British journal of hospital medicine最新文献

Aims/background: Liver transplantation specialist nurses provide comprehensive and safe care for liver transplant patients, which requires them to have a wide range of competencies. However, at present, there is no comprehensive understanding of the competency of liver transplantation specialist nurses in China, and there is a lack of comprehensive evaluation indicators. The purpose of this study was to construct a competency evaluation indicator system for specialist nurses in liver transplantation.

Methods: Utilizing the "Iceberg model" of competency, the indicator system for evaluating the competency of liver transplant specialist nurses was developed through literature review, semi-structured interviews, and two rounds of Delphi expert consultation.

Results: Twenty nursing and medical experts in liver transplantation were consulted over two rounds. The effective response rates for the expert consultation questionnaires were 90.91% and 100.00% for the first and second rounds, respectively. The coefficient of expert judgment was 0.920, the coefficient of familiarity was 0.880, and the authority coefficient was 0.900. The value range of the coefficient of variation in the second round was 0.00-0.16, both <0.25, indicating that the degree of coordination of expert opinions was high. The final competency evaluation index system for liver transplant specialist nurses encompassed 6 primary indicators, 17 secondary indicators, and 59 tertiary indicators, including professional knowledge, professional skills, social role, self-concept, personality quality, and motivation.

Conclusion: The developed competency evaluation indicator system for liver transplant specialist nurses possesses scientific validity and reliability, offering a reference for the training and assessment of liver transplant specialist nurses.

Aims/Background Hematospermia, characterized by blood in the ejaculate, is a common and distressing condition in urology. Identifying the underlying causes, including translucent membranes in the prostatic utricle, is crucial for effective management. Despite advancements in diagnostic techniques, reliable predictive tools are needed to enhance preoperative planning and patient outcomes. This study aimed to develop a novel nomogram to predict the presence of translucent membranes in the prostatic utricle of hematospermia patients. Methods In total, 284 patients were selected from The Second People's Hospital of Hefei database based on inclusion and exclusion criteria. The cohort was divided into a training set (198 patients) and a validation set (86 patients). To identify risk factors associated with the prostatic utricle translucent membrane, multivariable logistic regression analysis was employed. The identified risk factors were then used to construct a predictive nomogram model. The performance of the nomogram was evaluated using several statistical tools: receiver operating characteristic (ROC) curves to assess discriminative ability, calibration curves to evaluate prediction accuracy, and decision curve analysis (DCA) to determine clinical utility. Results The findings revealed that age, duration of disease, history of seminal vesiculitis, and seminal vesicle dimensions (width, length, and thickness) were independent risk factors for the presence of a prostatic utricle translucent membrane in patients with hematospermia. Using these variables, a nomogram was developed. The nomogram demonstrated strong predictive capability, as evidenced by its performance in ROC and calibration curve analyses. Furthermore, the DCA indicated that the nomogram offered significant clinical net benefits in predicting the presence of a translucent membrane. Conclusion Clinical use of the developed nomogram can assist clinicians in identifying patients with hematospermia who have translucent membrane in the prostatic utricle and in developing individualized treatment.

A 26-year-old female presented with a 3-month history of dry cough, unintentional weight loss, night sweats and fatigue. Her background history was significant for ulcerative colitis, managed with Adalimumab for almost 2 years. Clinical examination was unremarkable, apart from some mild pallor. Abnormal chest x-ray findings prompted a computerised tomography (CT) thorax which demonstrated multifocal peri-bronchial consolidation. The differential diagnosis was multifocal organising pneumonia and tuberculosis (TB). Extensive investigations, including invasive bronchial imaging and biopsy, ultimately ruled out TB. This paper reports a case of Adalimumab-induced organising pneumonia and discusses its clinical implications.

