British journal of hospital medicine最新文献

Aims/Background To implement a co-management mode among community-level diabetes patients and analyze its impact on diagnosis and treatment compliance and diabetic retinopathy of the patients. Methods A total of 80 patients who underwent diabetic retinopathy examination in Lanxi People's Hospital from January 2021 to March 2022 were retrospectively selected as the study objects. The clinical data of the patients were analyzed, including 40 patients who adopted the conventional diabetes management mode from January 2021 to August 2021 as the control group. From September 2021 to March 2022, 40 patients in the county medical service community diabetes management team model were adopted as the management group. The two groups of patients were compared in terms of diabetic retinopathy indictors, biochemical examination indicators, self-management ability, and nursing management satisfaction. Results Number of patients complying with treatment protocols in the management group was higher than that in the control group (p < 0.05). The blood spot area, macular thickness, hemangioma volume, and visual-field grayscale value in the management group at the last follow-up were all lower than those in the control group (p < 0.05). The levels of diastolic blood pressure (DBP), systolic blood pressure (SBP), fasting blood glucose (FBG), hemoglobin A1C (HbA1c), total cholesterol (TC), and triglyceride (TG) in the management group at the last follow-up were all lower than those in the control group (p < 0.05). The scores of disease cognition ability, self-management ability, and nursing management satisfaction in the management group were all higher than those in the control group (p < 0.05). Conclusion By changing management concept and implementing the whole-process management and treatment mode for diabetic patients within the scope of the county medical service community, the diagnosis and treatment compliance of the patients can be improved, and the effective control of blood glucose, blood pressure, and blood lipid levels can be achieved, thereby improving the self-management ability and nursing management satisfaction of the patients and providing a new nursing mode for chronic disease management.

Aims/Background Previous studies have indicated a strong correlation between disturbances in blood pressure (BP) circadian rhythm and major cardiovascular adverse events. Similarly, blood pressure variability (BPV) has been closely linked to cerebral small vessel disease and leukoaraiosis. This study aims to investigate the relationship between BP rhythm and BPV with the short-term prognosis of patients with Type A aortic dissection, offering insights for targeted perioperative nursing interventions and improving patient outcomes. Methods This retrospective study included patients undergoing surgical treatment for Type A aortic dissection at Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) from June 2022 to March 2024. The study followed patients from the completion of surgery to 30 days postoperatively, with all-cause mortality within 30 days as the endpoint representing poor short-term prognosis. Clinical data were compared along with: types of BP rhythm; BPV parameters including the mean 24-hour systolic BP (24hSBP), 24-hour diastolic BP (24hDBP), and pulse pressure; and the coefficient of variability (CV) for 24hSBP, 24hDBP, and pulse pressure. Multivariate logistic regression analysis was utilized to identify risk factors for poor short-term outcomes in these patients, and receiver operating characteristic (ROC) curves were plotted to assess the predictive value of BP rhythm types and BPV indicators. Results The study ultimately included 115 participants, with 31 deaths occurring within 30 days post-surgery, resulting in a postoperative mortality rate of 26.96%. The multivariate logistic regression analysis revealed that white blood cell count, neutrophil count, non-dipping BP rhythm, pulse pressure, and the CV for 24hSBP, 24hDBP, and pulse pressure, were significant risk factors for poor short-term prognosis (p < 0.05). The ROC curve analysis demonstrated that non-dipping BP rhythm, pulse pressure, 24hSBP-CV, 24hDBP-CV, and pulse pressure-CV had areas under the curve (AUC) of 0.685, 0.749, 0.751, 0.773, and 0.763, respectively. The combination of these indicators yielded the highest AUC at 0.918. Conclusion A combination of BP rhythm and BPV indicators provides significant predictive value for poor short-term outcomes in patients with Type A aortic dissection. Clinicians and nursing staff can use these features to formulate targeted preventive measures.

