British journal of hospital medicine最新文献

The rising prevalence of Alzheimer's disease (AD) with an aging population poses significant societal and healthcare challenges, leading to growing interest in strategies for early diagnosis and disease modification. This review synthesizes key developments in the diagnostic and therapeutic landscape of AD for general hospital clinicians. Diagnostic advances include improving the detection of hallmark biomarkers-amyloid beta (Aβ) and phosphorylated tau (p-tau)-via neuroimaging modalities, cerebrospinal fluid (CSF) analysis, and increasingly accessible plasma-based assays. Disease-modifying therapies which target amyloid, including Lecanemab and Donanemab, offer promising avenues but require close clinical monitoring due to associated risks such as amyloid-related imaging abnormalities (ARIA). While the amyloid and tau hypotheses continue to underpin much of the pathophysiological understanding of AD, current models also recognise the role of additional mechanisms such as chronic neuroinflammation and oxidative stress, broadening the scope for therapeutic targets. Collectively, these diagnostic and therapeutic advances represent a significant shift in AD early identification and management, with implications for the individual patient and the healthcare system.

Aims/Background The diagnosis of chronic endometritis (CE) in infertile women without demonstrable intrauterine abnormalities remains a significant clinical challenge. The primary aim of this study was to identify the independent risk factors for CE regarding reproductive history and clinical symptoms in infertile women, providing evidence-based guidance for targeted CE screening in this population. Methods In this retrospective case-control study, a total of 180 infertile female patients undergoing hysteroscopy between October 2022 and July 2024, who fulfilled the enrollment criteria, were included. The participants were divided into two groups: non-chronic endometritis (NCE) group (n = 78) and CE group (n = 102). CE was diagnosed based on the syndecan-1 (CD138) immunohistochemical staining results. To evaluate the association of CE with reproductive history and clinical symptoms, both univariate and multivariate logistic regression analyses were conducted. Results The prevalence of CE in this study was 56.67% (102/180). Univariate logistic regression analysis revealed statistically significant differences in gravidity, parity, abortion history, and prolonged menstruation between the two groups (p < 0.05), indicating their correlations with CE. Further multivariate analysis identified abortion history (odds ratio [OR] = 2.521, 95% confidence interval [CI]: 1.307-4.864, p = 0.006) and prolonged menstruation (OR = 3.624, 95% CI: 1.141-11.513, p = 0.029) as independent risk factors for CE, while gravidity and parity showed no significant associations after adjustment. Conclusion Abortion history and prolonged menstruation are independent risk factors for CE. For infertile women presenting with a history of abortion or prolonged menstruation but without apparent intrauterine abnormalities, hysteroscopy combined with CD138 immunohistochemical staining is recommended to facilitate early diagnosis and prompt therapeutic intervention for CE.

Aims/Background The neutrophil-to-lymphocyte ratio (NLR) was an independent influence factor for mortality in acute respiratory distress syndrome (ARDS). The systemic immune-inflammation index (SII) is a predictive indicator for sepsis. This study was designed to evaluate the predictive value of combined NLR and SII in sepsis-related ARDS. Methods Patients with sepsis-related ARDS (n = 112), admitted to Pingyang Hospital of Wenzhou Medical University from January 2022 to January 2025, were obtained for retrospective analysis. A survivor group (n = 62) and a non-survivor group (n = 50) were formed based on 28-day survival status. Neutrophil, lymphocyte, and platelet counts were detected, and NLR and SII were subsequently calculated. Logistic regression analysis and receiver operating characteristic (ROC) curves were performed to analyze the influences of NLR and SII in the prognosis of sepsis-related ARDS. Results Non-survivor group has longer intensive care unit (ICU) length of stay, higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score and white blood cell (WBC) count, and lower lymphocyte count than those of survivor group (p = 0.001, 0.032, 0.028, 0.004, respectively). Both NLR and SII values were elevated in the non-survivor group (p < 0.001). Furthermore, APACHE II score (odds ratio (OR): 1.150, 95% confidence interval (CI): 1.004-1.317, p = 0.044), ICU length of stay (OR: 1.147, 95% CI: 1.017-1.294, p = 0.026), NLR (OR: 1.158, 95% CI: 1.068-1.255, p < 0.001), and SII >2090.37 (OR: 5.207, 95% CI: 1.800-15.064, p = 0.002) as independent prognostic risk factors. The combined NLR and SII had a superior predictive value (area under the curve (AUC): 0.808, 95% CI: 0.730-0.887, p < 0.001) compared to APACHE II score (AUC: 0.618, 95% CI: 0.503-0.733, p = 0.045), ICU length of stay (AUC: 0.679, 95% CI: 0.573-0.784, p = 0.001), NLR alone (AUC: 0.788, 95% CI: 0.701-0.875, p < 0.001), or SII alone (AUC: 0.748, 95% CI: 0.657-0.840, p < 0.001). The optimal cut-off values for APACHE II score, ICU length of stay, NLR, and SII were 19.5, 15.5, 26.13, and 2090.37, respectively. Conclusion The combination of NLR and SII provides a strong predictive value for the prognosis of sepsis-related ARDS.

