British journal of hospital medicine最新文献

Aims/background: The adoption of standardized nursing terminology (SNT) is crucial for ensuring efficient information delivery and data sharing among nursing staff, as well as effective nursing care. This study aims to assess nurses' Knowledge-Attitude-Practice regarding SNT, and identify key influencing factors of SNT application.

Methods: This study involves the development of a questionnaire for a survey based on the Knowledge-Attitude-Practice (KAP) model, combined with literature research and Delphi method. A cross-sectional survey was conducted among 515 nursing staff from 26 departments.

Results: The resulting questionnaire consisted of 29 items, with a Cronbach's α coefficient of 0.959. The scores for Knowledge-Attitude-Practice of nurses toward SNT were 12.73 ± 4.61, 35.05 ± 5.70, and 31.72 ± 9.93, respectively. Multiple linear regression analysis indicated that the position title, education level and years of work were independent influencing factors of the SNT levels among the surveyed nurses. The three most frequently mentioned barriers by nursing staff were increased workload, insufficient support from information systems, and a lack of nursing informatics professionals.

Conclusion: This study indicates that nursing staff hold positive attitudes toward SNT, but their awareness and practical application remain insufficient. Strengthening competency-based training and urgently optimizing nursing information systems are therefore necessary.

Aims/background: Advanced biliary tract cancer (BTC) is an aggressive malignancy, and often presents with poor prognostic outcomes despite standard chemotherapy. This study aimed to evaluate the preliminary efficacy and safety of toripalimab in combination with gemcitabine + oxaliplatin (GEMOX) as a first-line treatment option for advanced BTC.

Methods: This prospective, single-arm, single-center study enrolled 35 patients with advanced BTC. The patients received toripalimab in combination with GEMOX as first-line treatment at Zhejiang Cancer Hospital, China, between February 2021 and April 2023. Each patient received 1 to 11 treatment cycles, and the objective response rate (ORR) was evaluated before and after chemotherapy using the Response Evaluation Criteria for Solid Tumors (RECIST) version 1.1. Progression-free survival (PFS) and overall survival (OS) were assessed using the Kaplan-Meier method. Furthermore, adverse events and their severity were recorded to evaluate the safety profile of the treatment.

Results: A study cohort of 35 patients was enrolled (median age, 57 years), including 15 men and 20 women. Of them, 18 had intrahepatic cholangiocarcinoma, 14 had gallbladder cancer, and 3 had hilar cholangiocarcinoma. Metastatic lesions were most commonly observed in the lymph nodes, liver, and pelvis. The ORR was 20% (95% confidence interval [CI] 8.4%-36.9%), including 2 for complete response (CR) and 5 for partial response (PR). The median PFS and OS were found to be 8.5 and 16.5 months, respectively. All patients experienced adverse events, with 11 (31.42%) of the patients having grade 3 or higher adverse events. The most commonly observed adverse events included increases in alanine aminotransferase (ALT) and aspartate aminotransferase (AST), leukopenia, neutropenia, and thrombocytopenia.

Conclusion: Toripalimab combined with GEMOX showed preliminary antitumor activity and an acceptable safety profile in patients with advanced BTC, warranting further validation in larger cohorts.

Clinical trial registration: Chinese Clinical Trial Registry (ChiCTR2600117154).

Aims/background: Bilateral spontaneous carotid artery dissections are rare, comprising only 10% of spontaneous carotid artery dissection cases. They occur when there is a tear in the innermost lining of the artery called the tunica intima. An intramural hematoma may form which can lead to vessel lumen narrowing or occlusion, causing an acute ischaemic stroke.

Case presentation: We present a case of a man in his 50s with bilateral spontaneous internal carotid artery dissection who presented with a sudden onset of headache, neck pain, and right arm weakness. After being treated, the patient presented again after 3 weeks with neck pain on the right side, headache, and transient left arm weakness. He was treated with anticoagulation followed by antiplatelet therapy.

Results: At 6 months, the computed tomography angiogram (CTA) of carotid and vertebral arteries showed a largely resolved left internal carotid artery dissection (ICAD) and a resolved right ICAD. At the 7 years follow up, the patient continues to do well as he has not had any more transient ischaemic attacks or strokes.

Conclusion: This case demonstrates that carotid artery dissections should be considered when a patient presents with these symptoms, even if they present bilaterally in a short period, and can be investigated with a CTA or magnetic resonance angiogram, with treatment by antiplatelets or anticoagulation.

Delivery of reperfusion therapies such as thrombolysis and mechanical thrombectomy have revolutionised the treatment for acute ischaemic stroke with reduction in disability and mortality. Extended time windows for thrombolysis for patients presenting beyond 4.5 hours including wake up stroke have now increased the eligibility for these treatments. Tenecteplase has emerged as alternative thrombolytic agent to alteplase, with practical advantages. Mechanical thrombectomy is now available to a wider group of patients than previously considered such as patients presenting beyond 6 hours up to 24 hours, those with large core anterior circulation infarcts and posterior circulation stroke. Advances in brain imaging and their application to determine salvageable brain tissue is crucial in delivery of these interventions. Systems of care to enhance the delivery of these time critical treatments such as pre-hospital video triage and mobile stroke units may play a vital role in maximising population benefits from high-quality hyper-acute stroke care. The purpose of this review is to highlight the expansion of evidence for acute therapeutic interventions for ischaemic stroke and technologies to facilitate their delivery.

Aims/background: As the global population ages, age-related chronic obstructive pulmonary disease (COPD) and sarcopenia present significant clinical and economic concerns. Emerging evidence suggests that these conditions are interrelated; however, potential confounding factors may impact observational investigations. Therefore, this study employed a bi-directional Mendelian randomization analysis to systematically investigate the causal relationship-rather than merely conducting a correlation analysis, between sarcopenia-related traits and COPD and hospitalization risk.

