British journal of hospital medicine最新文献

Predictive algorithms have myriad potential clinical decision-making implications from prognostic counselling to improving clinical trial efficiency. Large observational (or "real world") cohorts are a common data source for the development and evaluation of such tools. There is significant optimism regarding the benefits and use cases for risk-based care, but there is a notable disparity between the volume of clinical prediction models published and implementation into healthcare systems that drive and realise patient benefit. Considering the perspective of a clinician or clinical researcher that may encounter clinical predictive algorithms in the near future as a user or developer, this editorial: (1) discusses the ways in which prediction models built using observational data could inform better clinical decisions; (2) summarises the main steps in producing a model with special focus on key appraisal factors; and (3) highlights recent work driving evolution in the ways that we should conceptualise, build and evaluate these tools.

Advanced life support certification has traditionally been the gold standard of resuscitation training for doctors and has been shown to improve outcomes from cardiac arrest. In 2021, Health Education England removed named courses from mandatory Foundational Programme competencies, which has resulted in capping of reimbursement and reduced access to courses. This represents a drop in educational standards which is particularly concerning when the medical school curriculum has been shown to deliver inconsistent, poor-quality resuscitation training. Here we review the benefits and negatives of life support training, looking at both junior and senior clinicians with differing educational requirements.

Aims/Background Intrahepatic cholestasis of pregnancy (ICP) is associated with adverse perinatal outcomes, yet the correlation between ICP and the neutrophil-to-lymphocyte ratio (NLR) remains unclear. This study aims to investigate the diagnostic value of NLR in ICP. Methods In this retrospective case-control study, 113 patients with ICP treated in Beilun District People's Hospital from January 2020 to December 2022 were recruited and categorized as the ICP group, and 209 healthy pregnant women treated during the same period were selected as the control group. The levels of NLR and mean platelet volume (MPV) were compared between the two groups. The NLR of patients with different ICP severity were compared. Logistic regression model was used to analyze the relationship between relevant indicators and ICP. The capability of NLR in predicting ICP was evaluated using receiver operating characteristic (ROC) curves. Results There were significant differences in age, neutrophil count, lymphocyte count, platelet count, MPV, alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), NLR, and serum total bile acid (sTBA) among all groups (p < 0.05). The NLR in the severe ICP group was significantly higher than that in the mild ICP group (p < 0.05). Logistic regression analysis showed that MPV (odds ratio [OR] = 1.247) and NLR (OR = 1.885) were independent factors influencing the occurrence of ICP (p < 0.05). ROC curve analysis showed that the area under the curve (AUC) for both mild ICP and severe ICP was 0.679 and 0.869, respectively, substantiating the diagnostic value of NLR. Conclusion NLR can be used as an auxiliary indicator in the diagnosis of ICP and has important clinical value in predicting adverse pregnancy outcomes in ICP patients.

Aims/Background Deep venous thrombosis (DVT) represents a significant postoperative complication after artificial femoral head replacement, with the incidence increasing proportionally with patient age. This study aimed to evaluate the effect of early postoperative use of intermittent pneumatic compression devices (IPC), followed by the combined use of low molecular weight heparin (LMWH) after 48 hours, for the prevention of postoperative lower limb DVT in elderly patients undergoing hip arthroplasty. Methods The retrospective study included 100 elderly patients who underwent unilateral femoral head replacement. The control group (n = 55) received combined LMWH initiated 12 hours postoperatively, while the observation group (n = 45) started combined LMWH 48 hours postoperatively. Changes in coagulation parameters, perioperative complications, and the incidence of postoperative lower limb DVT were compared between the two groups. Results Coagulation parameters showed significant changes post-intervention in both groups, with no statistically significant inter-group differences observed post-intervention (p > 0.05). The incidence of postoperative lower limb DVT did not differ significantly between the two groups (p > 0.05). However, the observation group demonstrated significantly lower postoperative blood loss, incidence of periwound hematoma, and transfusion rates compared to the control group (p < 0.05). Conclusion The sequential application of IPC in the early postoperative period, followed by combined LMWH administration after 48 hours, demonstrates comparable efficacy in preventing lower limb DVT formation in elderly patients undergoing hip arthroplasty when compared to the initiation of combined LMWH starting 12 hours postoperatively. In addition, this approach significantly reduces the risk of postoperative bleeding and exhibits a high safety profile.

Patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) face considerable cardiorenal morbidity and mortality despite existing therapies. Recent clinical trials demonstrate the efficacy of finerenone, a novel non-steroidal mineralocorticoid receptor antagonist, in reducing adverse renal and cardiovascular outcomes. This editorial briefly reviews the evidence and its implications for clinical practice, advocating the use of finerenone in these high-risk patients in combination with currently established treatment agents.

Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are commonly prescribed in diabetes mellitus and increasingly for cardiorenal protection. They carry the risk of euglycaemic diabetic ketoacidosis (eDKA). Guidelines around the perioperative handling of these medications are limited and some evidence suggests that withholding them can lead to more surgical complications and poorer glycaemic control. This article gives an overview of arguments for and against withholding SGLT-2 inhibitors in the perioperative period.

Aims/Background A novel exercise protocol for cardiac rehabilitation aerobic (CRA) has been developed by Hebei Sport University, demonstrating efficacy in patients with coronary heart disease (CHD). The objective of this study was to evaluate the impact of CRA on precise cardiac rehabilitation (CR) for CHD patients presenting with stable angina pectoris. Methods The study cohort comprised patients with stable angina who were categorized into three groups: the CRA group (n = 35), the power bicycles (PB) group (n = 34), and the control group (n = 43). In addition to standard treatment, the CRA group underwent a 12-week CRA-based CR intervention, while the PB group participated in a similar program centered on PB exercise, and the control group received only standard treatment. Results At the end of the 12-week intervention, significant differences were observed among the groups in several physiological parameters, including systolic blood pressure (SBP), fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), Glycated Haemoglobin (Hb-A1c), peak oxygen uptake (Peak VO₂), anaerobic threshold (AT), and Peak VO₂/heart rate (HR) (p < 0.05). Both the CRA and PB groups showed significant reductions in SBP, FBG, TG, TC, LDL, and Hb-A1c compared to the control group (p < 0.05). Additionally, both groups exhibited significant improvements in Peak VO₂, AT, and Peak VO₂/HR (p < 0.05). Intra-group analysis revealed that the CRA group showed significant improvements from baseline to post-intervention in SBP, diastolic blood pressure (DBP), FBG, TG, TC, high-density lipoprotein (HDL), LDL, Hb-A1c, Peak VO₂, AT, and Peak VO₂/HR (p < 0.05). Similarly, the PB group demonstrated significant improvements across these parameters (p < 0.05). Conclusion Both CRA and PB exercises are safe and effective for achieving precise CR in patients with CHD. A 12-week CRA intervention, conducted three times per week for 30 minutes per session, significantly improves cardiopulmonary function and biochemical makers in patients with stable angina. These improvements are comparable to those achieved through PB exercise in precise CR.

Aims/Background Diabetes is a chronic lifelong condition that requires consistent self-care and daily lifestyle adjustments. Effective disease management involves regular blood glucose monitoring and ongoing nursing support. Inadequate education and poor self-management are key factors contributing to increased mortality among diabetic individuals. Providing personalized guidance and behavioral interventions through continuous nursing care is crucial for achieving optimal glycemic control and fostering positive societal outcomes. This study aimed to evaluate the impact of an Omaha System-based continuous nursing model, implemented through the "Internet+" framework, on enhancing self-health management skills, glycemic control, and treatment adherence among patients with type 2 diabetes mellitus (T2DM). Methods This retrospective study analyzed clinical data of T2DM patients who visited the diabetes health management clinic of Zhang Ye People's Hospital affiliated to Hexi University between December 2023 and May 2024. Participants were categorized into intervention and control groups based on whether they received the "Internet+"-enabled Omaha System continuous nursing care model. Variables, including demographic characteristics, self-management behaviors, cognitive abilities, environmental factors, glycemic control indicators, and treatment adherence (medication compliance, dietary compliance, lifestyle adherence, and follow-up punctuality), were assessed and compared at baseline, 1 month, and 3 months post-intervention. Results The study included 52 patients in the intervention group and 68 in the control group. Baseline characteristics revealed no significant differences between the two groups (p > 0.05). At 1 and 3 months post-intervention, the intervention group exhibited significant improvements in self-management behaviors, cognitive abilities, environmental factors, and overall scores compared to baseline and the control group (p < 0.05). Fasting plasma glucose (FPG) levels were also significantly reduced in the intervention group compared to baseline and the control group (p < 0.05). 3 months post-intervention, the intervention group demonstrated significantly higher adherence rates to dietary recommendations, healthy lifestyle practices, and treatment compliance compared to the control group (p < 0.05). Conclusion The "Internet+"-based Omaha System continuous nursing model significantly enhances self-health management capabilities, stabilizes glycemic control, and promotes adherence to healthy behaviors among patients with T2DM. These findings highlight the potential of the model for broader clinical application in diabetes management.

