British journal of hospital medicine最新文献

As the demographics of global and European countries change, the healthcare systems need to review existing pathways and service models. An ageing population is being offered more complex and invasive surgical procedures. Furthermore, there is an additional risk with this changing population profile, especially due to increasing frailty, sarcopenia, the incidence of cancer is high, and complex co-morbidities. An emerging challenge for the surgical population is the higher prevalence of obesity. These patients, with complex co-morbidities and needs, form the so-defined "high-risk" surgical patients-who account for 12.5% of surgical procedures but 80% of deaths. Prehabilitation is emerging as an important intervention to address the risk to functional capacity and quality of life. Trials have shown reductions of complications, length of stay and readmissions postoperatively. The best impact is arguably when prehabilitation is multimodal (exercise, nutrition, psychological, and lifestyle) and personalised. This article aims to explore the barriers to the availability of prehabilitation in the UK. The authors found the three most significant barriers were cost-effectiveness, workforce shortage and lack of national policy at the time of publication.

A 62-year-old female was referred to the acute medical unit with a history of progressively worsening mobility, shortness of breath and leg swelling over the last few months. Initial investigations revealed hypoxia with features of decompensated heart failure (HF) and a significantly elevated troponin. The patient developed a rapidly progressive type two respiratory failure (T2RF) over 24 hours requiring non-invasive ventilation (NIV). There was evidence of marked proximal and respiratory muscle weakness and following investigation the patient was diagnosed with anti-signal-recognition-particle immune mediated necrotising myopathy (SRP-IMNM) with myocardial and respiratory involvement. Following the introduction of high dose corticosteroid and further immunosuppression, the patient was discharged well and has had persistent improvement over the subsequent year.

Respiratory viruses are an important cause of acute respiratory illnesses in older adults. The spectrum of illness may range from pneumonia to an exacerbation of underlying respiratory disease or acute bronchitis. Respiratory viruses can account for a significant proportion of chest infections. However, respiratory viruses, either acting as primary pathogens or in conjunction with bacterial infections, are often underdiagnosed due to less frequent viral testing compared to bacterial infections. Hitherto neglected, the coronavirus disease 2019 (COVID-19) pandemic has brought into sharp focus and generated interest in respiratory viruses and their burden in all age groups. This article addresses this interest and summarises the most prevalent and emerging respiratory viruses affecting the elderly. There is a general overview as well as specific information on how to approach, identify, and treat these viruses. We will also discuss the latest guidance on vaccination, as well as adjunctive tests like procalcitonin and point-of-care testing and the niche that these occupy in the diagnosis and management of chest infections.

Aims/Background Burnout among nursing students has become a critical issue, negatively impacting their academic performance, psychological well-being, and professional development. This systematic review aims to synthesise literature on nursing student burnout and explore its effects on self-concept, engagement, and psychological health, along with strategies to mitigate burnout. Methods This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included studies published between January 2015 and January 2024. Data were extracted from peer-reviewed studies identified in databases including MEDLINE, CINAHL, PsycINFO, and SCOPUS, focusing on burnout among undergraduate and graduate nursing students. Results A total of 28 articles were included in the review. Three major themes emerged: (1) burnout's negative effect on student self-concept and self-efficacy, (2) the protective role of academic and clinical engagement in preventing burnout, and (3) interventions such as resilience training and mindfulness-based programs that help reduce burnout. Promoting self-concept, fostering engagement, and building resilience were identified as key strategies to alleviate student burnout. Conclusion Burnout in nursing students is linked to poorer academic performance and psychological distress. Early interventions, such as resilience training and mindfulness, should be integrated into nursing programs to help mitigate burnout. Nurse educators and clinical supervisors can play a pivotal role by creating supportive and engaging learning environments that reduce burnout and promote students' well-being.

There has been an increase in the routine use of point of care ultrasound (POCUS) in the UK over the last decade, which has been reflected by its inclusion in the training curriculum of several specialties. Despite this fact there are still those within medicine who are reluctant to engage with POCUS, remaining sceptical about its benefits. A substantial evidence base exists in support of POCUS use in patient assessment and management. Though there are accepted challenges in achieving competency, these are being acknowledged and work undertaken to overcome them. There is growing enthusiasm amongst the medical workforce for the development of POCUS competencies, and as its use becomes increasingly normalised those still in doubt may see its value. This review aims to highlight the current state of play of POCUS within internal medicine, explore the current barriers to accreditation whilst also suggesting solutions, and discuss the future possible directions for this imaging modality. We conclude that to facilitate the use of POCUS as a routine part of care within internal medicine, there must be collaboration between multiple specialties to facilitate high quality training and sustainable safe practice to the benefit of our patients.

