British journal of hospital medicine最新文献

Sedation plays a crucial role in gastrointestinal endoscopy, balancing patient comfort and procedural safety. With the increasing complexity of gastrointestinal endoscopic procedures, comes the inherent risk of sedation-related complications. This review, based on the 2024 British Society of Gastroenterology (BSG) guidelines, outlines updated strategies to address the increasingly diverse clinical needs. This review article focuses on case studies to highlight key recommendations for different patient groups. Case analyses highlight unique sedation considerations for patients with comorbidities such as obstructive sleep apnoea (OSA), cardiac dysrhythmia, and chronic kidney disease, emphasizing the need for thorough pre-procedural assessment and individualized sedation plans. Special considerations for the choice of sedation in pregnant and breastfeeding patients are explored. In emergency endoscopies, particularly for upper gastrointestinal bleeding, close collaboration with anaesthetics is essential to determine sedation choice, airway management, and the ceiling of care. The review also examines the need for deep sedation in complex or combined procedures such as endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP), advocating for resource investment to support safe and effective sedation practices.

Aims/background: Hypoxemia and respiratory failure are common among critically ill patients, and high-flow nasal cannula (HFNC) therapy has been increasingly utilized as a non-invasive respiratory support modality. However, a subset of patients eventually requires mechanical ventilation (MV), and predicting this transition remains challenging. This study aimed to develop and validate nomograms that predict the risk of MV among patients undergoing HFNC therapy.

Methods: A retrospective cohort study was conducted using the publicly available Multiparameter Intelligent Monitoring in Intensive Care IV version 2.0 (MIMIC-IV v2.0) database to identify adult intensive care unit (ICU) patients who received HFNC oxygen therapy for 24 hours or longer. Patients who had undergone MV before HFNC initiation were excluded. Key clinical variables, including demographic data and illness severity scores, were extracted. A multivariable logistic regression model was employed to identify independent predictors of subsequent MV, and a nomogram was constructed based on these predictors. The cohort was randomly divided into training (70%) and validation (30%) sets. Model performance was evaluated using the area under the curve (AUC), calibration plots, the Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis (DCA).

Results: Among 4069 patients included in the final analysis, 1332 (32.7%) transitioned from HFNC to MV. Multivariable analysis identified body weight, Sepsis-3 status, urine output score, the ratio of the partial pressure of oxygen in arterial blood (PaO₂) to the fraction of inspired oxygen (PaO₂/FiO₂ ratio), Pulmonary Score, Glasgow Coma Scale (GCS), and creatinine as independent predictors of MV. The constructed nomogram demonstrated AUC values of 0.659 in the training cohort and 0.656 in the validation cohort. Calibration curves and Hosmer-Lemeshow tests indicated good model calibration, while DCA confirmed its clinical utility within low-to-moderate risk thresholds (≤0.4).

Conclusion: We developed and validated a nomogram to predict the likelihood of MV requirement in patients receiving HFNC therapy. The nomogram may serve as a practical clinical tool to assist physicians in determining whether to continue HFNC therapy or initiate MV in clinically ill patients.

Aims/background: This study explores the attitudes and barriers faced by UK orthopaedic trainees regarding less than full time (LTFT) training. LTFT training has become more accessible since 2022, yet surgical trainees have been slower to adopt it compared to other specialties.

Methods: A cross-sectional, questionnaire-based study was carried out via a 16-item online questionnaire which was distributed to aspiring orthopaedic surgeons registering for an orthopaedic themed teaching programme.

Results: 216 respondents met the inclusion criteria. The study found that 42% of respondents would consider LTFT training, with higher interest among female trainees. Key barriers identified included extended training duration, financial concerns, potential decline in surgical skills, and negative perceptions from colleagues.

Conclusion: The research highlights the need for clearer guidance, better support, and a cultural shift within orthopaedic departments to address these barriers. Initiating education and awareness programmes for senior staff and providing comprehensive information to trainees are essential steps to fostering a more inclusive and supportive environment for LTFT training in orthopaedic surgery.