Aims/Background Gestational diabetes mellitus (GDM) is a common complication during pregnancy. This retrospective study investigates the correlation between umbilical blood flow index and maternal-fetal outcomes in pregnant women with GDM, aiming to contribute to evidence-based risk assessment and management strategy in this high-risk obstetric population. Methods This retrospective study recruited 119 pregnant women with GDM who were admitted to the Yichang Central People's Hospital, between January 2022 and January 2024. Based on the umbilical blood flow index, the study participants were divided into a normal umbilical blood flow (UBF) index group (n = 56) and a high UBF index group (n = 63). Colour Doppler ultrasound was used to assess umbilical blood flow, and relevant data on maternal, fetal, and neonatal outcomes were obtained from the hospital's electronic medical records. Results We observed that, compared to the normal UBF index group, the high UBF index group exhibited significantly higher rates of adverse pregnancy outcomes, including the cesarean section (p = 0.022), preterm delivery (p = 0.020), gestational hypertension (p = 0.019), neonatal hypoglycemia (p = 0.015), as well as increased incidence of neonatal complications such as respiratory distress syndrome (p = 0.009), neonatal jaundice (p = 0.022), neonatal intensive care unit (NICU) admission (p = 0.015), lower 5-minute Apgar scores (p = 0.013), and neonatal sepsis (p = 0.005). Furthermore, significant differences were observed in fetal biometric parameters and placental morphology between the two groups (fetal weight: p = 0.003; estimated fetal weight percentile: p = 0.017; femur length: p = 0.018; placental weight: p = 0.019; placental volume: p = 0.021). Additionally, correlation analyses indicated significant associations between umbilical blood flow index and maternal and fetal outcomes (p < 0.05). Conclusion We observed a significant correlation between umbilical blood flow indices and maternal and fetal outcomes in pregnant women with gestational diabetes mellitus, implying its utility as a non-invasive parameter for risk stratification and personalized management in this high-risk obstetric population.

Aims/Background Artificial intelligence (AI), with advantages such as automatic feature extraction and high data processing capacity and being unaffected by fatigue, can accurately analyze images obtained from colonoscopy, assess the quality of bowel preparation, and reduce the subjectivity of the operating physician, which may help to achieve standardization and normalization of colonoscopy. In this study, we aimed to explore the value of using an AI-driven intestinal image recognition model to evaluate intestinal preparation before colonoscopy. Methods In this retrospective analysis, we analyzed the clinical data of 98 patients who underwent colonoscopy in Nantong First People's Hospital from May 2023 to October 2023. Among them, 47 cases were evaluated based on the intestinal preparation map and the last fecal characteristics (Regular group), and 51 cases were evaluated using an AI-driven intestinal image recognition model (AI group). The duration of colonoscopy examination, intestinal cleanliness, incidence of adverse reactions, and satisfaction with intestinal preparation of the two groups were analyzed. Results The time for colonoscopy in the AI group was shorter than that in the Regular group, and the intestinal cleanliness score in the AI group was higher than that in the Regular group (p < 0.05). The incidence of adverse reactions in the AI group (3.92%) was lower than that in the Regular group (10.64%), but the difference was not statistically significant (p > 0.05). The satisfaction rate of intestinal preparation in the AI group (96.08%) was comparable to that of the Regular group (82.98%) (p > 0.05). Conclusion Compared with the assessment based solely on the intestinal preparation map and the last fecal characteristics, the application of AI intestinal image recognition model in intestinal preparation before colonoscopy can shorten the time of colonoscopy and improve intestinal cleanliness, but with comparable patient satisfaction and safety.