An Intensive Care Medicine (ICM) rotation provides fantastic learning opportunities for doctors of all specialties. Understanding your role in this highly specialised field will assist you in gaining maximal benefit from your time in ICM while ensuring the best outcomes for your patients. It can be quite daunting reviewing deteriorating patients and admitting patients to the Intensive Care Unit (ICU). This article provides tips and advice for doctors new to the specialty, and will be a useful guide for medical, surgical, and emergency medicine trainees before they begin working in the ICU for the first time. We provide a structured, systematic framework which can be used comprehensively to assess ICU patients.

Aims/Background The connection between lymph node (LN) metastases in papillary thyroid carcinoma (PTC) and chronic lymphocytic thyroiditis (CLT) has been examined in a number of prior investigations. However, there is ongoing debate over the effect of CLT on LN metastasis in PTC. In order to explain the relationship between CLT and LN metastasis more convincingly, we aimed to retrospectively review clinical data to investigate the correlation between CLT and LN metastasis in PTC using propensity score matching (PSM). Methods Data on PTC patients at Wenzhou Central Hospital were collected retrospectively between 1 January 2018, and 31 March 2022. The patients were split into two groups based on whether they had CLT or not. The clinicopathological characteristics of the two groups were compared using a PSM analysis. The relationship between CLT and LN metastases was analyzed using logistic regression analysis. Results Among the 773 PTC patients collected and examined, 213 showed simultaneous CLT. Prior to PSM, patients with CLT displayed a significantly lower incidence of LN metastasis (34.3% VS 44.8%, p = 0.008), a lower metastatic LN ratio (0 (0, 0.17) VS 0 (0, 0.38), p = 0.011), and a greater number of LNs dissected (7 (5, 11) VS 5 (3, 7), p < 0.001). These differences persisted after the PSM of 208 pairs. After PSM, patients with CLT displayed a significantly lower incidence of LN metastasis (35.0% VS 44.7%, p = 0.045), a lower metastatic LN ratio (0 (0, 0.17) VS 0 (0, 0.33), p = 0.038), and a higher number of dissected LNs (7 (5, 11) VS 5 (3, 7), p ≤ 0.001). Additionally, the multivariate logistic regression analysis indicated that CLT had a protective role against LN metastasis in both the matched group (odds ratio (OR), 0.62; 95% confidence interval (CI): 0.39-0.96; p = 0.032) and the unmatched group (OR, 0.63; 95% CI: 0.44-0.91; p = 0.014). Conclusion Our data indicate that CLT may protect against LN metastases in patients with PTC. Patients having PTC with coexisting CLT have fewer LN metastases, a greater number of LNs dissected, and a lower metastatic LN ratio.

Large bowel obstruction is most commonly due to colorectal carcinoma, diverticular disease or volvulus. Rare causes of large bowel obstruction like endometriosis may occur in premenopausal women and diagnosis of large bowel endometriosis can be challenging to confirm preoperatively. Hence, clinicians should maintain a high index of suspicion for rare causes of large bowel obstruction like endometriosis. This may require complete surgical resection of the involved bowel to eliminate the risk of local recurrence.

Aims/Background Neonatal morbidity, including various diseases such as sepsis, cholestasis, and bronchopulmonary dysplasia (BPD), is a significant concern, especially in preterm infants. Selecting the appropriate lipid emulsion in parenteral nutrition (PN) is essential to improve clinical outcomes. This analysis aimed to assess the impact of a novel composite lipid emulsion, SMOFlipid, on neonates receiving PN. Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted. We compared SMOFlipid to various other lipid emulsions in PN received by infants. Research findings that addressed outcomes such as mortality, sepsis, cholestasis, necrotizing enterocolitis (NEC), BPD, patent ductus arteriosus (PDA), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH), and length of hospital stay were included. Subgroup analyses were conducted based on gestational age (GA). Twenty RCTs involving 1904 neonates were included. Results Compared to other lipid emulsions, SMOFlipid significantly reduced the cholestasis risk (risk ratio (RR): 0.65, 95% confidence interval (CI): 0.48-0.87, p = 0.004, I² = 0%). However, the incidence related to IVH, BPD, ROP, NEC, and PDA (excluding an infant subgroup with GA <28 weeks), mortality, sepsis, and duration of hospital stay did not exhibit any substantial variations. The subgroup analysis indicated a decline in PDA incidence (RR: 0.88, 95% CI: 0.79-0.99, p = 0.04, I² = 0%) among extremely premature infants receiving SMOFlipid. Conclusion SMOFlipid offers a promising option for neonatal PN, particularly for reducing cholestasis in preterm infants and PDA in extremely premature infants. Further investigations into its comprehensive benefits and long-term effects are warranted.