Lower extremity amputation is the most feared complication in people living with diabetes and produces a significant physical, psychosocial and economic burden. The annual cost of diabetes-related ulceration and amputation is £837-£962 million, i.e., 0.8-0.9% of the National Health Service budget for England. Major amputation rates have reduced globally, largely in association with the introduction of diabetes foot multidisciplinary team services. However, more recently, amputation rates have stagnated in the UK and started to increase again in the USA, driven by increased amputation rates in younger patients and those from areas of greater social deprivation. We discuss interventions shown to reduce lower limb amputation in diabetes including multidisciplinary team services, root cause analysis, prompt referral for expert assessment and whole systems approaches designed to improve diabetic foot care throughout the patient experience. Some recent novel clinical interventions also demonstrate potential for greater limb preservation. We also discuss recent novel plastic and vascular surgery interventions and advanced dressing solutions, which show promise in improving limb salvage rates in the context of diabetic foot ulceration.

Aims/Background Esketamine exhibits strong sedative and analgesic effects. Similarly, erector spinae plane block (ESPB) blocks somatic and visceral nerves and is commonly used for pain relief in thoracic surgery. Therefore, this study aims to investigate the impacts of combining esketamine with ESPB on opioid consumption, inflammatory stress, and cognitive function after thoracoscopic surgery. Methods This retrospective study collected clinical data from 114 patients who underwent thoracoscopic surgery at Jinhua Municipal Central Hospital, between January 2022 and January 2024. Based on anesthesia approaches, patients were divided into the ESPB (n = 62) and esketamine + ESPB groups (n = 52). Several variables, such as perioperative indicators, postoperative recovery, inflammatory stress, and cognitive function were compared between the two groups. Results In both groups, the Numeric Rating Scale (NRS) score increased at 6 h postoperatively compared to at 1h, and gradually decreased at 12 h, 24 h, and 48 h (p < 0.05). Compared to the ESPB group, the NRS score was significantly decreased in the esketamine + ESPB group at 6 h, 12 h, 24 h, and 48 h after surgery (p < 0.001). The oxycodone consumption was significantly lower in the esketamine + ESPB group at 24 h and 48 h post-surgery than in the ESPB group (p < 0.001). Furthermore, the incidence of adverse reactions was 30.6% (19/62) in the ESPB group and 34.6% (18/52) in the esketamine + ESPB group, with the difference being statistically insignificant (p = 0.652). Compared to the ESPB group, the white blood cell (WBC) count, C-reactive protein (CRP), procalcitonin (PCT), interleukin (IL)-6, and tumor necrosis factor (TNF)-α levels were significantly decreased in the Esketamine + ESPB group at day 3 after surgery (p < 0.001). Compared to the ESPB group, the Montreal Cognitive Assessment Scale (MoCA) score was substantially elevated in the esketamine + ESPB group at days 1 and 3 after surgery (p < 0.001, p = 0.001). Conclusion The combination of esketamine and ESPB effectively alleviated postoperative pain and reduced opioid consumption after thoracoscopic surgery. Furthermore, the combined approach significantly improved postoperative inflammatory stress and cognitive impairment compared to the use of ESPB alone without increasing adverse reactions.

The use of [¹⁸F]fluorodeoxyglucose positron emission tomography/computed tomography ([¹⁸F]FDG PET/CT) in breast cancer response assessment and monitoring is well established. However, there are limitations not only to the use of [¹⁸F]FDG PET/CT in breast cancer, but also deficiencies in the conventional imaging assessment of treatment response. Breast cancer is biologically heterogeneous, and heterogeneity of tumours limits the accuracy of [¹⁸F]FDG PET/CT assessment in some subtypes of breast cancer. Increased understanding of tumour biology and the tumour microenvironment have led to the development of new, specific radio-tracers. These targeted tracers may offer a solution in terms of more accurate response assessment, and prognostication.

Aims/Background Chemotherapy-induced myelosuppression (CIM) is associated with increased risks of life-threatening complications, treatment delays, and reduced therapeutic efficacy. However, the predictors contributing to these risks remain unclear. Therefore, this study aimed to systematically review the existing risk prediction models developed for CIM and to evaluate prognostic factors associated with patient outcomes. Methods We comprehensively searched domestic and international databases for literature on CIM risk prediction models, covering records from database inception to 31 December 2024. Two researchers independently performed literature screening and data extraction. The risk of bias and applicability of included studies were assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Results A total of 17 risk prediction models developed for CIM were identified. The area under the curve (AUC) of the selected models ranged from 0.708 to 0.95. Among the six models that underwent external validation, AUC values ranged from 0.708 to 0.95. Fifteen models reported discriminative performance metrics (AUC) exceeding 0.70. The included models incorporated between 2 and 16 predictors, with chemotherapy regimen intensity, baseline haematological parameters (platelet count, haemoglobin, and neutrophil count), and age being the most frequently selected variables. Conclusion Current CIM risk prediction models demonstrate promising predictive performance, with clinically relevant predictors. However, high bias risks necessitate future optimisation through multicenter prospective studies, the integration of dynamic biomarkers, and standardised validation frameworks to enhance the utility of clinical decision-making.