Aims/Background The prognostic significance of body composition variables has become a popular area of research over the recent years. This study aimed to determine whether adipose tissue variables and sarcobesity index measured by computed tomography (CT) could predict cardiopulmonary exercise testing (CPET) performance and long-term mortality in patients undergoing major colorectal surgery. Methods The Strengthening the Reporting of Cohort Studies in Surgery (STROCSS) statement standards were followed to conduct a retrospective cohort study of consecutive patients who had CPET prior to major colorectal surgery between January 2011 and January 2017. Receiver Operating Characteristic curve analysis was conducted to assess the discriminative performances of adipose tissue variables. The association between CT-derived adipose tissue variables (sarcobesity index, visceral adipose tissue, subcutaneous adipose tissue, and total adipose tissue) and CPET performance and mortality were assessed using regression analyses. Results 457 patients were included. Total adipose tissue evaluated via 2-dimensional (2D) and 3-dimensional (3D) approaches predicted oxygen uptake (V̇O₂) Rest, V̇O₂ anaerobic threshold (AT), ventilatory equivalents for carbon dioxide (V̇E/V̇CO₂) AT, ventilatory equivalents for oxygen (V̇E/V̇O₂) AT, V̇O₂ peak, exercise time, maximum work, peak metabolic equivalents (METS), peak respiratory rate (RER), and peak oxygen pulse. Sarcobesity index (2D and 3D) predicted V̇O₂ Rest, V̇O₂ AT, V̇E/V̇CO₂ AT, V̇O₂ peak, maximum work, peak METS, maximum heart rate, and peak RER. Neither total adipose tissue nor sarcobesity index (2D and 3D) predicted 1-year, 3-year, or 5-year mortality. There was no difference in the discriminative performance of adipose tissue variables in predicting mortality. Conclusion The CPET performance may be predicted by radiologically measured adipose tissue variables and sarcobesity index. However, the prognostic value of the variables may not be significant in this setting.

This article reviews point-of-care ultrasound (POCUS) in the perioperative period. Ultrasound-guided techniques for regional anaesthesia and vascular access have been well-established in anaesthesia for many years. However, integration of whole-body POCUS into UK anaesthetic practice remains limited. There is a growing body of evidence highlighting the benefits of POCUS throughout the perioperative period. Widespread use may help to improve patient care in anaesthesia.

Aims/Background Gangliogliomas are grade 1 glioneuronal tumors occurring predominantly in the temporal lobe, as per the World Health Organization (WHO) classification. Gangliogliomas often harbor BRAF (v-Raf murine sarcoma viral oncogene homolog B1) p.V600E hotspot mutation or other alterations leading to activation of RAS/RAF/MAPK (rat sarcoma virus oncogene/rapidly accelerated fibrosarcoma/mitogen-activated protein kinase) signaling pathway, which is the driver factor of this tumor. This study aims to investigate a case of ganglioglioma patient with distinctive molecular features, and to present the clinical and pathological characteristics as well as the treatment employed for this individual. Case Presentation We reported a primary ganglioglioma harboring MAP2K1 (mitogen-activated protein kinase kinase 1) mutation and CDKN2A/B (cyclin-dependent kinase inhibitor 2A/2B) homozygous deletion in a 4-year-old patient. The patient experienced tumor recurrence 12 months after gross total resection of the tumor. Subsequently, salvage chemotherapy with a combination of temozolomide and irinotecan was administered, resulting in effective control of the tumor. Conclusion To our knowledge, this is the first reported case of ganglioglioma with anaplastic features harboring MAP2K1 mutation and homozygous deletion of CDKN2A/B. These findings may shed light on the genetic features of ganglioglioma and offers insights into potential therapeutic approaches for this rare neoplasm.