Aims/Background Patients receiving treatment in specialized cancer hospitals are particularly susceptible to multidrug-resistant organisms (MDRO) infections due to factors such as weakened immune systems caused by intensive treatments and prolonged hospital stays. This study aims to investigate the risk factors for MDRO infections in the cancer specialty hospital setting and to develop a corresponding risk prediction model. Methods Patients diagnosed with MDRO infections were selected for the MDRO infection group (n = 238), and those without for the non-MDRO infection group (n = 238). Non-parametric tests, chi-square tests, and multivariate logistic regression analysis were used to identify the primary risk factors for MDRO infections. With the aid of analysis utilizing R software 4.4.1 (R Foundation for Statistical Computing, Vienna, Austria), we developed a nomogram prediction model, which was evaluated using the receiver operating characteristics (ROC) curve, calibration curve, and decision curve analysis (DCA). Results Age, antibiotic application time, and central venous catheterization were independent risk factors for MDRO infection (p < 0.05). The constructed nomogram prediction model for patients with MDRO infection has a C-index of 0.8640. The ROC curve results showed that the prediction model has a specificity of 0.7700, a sensitivity of 0.8800, and an area under the curve (AUC) of 0.8800. Conclusion This study identifies significant risk factors for MDRO infections in a cancer specialty hospital setting and offers a clinically useful prediction model, which may aid in targeted preventive measures and optimization of antibiotics usage, thereby potentially reducing the incidence and impact of these infections.

Aims/Background Pregnancy may cause physiological and pathological changes in multiple organs in a woman's body, including the heart, liver, and eyes. With rapid advances in societies and economies, the proportion of advanced maternal age (AMA) women has significantly increased. Here, we aimed to investigate the changes in arteriole retinal diameter, venule diameter, macular layer thickness, and arteriole to venule ratio (AVR) in this population. Methods This retrospective case-control study included 523 pregnant women (1046 eyes) and was performed on both eyes. In total, 318 subjects were included in the AMA group, and 205 subjects were included in the non-AMA group. Nonmydriatic fundus photography and optical coherence tomography (OCT) were performed on the same day, and the results were analyzed for the central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), AVR, and macular thickness (9 subfields) by integrative vessel analysis and automatic OCT software. Results In both eyes, the CRAE was significantly lower in the AMA group than that in the non-AMA group (p < 0.05; respectively). The CRVE in the AMA group was higher than that in the non-AMA group (p < 0.001; respectively). Compared to the non-AMA group, the AMA group exhibited a significant reduction in macular thickness within the inner nasal, outer nasal, and inner temporal subfields of both eyes (p < 0.05; respectively). Age was significantly correlated with CRVE and AVR in both eyes of pregnant women (CRVE: p < 0.0001; AVR: p < 0.01). Conclusion This study reports variations in the diameter of the retinal vasculature and the thickness of the macula in women of AMA. It is important to consider these changes when interpreting the adverse eye outcomes experienced by women of AMA.