Point-of-care ultrasound (POCUS) has evolved from a simple tool for fluid localization to a comprehensive modality for hemodynamic assessment and real-time clinical decision-making. The Bedside Lung Ultrasound in Emergency (BLUE) protocol enables clinicians to diagnose causes of cardiorespiratory failure more accurately than clinical examination alone. In patients presenting with shock and hypotension, POCUS facilitates rapid identification of the underlying aetiology. This allows for targeted treatment in these critically ill patients. In complex patients presenting with concurrent cardiac failure and renal dysfunction, the venous excess ultrasound (VExUS) score provides a valuable assessment of volume status, guiding fluid management and therapeutic interventions. The increasing availability of handheld ultrasound devices, cloud-based services and artificial intelligence (AI) is driving POCUS beyond the traditional hospital settings into the community. Associated healthcare professionals already perform initial scans in community settings with remote expert review. In future models of care, patients or carers could use AI-assisted handheld devices to enable self-monitoring and early disease management at home. This review examines the expanding role of POCUS in acute and critical care settings, with a focus on key protocols that enhance diagnostic accuracy and guide clinical management, and considers future expansion of POCUS into the community.

Aims/Background Despite national frameworks outlining the four pillars of advanced practice (clinical practice, leadership and management, education, and research), engagement of Advanced Clinical Practitioners (ACPs) in the UK remains inconsistent, and significant challenges persist. This scoping review aimed to explore ACPs' engagement with each pillar and to identify both successful and challenging factors. Methods A scoping review was conducted following Arksey and O'Malley's framework in 2005 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was undertaken across five databases (CINAHL, MEDLINE, Scopus, PsycInfo, and Cochrane Library) and grey literature sources. The search covered studies published from 2017 to 2025, in line with the introduction of the Multi-professional Framework. A three-stage screening process was used to identify eligible studies, and data were extracted using a standardised form. Thematic analysis was employed to synthesise the findings. Results Thirty-three studies met the inclusion criteria. The review identified strong ACP engagement in clinical practice, including contributions to direct patient care, improved patient satisfaction, and reduced waiting times. However, engagement with the leadership, education, and research pillars was inconsistent and often limited by excessive workload, lack of protected time, and ambiguity in role definitions. Structural variation across National Health Service (NHS) trusts further contributed to disparities in advanced clinical practice role development and utilisation. Conclusion Advanced clinical practice roles are firmly embedded in clinical care but remain underutilised in leadership, research, and education. Addressing these disparities requires clearer career pathways, organisational investment, and structured policy support to enable ACPs to contribute fully across all four pillars of practice.

Genetic testing is indicated for suspected familial thoracic aortic aneurysm or following dissection to complement targeted screening of first-degree relatives. Our data suggest that tissue storage and genetic testing in the setting of suspected heritable thoracic aortic aneurysm and dissection (HTAAD) are underutilized. In this focussed review, we outline the genetic basis of HTAAD and the current guidelines regarding genetic testing. We present a case series demonstrating both favourable and unfavourable genetic testing practices. We suggest potential improvements to current genetic testing algorithms, such as increased involvement of medical examiners and emergency department clinicians, to help identify patients and families suitable for genetic testing. Additionally, we provide a description of the pathophysiology underlying inheritable aortopathies.

