British journal of hospital medicine最新文献

Placenta accreta spectrum (PAS) disorders pose significant challenges in the anaesthetic management of elective caesarean section. This article explores the anaesthetic considerations for patients with PAS focusing on the optimal techniques to ensure maternal safety and surgical success. The analysis examines the advantages and disadvantages of general anaesthesia, neuraxial anaesthesia, and combined techniques to inform considerations of anaesthetic management in this high-risk population.

Aims/Background Symptomatic abdominal aortic aneurysms carry significant mortality risk. This is supplemented by the Royal College of Emergency Medicine guidelines which suggest imaging for patients 50 years of age or older presenting with unexplained abdominal, flank, or back pain. This study aimed to evaluate the prevalence and mortality rates of patients with symptomatic abdominal aortic aneurysms in a high-risk population and to assess scanning rates in the accident and emergency department. Methods Retrospective analysis of patients presenting to the accident and emergency department at a district general hospital over 6 months was performed. Patients 50 years of age or older presenting with abdominal, flank, or back pain were included. Collected data points included; whether or not a scan was performed in the emergency department, the modality of imaging, whether an abdominal aortic aneurysm was identified on the scan, the age of patients with an abdominal aortic aneurysms identified on the scan, size of the identified abdominal aortic aneurysms, primary diagnosis at the time of review in the emergency department, and all-cause mortality rates. Results 361 patients were identified to have an indicated scan, of which only 122 (33.8%) had a scan in the emergency department. In the syndromic group, the prevalence and 30-day mortality of patients with an abdominal aortic aneurysm were 5.5% and 1.1% respectively. Only 12 out of 20 patients with an abdominal aortic aneurysm were identified in the emergency department. Conclusion The criteria outlined by the Royal College of Emergency Medicine does well at identifying patients with abdominal aortic aneurysms when followed. However, this study reveals that scanning rates in the emergency department are low. The encouragement of scanning and improved ultrasound skills among emergency medicine clinicians can reduce missed diagnoses. Additionally, we recommend further studies to assess the mortality rates of emergent abdominal aortic aneurysm presentations.

Aims/Background This study expanded the existing literature on obesity and distortion of body image by examining subjective and objective body type among young medical workers, specifically investigating whether fat percentage independently influences body type cognitive bias. Methods We recruited 264 participants (41.29% male, mean age 26.2 ± 3.1 years, mean body mass index (BMI) 21.7 ± 3.1 kg/m²) at a comprehensive hospital in central China. The questionnaire responses of the enrolled participants concerning basic information and body type self-assessment were extracted. Their weights and body compositions were evaluated by the bioelectrical impedance analysis technique (BIA). Objective indicators included measured weight, BMI, fat percentage, waist circumference (WC) and waist-to-hip ratio (WHR). Results Based on this sample, the prevalence rate of body type cognitive bias was 28.79%. For women, the univariate regression analysis showed that fat percentage was significantly correlated with body type cognitive bias (odds ratio [OR] 1.107, 95% confidence interval [CI] 1.033-1.185, p = 0.004). BMI (OR 1.303, 95% CI 1.098-1.546, p = 0.002) and WC (OR 1.109, 95% CI 1.043-1.180, p = 0.001) might also be positively associated with body type cognitive bias. After adjusting for age, BMI, WHR, and job position, the risk of body type cognitive bias decreased with fat percentage up to the first inflection point (26.8%) (OR 0.78, 95% CI 0.62-0.98, p = 0.036), and then it increased up to the second inflection point (33.0%). When fat percentage exceeded 33.0%, the relationship lost statistical significance. No significant relationships were found for men. Conclusion Fat percentage is an independent, nonlinear factor influencing women's body type cognitive bias. Gender and fat percentage should be considered when establishing weight management intervention strategies to prevent obesity from becoming a public health problem.

Aims/Background By addressing patients' physical, psychological, social, cultural, and environmental comfort needs holistically, Kolcaba's Comfort Theory raises the standard of care and increases patient satisfaction. This study explored the combined application of these nursing models during the perioperative period for patients undergoing nasal deformity correction surgery. Methods 92 patients undergoing nasal deformity correction at the Seventh Affiliated Hospital of Sun Yat-sen University were randomly divided into two groups: the conventional group (46 patients), which received standard perioperative nursing care, and the experimental group (46 patients), which received concept map thinking nursing combined with Kolcaba's comfort nursing intervention during the perioperative period. Clinical indicators, including the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI), Rhinoplasty Outcome Evaluation (ROE) and General Comfort Questionnaire (GCQ), were compared between the two groups at multiple time points. Results The experimental group demonstrated significantly shorter operation times (p < 0.001), faster recovery of nasal breathing (p = 0.002), and shorter hospital stays (p < 0.001) compared to the conventional group. Additionally, the experimental group experienced less intraoperative blood loss (p < 0.001) and a lower incidence of complications (p = 0.013). At 2 days, 1 month, and 3 months post-surgery, both groups showed decreases in SAS, SDS, and PSQI scores, with the experimental group demonstrating significantly lower scores (p < 0.05). At these same time points, the ROE and GCQ scores increased in both groups, with the experimental group achieving significantly higher scores than the conventional group (p < 0.05). Conclusion The integration of concept map thinking with Kolcaba's comfort nursing significantly improves the postoperative recovery of patients undergoing nasal deformity correction. Reduced surgical trauma, enhanced psychological health, better sleep, increased comfort, and quicker nasal function recovery are all results of this method. Clinical Trial Registration China Clinical Trial Registration Center (https://www.chictr.org.cn/showproj.html?proj=191278).