Aim/Background Acute coronary syndrome (ACS), a condition characterized by acute cardiac ischemia, is among the major causes of death from cardiovascular diseases (CVD). However, whether there is a correlation between platelet reactivity and major adverse cardiovascular events (MACE) remains debatable, and whether platelet function tests should be tailored for ACS patients after percutaneous coronary intervention (PCI) is still under discussion. This study aims to investigate the relationship between platelet reactivity and the occurrence of MACE in ACS patients post-PCI and to discuss the implications of these findings. Methods Clinical studies on 'PCI, ACS, dual antiplatelet therapy (DAPT), platelet reactivity, major adverse cardiovascular events (MACE)' up to 31 October 2023, were systematically collected from Embase, PubMed, and the Cochrane Library. Twelve articles meeting predefined criteria were selected. Meta-analysis was performed using Review Manager 5.4 (Cochrane, London, UK) and Stata 15.0 (StataCorp LLC, College Station, TX, USA) to compute pooled effect sizes, assess heterogeneity, explore sources of heterogeneity, and evaluate publication bias. Results Twelve articles consisting of 9297 patients were included. The meta-analysis showed that ACS patients with high platelet reactivity (HPR) who received PCI and used DAPT for 1-2 years had a greater risk of MACE (risk ratio (RR) = 1.79, 95% confidence interval (CI): 1.30-2.46) compared to those with low platelet reactivity. Moreover, greater platelet reactivity was associated independently with all-cause mortality (RR = 2.26, 95% CI: 1.63-3.12), cardiac mortality (RR = 2.87, 95% CI: 2.16-3.8), myocardial infarction (RR = 1.98, 95% CI: 1.53-2.5), in-stent restenosis (RR = 1.87, 95% CI: 1.22-2.87), as well as stroke (RR = 1.62, 95% CI: 1.02-2.57), but not with coronary revascularization events (RR = 0.99, p = 0.96, 95% CI: 0.80-1.24). On the other hand, meta-regression revealed that region (p = 0.99), type of ACS patient (p = 0.16), drug regimen (p = 0.48), testing method (p = 0.51), sampling time (p = 0.70), follow-up time (p = 0.45), and PCI protocol (p = 0.27) were not sources of heterogeneity in the study. Conclusion The meta-analysis outcomes indicate that in ACS patients receiving PCI and using dual antiplatelet therapy for 1-2 years, HPR was independently positively correlated with major adverse cardiovascular events, all-cause (or cardiac) mortality, recurrent myocardial infarction, in-stent restenosis, and stroke. This suggests that platelet reactivity testing has clinical and translational significance in predicting patients' risk of adverse cardiovascular events.

Aims/Background Although the incidence of nephrotic syndrome (NS) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) is relatively low, it can significantly affect patients' quality of life and may even be life-threatening. Therefore, it is essential to investigate the clinical manifestations and prognosis of patients with NS after allo-HSCT, as well as to identify potential high-risk factors associated with this condition. Methods We investigated the incidence rate of NS in 1457 patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) at the First Affiliated Hospital, Zhejiang University School of Medicine between June 2007 and March 2020. Among these, we identified 12 patients who developed NS after allo-HSCT (NS group). For comparison, we selected a control group of 48 patients matched by gender and transplantation time who did not develop NS. Univariate and multivariate logistic regression analyses were performed using SPSS software, version 25.0 (IBM Corp., Armonk, NY, USA) to identify independent risk factors for NS. Results Among the 1457 patients, 12 (0.82%) developed post-transplantation NS, with a median onset time of 14.99 months (range: 5.39-48.43 months) after transplantation. Univariate analysis indicated that the occurrence of post-transplantation NS was significantly correlated with total cholesterol (TC) levels at 6 months post-transplantation (p = 0.041), triglycerides (TG) and TC levels at 1 year post-transplantation (p = 0.004 and p = 0.011, respectively), and cytomegalovirus (CMV) infection (p = 0.002). Multivariate analysis revealed that CMV infection (p = 0.004, odds ratio = 15.871; 95% confidence interval: 2.465-102.194) was independently associated with the development of NS. Conclusion After allo-HSCT, NS may manifest as a form of chronic graft-versus-host disease. CMV infection is a risk factor for developing NS. Effective management through the administration of calcium inhibitors and corticosteroids can enable long-term survival in these patients.