Methods: Univariate, two-sample, and bi-directional Mendelian randomization (MR) analyses were performed using data from genome-wide association studies. The data on Sarcopenia features, including appendicular lean mass (ALM), hand grip strength (HGS), usual walking pace (UWP), and moderate-to-vigorous physical activity (MVPA) were acquired from the UK Biobank. However, data on COPD and hospitalization risk were sourced from the FinnGen consortium. Inverse-variance weighted (IVW) MR and sensitivity analyses were performed to evaluate causal relationships. Additionally, the observed findings were validated using an independent COPD dataset sourced from the UK Biobank.

Results: The forward MR analysis using IVW revealed a significant negative causality between ALM, HGS, UWP, MVPA, and COPD (all p < 0.05, all p_FDR < 0.05) (False Discovery Rate, FDR), as well as with COPD-related hospitalization (all p < 0.05, all p_FDR < 0.05). These findings were corroborated by validation analyses. Furthermore, reverse MR assessment demonstrated that COPD alleviates UWP (p = 0.001, p_FDR = 0.015); however, validation analysis did not confirm this result. Moreover, additional MR analyses yielded similar trends in causal relationships as evidenced by robust sensitivity tests.

Conclusion: Our study supported a unidirectional, negative causality between sarcopenia-related traits and COPD and hospitalization risk. This provides possible evidence that sarcopenia increases the risk of COPD and hospitalization at the genetic level. Our findings suggest that improving sarcopenia may serve as a promising strategy for minimizing the incidence of COPD and hospitalization risk, thereby reducing the health burden on these patients.

Tracheostomy insertion is becoming increasingly common in the UK. As patients with tracheostomies may be encountered in any healthcare setting, it is vital that doctors of all grades and specialties are familiar with the basic components of a tracheostomy and their management. This article aims to 'demystify' tracheostomies to enable the reader to feel more confident and competent at managing these patients in their clinical practice.

Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating respiratory condition marked by chronic symptoms and frequent exacerbations, contributing to significant morbidity and mortality. The advent of molecular microbiology and next-generation sequencing (NGS) has expanded our understanding of the lung microbiome, and integration of microbiome datasets with other omics reveals important microbial-metabolic-immuno-inflammatory interactions that influence COPD pathogenesis. Recent studies have highlighted dysbiosis of the airway microbiome, with shifts in bacterial, viral, and fungal communities playing a crucial role in disease progression, exacerbations and clinical outcomes. Moreover, microbiome changes are observed in COPD associated overlap syndromes, complicating diagnosis and treatment. This review synthesizes current microbiome research in COPD, focusing on its clinical relevance, including its potential as a diagnostic and prognostic tool. We additionally discuss the challenges of integrating microbiome data into clinical practice, emphasizing the need for personalized, precision medicine approaches to optimize COPD management and improve patient outcomes.

Aims/background: Staphylococcus aureus bacteremia (SAB) bloodstream infection (BSI) is a common complication among patients treated in the intensive care unit (ICU), predisposing them to high morbidity and mortality. The mortality rate at one and three months is 18% and 27%, respectively, and the recurrence and reinfection rate reaches 9%. This study aims to analyze prognostic factors for ICU patients with SAB BSI and establish a prediction model.

Methods: A total of 210 SAB BSI patients admitted to the ICU from January 2020 to December 2023 were retrospectively selected. Patients were randomly divided in a 3:2 ratio into a modeling group (n = 126) and a validation group (n = 84). Within the modeling group, patients were further categorized into the good prognosis group (n = 75) and the poor prognosis group (n = 51) based on their prognosis outcomes. Univariate and binary logistic regression analyses were conducted to identify prognostic factors for SAB BSI patients. A prediction model was constructed using SPSS, receiver operating characteristic (ROC) curves were generated with R programming language, and calibration and decision curve analysis (DCA) curves were utilized to assess the model's application value.

Results: Inappropriate initial antibiotic therapy, infection source, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and central venous catheter placement showed significant differences (p < 0.05). The results of binary logistic regression analysis indicated that inappropriate initial antibiotic therapy, infection source, APACHE II score, and central venous catheter placement were prognostic factors for SAB BSI patients (p < 0.05). The model equation was Logit(P) = -3.549 + (0.871X₁) + (0.959X₂) + (0.070X₃) + (0.832X₄). The model in the modeling group and the validation group showed a calibration curve with a slope close to 1, which indicates good consistency between the predicted risk and the actual risk. The ROC analysis results indicated that in the validation group, the model had an area under the curve of 0.7857 with a standard error of 0.0331 (95% confidence interval (CI): 0.7229-0.8518, p < 0.001) and a Youden's index of 0.61, resulting in a sensitivity of 80.96% and a specificity of 79.64%. The decision curve analysis (DCA) curve demonstrated that the model had a clear positive net benefit.

Conclusion: Inappropriate initial antibiotic therapy, infection source, APACHE II score, and central venous catheter placement are prognostic factors for SAB BSI patients receiving care in the ICU. This study successfully established and validated a prediction model for SAB BSI.

Kidney stone disease (KSD) is a common urological condition. For the patient, it typically presents with severe colicky flank pain and can have a substantial impact on quality of life, work productivity, and livelihood. For the clinician, they can present a diagnostic conundrum particularly in the absence of appropriate imaging, and the cost burden to the healthcare system can be significant. Investigations serve to rule out underlying metabolic, structural or pathological abnormalities, as well as identify the size, number, location, type and associated features of stone. KSD treatment can be complex, encompassing a spectrum of conservative, dietary, medical, and surgical approaches. This article provides an overview of the risk factors, clinical features, diagnosis, prevention and management of KSD. We conclude with a review of the recent innovations in this field.