Aims/background: Prevalent societal narratives, terminology, and imagery regarding body weight, obesity, diet, and physical activity reinforce weight stigma, and lead to adverse health and social consequences for individuals throughout their lifespan and body weight continuum. This study analyzed hotspots, frontiers, collaboration mapping, themes, and emerging topics in research on non-stigmatizing language in obesity and weight management (RnSLO).

Methods: A bibliometric analysis was performed using VOSviewer and Bibliometrix, with data extracted from the Scopus database. The study examined 480 documents (1953-2024) using co-citation analysis, co-occurrence network mapping, and thematic evolution analysis. H-, G-, and M-index metrics were used to assess research impact, while thematic clustering and keyword analysis identified key focus areas. Descriptive statistical analysis was applied to assess publication trends, regional contributions, and institutional collaborations.

Results: Research output and citation peaks indicate a growing academic focus on RnSLO. North America, particularly the United States and Canada, led contributions, followed by Europe, Asia, and Oceania. Key institutions, including Harvard Medical School and Johns Hopkins University, were at the forefront of this research. Collaborative networks and international co-authorships were crucial in advancing the field. Finally, major research themes included obesity management, health communication, and diabetes care, highlighting the domain's interdisciplinary nature.

Conclusion: This study provides the first comprehensive bibliometric analysis of RnSLO research, revealing key trends, influential institutions, and collaborative networks. It highlights the growing shift toward inclusive health communication, emphasizing the need for policy interventions to promote non-stigmatizing language in healthcare settings. These insights can inform future clinical practices, public health strategies, and policymaking, thereby ensuring more equitable and patient-centered obesity management.

Aims/background: Severe hypocalcemia (SH) is a common and serious complication after parathyroidectomy (PTX) in patients with secondary hyperparathyroidism (SHPT). However, accurately predicting high-risk patients remains challenging. This study aimed to develop and validate a linear predictive model to identify these patients preoperatively.

Methods: From January 2013 to May 2025, 755 total parathyroidectomy (TPTX) or TPTX with autotransplantation (TPTX-AT) were performed by a single surgical team at the 960th Hospital of the PLA Joint Logistics Support Force. After applying inclusion and exclusion criteria, 685 patients were enrolled and randomly divided (7:3) into training and validation cohorts. Variables associated with serum calcium levels on the first postoperative day (POD1 Ca) were identified through linear regression analysis in the training cohort. Model validity was assessed using ten-fold and leave-one-out cross-validation. Bland-Altman plots and paired t-tests evaluated agreement within groups. Model performance in the validation cohort was measured using bias, precision, and accuracy metrics.

Results: Significant predictors of POD1 Ca included TPTX-AT (β [95% confidence interval (CI)]: -0.055 [-0.119, -0.001]), parathyroid hormone (PTH) (-0.078 [-0.115, -0.041], ng/mL), C-terminal cross-linked telopeptide of type I collagen (CTX) (-0.147 [-0.198, -0.096], μg/L), preoperative serum calcium (0.626 [0.516, 0.736], mmol/L), and alkaline phosphatase (ALP) (-0.018 [-0.024, -0.012], μkat/L). Bland-Altman analysis showed good agreement in the validation cohort (bias <0.001, 95% limits of agreement [LoA]: -0.507, 0.566).

Conclusion: The nomogram provides an accurate, individualized prediction of postoperative hypocalcemia risk after parathyroidectomy, supporting tailored clinical management of SHPT patients.

Aims/background: Heart failure with preserved ejection fraction (HFpEF) poses therapeutic challenges, especially among the elderly. Dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, has potential benefits beyond glucose regulation, including possible cardioprotective effects. This study evaluates the efficacy and safety of dapagliflozin in patients over 75 years old with HFpEF.

Methods: This retrospective cohort study included 215 patients over 75 years old with HFpEF, divided into a standard treatment group (known as routine group, n = 105) and a dapagliflozin plus standard treatment group (known as dapagliflozin group, n = 110). Key assessments included Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, Six-Minute Walk Test (6MWT), echocardiographic parameters, adverse events, and biochemical markers such as N-terminal pro-B-type natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP), alongside patients' satisfaction with the treatment administered.