Aims/Background Acute radiation dermatitis is the most common complication of radiotherapy in patients with breast cancer, with mild severity relieved by symptomatic treatment and moderate-to-severe severity leading to compromised skin integrity and affecting the patient's quality of life. Therefore, this study aims to develop a prediction model for moderate-to-severe acute radiation dermatitis in patients with breast cancer to reduce its severity. Methods A retrospective analysis of 713 patients receiving radiotherapy for breast cancer at the Affiliated Cancer Hospital of Xinjiang Medical University from January 2019 to December 2023 was conducted, with January 2019 to December 2021 serving as the training group (497 patients) and January 2022 to December 2023 serving as the validation group (216 patients). Patients in the training group were classified as having mild (383 patients) or moderately severe (114 patients) acute radiation dermatitis. Binary logistic regression was used to analyze the independent effects on moderately severe acute radiation dermatitis in patients with breast cancer, and a predictive model of the bar-folding plot was constructed and validated. Results Univariable analysis revealed that age, body mass index, targeted therapy, oral tamoxifen use, hyperlipidemia, diabetes, positive regional lymph node metastasis, value-added index, and triple-negative breast cancer were factors influencing moderate-to-severe acute radiation dermatitis in patients with breast cancer. Multivariate analysis showed that body mass index, hyperlipidemia, diabetes, positive regional lymph node metastasis, and value-added index were independent influencing factors for moderate-to-severe acute radiation dermatitis in patients with breast cancer. A nomogram prediction model was constructed, and the area under the receiver operating characteristic curve of the model was 0.814 and 0.743 for internal and external validation, respectively. The calibration curve showed that the model predicted moderate-to-severe acute radiation dermatitis better, and the decision curve analysis curve showed that the model had a high clinical benefit. Conclusion This risk prediction model can predict moderate-to-severe acute radiation dermatitis in patients with breast cancer, and help clinical providers screen high-risk patients and reduce acute radiation dermatitis severity.

Lesions with central hypointensity and peripheral contrast enhancement are defined as ring-enhancing lesions. The aetiologies of ring-enhancing lesions may be various, including infections, tumours, demyelinating diseases, treatment-related conditions and hematoma. The imaging findings and their distinguishing features also vary among different ring-enhancing lesions. This review examines the magnetic resonance imaging findings of different ring-enhancing lesions and their distinguishing features.

Aims/Background The clinical presentation of non-lactational mastitis (NLM) shares similarities with some symptoms and examination results of breast cancer (BC), which can lead to misdiagnosis or delayed treatment. Current studies on breast lesions mostly focus on the diagnostic performance of a single imaging technique. This study aims to construct a discrimination diagnostic model for NLM and BC based on such imaging features as ultrasound and magnetic resonance imaging (MRI) and to validate the application value of the model, assisting clinicians in improving disease diagnosis and refining medical decisions. Methods This study is a retrospective analysis. Clinical data of 108 patients suspected of NLM based on imaging diagnosis, admitted to The First Affiliated Hospital with Nanjing Medical University between May 2018 and August 2023, were collected. Among them, 94 cases were pathologically confirmed as NLM and 14 cases as BC. Univariate and multivariate logistic regression analyses were performed on the patients' clinical data, ultrasound features, and MRI features to select the risk factors for discriminating NLM and BC, and construct a discrimination model. The discrimination performance of the model was analyzed with the receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and calibration curve. Results In the NLM group, there were 24 cases of granulomatous lobular mastitis (25.53%) and 70 cases of plasma cell mastitis (74.47%). In the BC group, there were 2 cases of infiltrating ductal carcinoma, 2 cases of atypical hyperplasia, 3 cases of papillary carcinoma, and 7 cases of ductal carcinoma in situ. Age, internal blood flow, calcification, edge, enhancement characteristics, apparent diffusion coefficient (ADC) values, and time-intensity curve (TIC) type were independent factors for differentiating NLM and BC (p < 0.05). The ROC analysis showed that the area under the curve of the model for discriminating NLM and BC was 0.920. The DCA results showed that the model had high net benefits for discriminating NLM and BC. The calibration curve analysis showed that the model had good consistency with the actual diagnosis of NLM and BC, with a chi-square value of 4.545 and a p-value of 0.155 according to the Hosmer-Lemeshow test. Conclusion Age, internal blood flow, calcification, edge, enhancement characteristics, ADC, and TIC curve types are important factors in distinguishing NLM and BC, and the model based on the above characteristics to distinguish NLM and BC has a high net benefit in distinguishing the two.