from 2018 to 2024. A total of 1307 patients with confirmed benign or malignant thyroid nodules were included.

Results: Nodules located in the lower part of left/right thyroid lobe had a higher frequency of malignancy (41.2%) compared to the isthmus (5.4%). A logistic regression model uncovered that the location of thyroid nodules was a significant risk factor for the diagnosis of TC (P = .044), both the upper [P = .040, odds ratio (OR) = 2.009] and the middle (P = .020, OR = 1.702) nodules in left/right lobe were distinctly malignant compared those in the lower. Adjusted by age, maximum nodule size, and aspect ratio, nodules in the middle part still had higher malignancy than the lower lobe (P = .046, OR = 1.630). We also evaluated the correlation between the location and capsular invasion. Compared with nodules in the lower part, non-lower nodules had a greater likelihood of invading the capsule, indicating a poorer prognosis for TC patients.

Conclusions: Our study showed that the location of thyroid nodules is an independent risk factor in determining TC. Nodules located in the lower part of the left/right lobe are considered as having the lower risk of malignancy and capsular invasion.

The rapid integration of generative artificial intelligence (AI) is transforming scientific writing and publishing, creating both unprecedented opportunities and critical ethical challenges. This article investigates how the use of AI tools affects research integrity, authorship accountability, and peer review processes in scientific publishing. Methodologically, the review synthesizes literature on current AI policies, detection tools, and empirical surveys of author and reviewer practices. Three key hypotheses are proposed for future empirical testing: (H1) mandatory AI disclosure improves the detection of fabricated content; (H2) AI-assisted language refinement enhances manuscript clarity without compromising originality; and (H3) undisclosed AI use by reviewers diminishes the depth of critique. The main findings indicate dominant reliance on descriptive studies, highlighting the need for hypothesis-driven, cross-disciplinary research frameworks and greater transparency to ensure that AI adoption fortifies the trustworthiness of scholarly communication.

Background: Edentulism is a common disease among the elderly. The relationship between sleep patterns and edentulism has not been fully explored.

Methods: This study utilized baseline and follow-up data from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011 and 2015-participants aged 45 or above. The outcome variable was self-reported edentulism. Independent variables included nap duration, nighttime sleep duration, and sleep quality. The association between edentulism and sleep patterns was evaluated using multivariable logistic regression analysis. To further explore the potential non-linear relationship between nighttime sleep duration and the risk of edentulism, restricted cubic spline (RCS) regression was performed with nighttime sleep duration treated as a continuous variable. Subgroup analysis by gender and age, and introduce interaction terms into the Multivariable logistic regression analysis.

Results: 466 of the 9732 participants were edentulous. After adjusting for potential confounders, participants with short nighttime sleep duration had a 34.5% higher risk of edentulism than those with normal nighttime sleep duration (OR: 1.345; 95% CI:1.097-1.653). RCS regression demonstrates dose-response relationship. Subgroup analyses revealed a significant association between short nighttime sleep duration and edentulism in both men (OR: 3.89; 95% CI: 2.75-6.24) and women (OR: 4.25; 95% CI: 2.99-6.86), as well as in individuals aged ≥65 years (OR: 5.26; 95% CI: 3.25-10.72). Interaction analyses showed no significant interaction between nighttime sleep duration and gender or age.

Conclusion: Short nightly sleep duration may be closely connected to the prevalence of edentulism in people of middle age and older age.

Background: Latent Class Analysis (LCA) is an unsupervised clustering and analytical approach to identify subgroups of people with similar characteristics within a heterogenous population. We examined patterns of comorbidities in people with atrial fibrillation (AF) admitted to hospital using LCA and their relationship with 12-month mortality and length of hospitalisation.

Methods: We conducted a retrospective cohort study using hospital data from Flinders Medical Centre, a major tertiary public hospital in Southern Adelaide (South Australia), covering a period of 10 years (2009-2018). We explored the patterns of comorbidities using LCA and used Cox regression and logistic regression models to examine their association with 12-month mortality and length of hospitalisation.

Results: Three phenotypes were identified using LCA in 12 555 AF patients: phenotype 1 (lower comorbidity burden; n = 7689, 61%), phenotype 2 (higher comorbidity burden; n = 4120; 33%), and phenotype 3 (cerebrovascular, hypertensive disease, nervous system and non-specific abnormalities; n = 746, 6%). The hazard of death was significantly higher in phenotype 2 (adjusted hazard ratio (aHR) = 2.25, 95% CI = 2.01-2.50) and phenotype 3 (aHR = 1.69, 95%CI = 1.38-2.08) compared to phenotype 1. The odds of being hospitalized for ≥10 days (vs. <10 days) were significantly higher in phenotype 2 (adjusted odds ratio [aOR] = 8.53, 95%CI = 7.70-9.44) and phenotype 3 (aOR = 4.23, 95%CI = 3.56-5.04) compared to phenotype 1.

Conclusions: In this large cohort study in AF patients, LCA identified three comorbidity phenotypes with distinct associations with 12-month all-cause mortality and length of hospitalisation. Our findings suggest that phenotyping is valuable in identifying high-risk group of patients that may benefit from targeted intervention. Key messages What is already known on this topic? Previous studies have examined the impact of individual comorbidities in people with atrial fibrillation (AF), but there is limited data on how different combinations of comorbidity patterns occur in people with AF and their impact on health outcomes. What this study adds? Latent class analysis identified three comorbidity phenotypes with distinct associations with 12-month all-cause mortality and length of hospitalisation in people with AF. How this study might affect research, practice, or policy? Risk-stratified care management may help improve health outcomes of AF patients.

This paper provides a comprehensive overview of cardiopulmonary events associated with the occurrence, development, and treatment of tumours, serving as a valuable resource for the clinical management of cancer patients. It explores the complex relationship between the heart and lungs, collectively discussing the cardiopulmonary implications linked to tumours. Common risk factors that connect tumours with cardiac and pulmonary conditions are delineated, highlighting their direct and indirect correlations. Additionally, the paper addresses the cardiopulmonary disorders and symptoms resulting from tumour progression and their subsequent manifestations. The final section focuses on the cardiopulmonary repercussions of various tumour treatments, including chemotherapy, targeted therapy, radiation therapy, and immunotherapy, elaborating on their associated cardiopulmonary effects. Effective management of aggressive proliferative diseases, such as tumours, requires selecting appropriate treatment modalities that balance therapeutic efficacy with vigilant monitoring of cardiopulmonary function and thorough assessment of treatment outcomes and related side effects.

Objective: To review the role of high-sensitivity C-reactive protein (hsCRP) as a biomarker of inflammation in coronary atherosclerotic disease and its potential clinical applications.

Methods: A narrative review of key clinical trials, meta-analyses, and guideline recommendations was performed to evaluate the association between hsCRP levels, cardiovascular risk, and therapeutic interventions.

Results: Elevated hsCRP levels are associated with increased risk of coronary events, both in primary and secondary prevention settings. Statins, independent of their lipid-lowering effects, significantly reduce hsCRP levels and associated cardiovascular events. Anti-inflammatory agents such as canakinumab and colchicine also demonstrate benefit in reducing major adverse cardiovascular events, while newer agents like bempedoic acid show promising hsCRP-lowering effects. Current guidelines recommend selective hsCRP use for risk stratification, particularly in intermediate-risk patients.

Conclusion: hsCRP is a valuable biomarker reflecting residual inflammatory risk in coronary atherosclerosis. Incorporating hsCRP into routine clinical practice may enhance cardiovascular risk stratification and guide therapeutic decisions.

Categories: Cardiology, Internal medicine.