Results: The dapagliflozin group showed significant improvements in KCCQ Overall Summary Score (72.48 ± 12.49 vs 68.59 ± 13.11, p = 0.027) and 6MWT distance (358.47 ± 28.62 m vs 311.69 ± 30.26 m, p < 0.001) compared to the routine group. NT-proBNP and BNP levels showed significantly greater reductions in the dapagliflozin group (p = 0.046 and p = 0.039, respectively). Echocardiographic parameters indicated favorable cardiac remodeling. Incidence of adverse events was similar between groups, with no increase in serious renal or metabolic events in the dapagliflozin group. Dapagliflozin significantly improves patients' satisfaction in elderly patients with HFpEF (p = 0.041).

Conclusion: Dapagliflozin administration in HFpEF patients over 75 years significantly enhances cardiac function and exercise capacity, as well as improves quality of life markers, without notable safety concerns.

Aims/background: Non-small cell lung cancer (NSCLC) accounts for approximately 80-85% of all lung cancers, and lymph node metastasis is a key determinant of patient prognosis, often leading to poorer clinical outcomes. Although immune checkpoint inhibitors (ICIs) have transformed the therapeutic landscape of advanced NSCLC, their specific efficacy in patients with lymph node metastases remains unclear. This study aimed to evaluate the efficacy and safety of ICI monotherapy versus chemotherapy in previously treated, unresectable NSCLC patients with lymph node metastasis.

Methods: A retrospective analysis was performed on patients with unresectable, previously treated NSCLC with lymph node metastasis who received treatment at Xi'an International Medical Center Hospital between April 2019 and October 2022. Following 1:1 propensity score matching (PSM), 112 patients were included in the final analysis, comprising 56 in the ICI group (treated with pembrolizumab) and 56 in the chemotherapy group (treated with docetaxel). The primary endpoint was objective response rate (ORR), while secondary endpoints included disease control rate (DCR), overall survival (OS), and safety.

Results: The ICI group demonstrated a significantly higher ORR compared with the chemotherapy group (50.0% vs. 26.8%, p = 0.012). No significant difference in DCR was observed between the groups (p = 0.057). Kaplan-Meier analysis revealed significantly longer OS in the ICI group (p = 0.009). Multivariate analysis indicated a high risk of death in the chemotherapy group compared to the ICI group (hazard ratio [HR] = 1.796; 95% confidence interval [CI]: 1.112-2.900; p = 0.017). In terms of safety, leukopenia occurred more frequently in the chemotherapy group (p = 0.039), while immune-related adverse events (irAEs), including hypothyroidism (p = 0.027) and rash (p = 0.008), were more common in the ICI group.

Conclusion: In previously treated patients with unresectable NSCLC and lymph node metastasis, real-world evidence from this study suggests that pembrolizumab monotherapy offers superior efficacy and survival benefits compared with docetaxel chemotherapy. Moreover, the two therapies display distinct safety profiles, with ICI therapy associated with fewer severe hematologic toxicities.

Aims/background: Young and middle-aged patients undergoing maintenance hemodialysis (MHD) experience significant physical impairment and psychological stress, resulting in reduced levels of subjective well-being. Therefore, this study aimed to assess the subjective well-being of this population and to identify its influencing factors, thereby informing the clinical development of targeted nursing strategies.

Methods: Clinical data were collected from 220 young and middle-aged MHD patients at the Blood Purification Center of the Second Affiliated Hospital, Zhejiang University School of Medicine between April 2024 and April 2025. General demographic and clinical characteristics, along with scores from relevant assessment scales, were collected. The factors influencing subjective well-being were analyzed in this patient cohort.

Results: The mean General Well-Being (GWB) scale score among these patients was 62.44 ± 3.12. Statistically significant differences were observed across education level, per capita monthly family income, self-care ability, self-management ability, symptom distress, financial burden to the family, and social support (p < 0.05). Multiple linear regression analysis indicated that education, per capita monthly family income, self-care ability, self-management ability, symptom distress, financial burden on the family, and social support were significant predictors of subjective well-being among young and middle-aged MHD patients (p < 0.05).

Conclusion: The subjective well-being of young and middle-aged MHD patients remains at a moderate level and is influenced by factors such as education level, per capita monthly family income, self-care ability, self-management ability, symptom distress, financial burden on the family, and social support. Nursing care interventions should be designed and implemented based on these factors to improve the overall well-being of this patient group.