Systemic sclerosis is a multisystem connective tissue disease which can present to a broad range of medical specialities. It carries significant morbidity and mortality, but substantial advances have been made in recent years. Recent advances include autologous haematopoietic stem cell transplantation for early diffuse disease (for highly selected patients), the increasing use of phosphodiesterase type 5 inhibitors and of bosentan for digital ulceration, a better understanding of the use of different immunosuppressant therapies for interstitial lung disease (and which patients are likely to benefit from antifibrotic therapy), and the increasing early use of combination therapies for pulmonary arterial hypertension (PAH). Ongoing clinical trials investigating new therapeutic approaches should lead to further advances in the next 10 years. This review provides a broad overview of the condition with a focus on recent progress in specific areas: early diffuse cutaneous disease, digital vasculopathy, interstitial lung disease, and PAH.

Patients with advanced heart failure (AHF) have a poor prognosis. Significant advancements have been made in the surgical treatment of AHF with the use of mechanical circulatory support (MCS) and heart transplantation (HT). In carefully selected patients with AHF, HT remains the gold standard treatment, but left ventricular assist device (LVAD) therapy has become an important alternative. The 5-year survival post HT is 72% compared to 58-63% with contemporary LVADs. While HT provides a better quality of life and freedom from device-related complications, it is limited by the availability of donor organs. In the future, fully implantable LVAD systems and expanded donor strategies are expected to further optimise treatment options for patients with AHF.

This review examines the effectiveness of non-pharmacological interventions for managing orthostatic hypotension (OH), a condition prevalent among older adults. Current guidelines prioritise non-pharmacological methods such as physical counter-manoeuvres and compression garments as first-line treatments for OH. Conducting a comprehensive medication review to identify potentially causative agents, along with patient education, is highlighted as essential for optimising the efficacy of non-pharmacological interventions. The review addresses the potential pathophysiological underpinnings of OH, identifying neuro cardiovascular control, vascular insufficiency and the effects of ageing as key treatment considerations. Additionally, it highlights the importance of patient-specific factors, emphasising the strengths of individualised treatment plans. Limitations, including the challenges of heterogeneity in OH, patient adherence and inter-individual variability are discussed, alongside future research needs aimed at optimising these strategies. Effectively managing OH with accessible, cost-effective and low-risk non-pharmacological methods could benefit individuals with OH and help meet the growing healthcare demands of an ageing population.

Aims/Background Helicobacter pylori (H. pylori) infection is prevalent in 42-64% of the Chinese population, with emerging evidence linking it to extragastrointestinal diseases, including stroke. This study aimed to investigate the association between H. pylori infection and lipid metabolism, inflammatory markers, and the modified Framingham stroke risk score in patients at high risk of ischemic stroke, and to further analyze the relationship between the Framingham risk score and related clinical variables. Methods A retrospective analysis was performed on 320 patients at high risk of ischemic stroke (10-year stroke risk ≥10% by modified Framingham scale) admitted to Jinhua People's Hospital from January 2020 to December 2022. Patients were divided into a H. pylori-positive group (n = 180) and a H. pylori-negative group (n = 140) based on ¹⁴C urea breath test (≥100 dpm/mmol vs. <100 dpm/mmol). Clinical data, lipid profiles (total cholesterol [TC], triglycerides [TG], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C]), inflammatory markers (high-sensitivity C-reactive protein [hs-CRP], homocysteine [Hcy], fibrinogen [FIB]), and modified Framingham stroke risk scores were compared between groups. Correlation and multivariate regression analyses were used to explore the relationships between variables. Results Compared with the H. pylori-negative group, the H. pylori-positive group had significantly higher levels of TC, TG, LDL-C, hs-CRP, Hcy, FIB, and modified Framingham scores (all p < 0.05), and lower HDL-C (p < 0.05). H. pylori infection correlated positively with the modified Framingham stroke risk score (point-biserial r = 0.33, p < 0.001). Multivariate regression showed that H. pylori infection was an independent predictor of elevated modified Framingham stroke risk scores (β = 0.21, p < 0.001). Conclusion H. pylori infection is associated with abnormal lipid metabolism, enhanced inflammatory response, and increased ischemic stroke risk in high-risk patients, suggesting its potential role in stroke pathogenesis.