Aims/Background Chronic heart failure (CHF) is a complex clinical syndrome resulting from various cardiac diseases, characterized by weakened cardiac pumping capacity and inadequate blood supply to body tissues. This study aims to investigate the expression and clinical implications of pro-B-type natriuretic peptide (pro-BNP) and soluble suppression of tumorigenicity 2 (sST2) in CHF to explore their potential in early diagnosis and severity assessment of the pathological condition. Methods This study included 146 CHF patients treated at our hospital from January 2022 to December 2023, who were classified in the observation group, and 150 concurrent healthy people categorized in the control group. pro-BNP and sST2 levels in the observation and control groups were compared. The diagnostic value of pro-BNP and sST2 in CHF was determined using receiver operating characteristic (ROC) curves. Besides, pro-BNP and sST2 levels in patients with different New York Heart Association (NYHA) grades were compared, and their relationships with left ventricular ejection fraction (LVEF), left atrial diameter (LAD), and left ventricular end-diastolic diameter (LVEDD) were assessed by means of Pearson's correlation. Results CHF cases showed markedly higher pro-BNP and sST2 levels than healthy controls (p < 0.05). The area under the ROC curves for pro-BNP and sST2 in diagnosing CHF was 0.826 (95% CI: 0.778-0.875) and 0.733 (95% CI: 0.674-0.791), respectively. pro-BNP and sST2 levels were similar in grades I and II patients (p > 0.05), but lower when compared with those in grades III and IV patients (p < 0.05). Grade III patients showed lower pro-BNP and sST2 expression than grade Ⅳ patients (p < 0.05). Additionally, pro-BNP and sST2 had an inverse connection with LVEF (r = -0.764 and r = -0.535, respectively) and a positive correlation with LAD (r = 0.752 and r = 0.535, respectively) and LVEDD (r = 0.721 and r = 0.544, respectively). Conclusion pro-BNP and sST2 exhibit good diagnostic value for CHF, owing to their close association with patients' cardiac function. These biomarkers can be used as effective indicators to evaluate the severity of heart failure.

Aims/Background This study aims to evaluate the safety and efficacy of α-n-butyl-2-cyanoacrylate (NBCA) glue in comparison with traditional embolization materials for the treatment of acute renal hemorrhage. Methods A total of 105 patients with the acute renal hemorrhage who underwent superselective renal artery embolization were enrolled. The patients were divided into two groups based on the embolization materials used: the traditional group (43 cases, control group) and the medical glue group (62 cases, observation group). Demographic characteristics, medical history, preoperative and postoperative 24-hour blood counts, renal function, and other clinical data were collected. The safety and efficacy of the two treatment methods were then compared between the groups. Results No significant difference in efficacy was observed between the traditional group and the medical glue group (p > 0.05). However, significant differences were found between the two groups in terms of embolization vessel grade, systemic immune-inflammation index (SII) difference, estimated glomerular filtration rate (eGFR) difference, and combined eGFR difference (p < 0.05). The traditional group exhibited a higher postoperative inflammatory response and greater renal function damage compared to the medical glue group. The degree of vascular embolization also influenced the extent of postoperative inflammatory response and renal function damage in patients with acute renal hemorrhage. Conclusion Compared to traditional embolization materials, NBCA glue demonstrates a clear hemostatic effect in the treatment of patients with acute renal hemorrhage, while also leading to reduced postoperative inflammatory response and renal function damage. NBCA adhesive is both safe and effective for treating acute renal hemorrhage.

Aims/Background Sepsis is a life-threatening condition resulting from dysregulated immune responses to infection, leading to organ dysfunction. High-density lipoprotein (HDL) and red cell distribution width (RDW) have shown significant correlations with sepsis severity, yet the combined prognostic value of HDL and RDW in evaluating sepsis severity and outcomes remains unclear. This study examines the relationship between HDL and RDW levels and sepsis severity, as well as evaluates the combined utility of these markers in predicting disease severity and patient outcomes. Methods This retrospective study included 103 patients diagnosed with sepsis. Clinical data, including HDL and RDW levels, were collected for analysis. Patients were divided into shock and non-shock groups based on the presence of septic shock and into survival and death groups based on 30-day in-hospital mortality. Multivariate logistic regression was used to identify factors influencing sepsis severity and prognosis, while the predictive value of HDL in combination with RDW was evaluated using receiver operating characteristic (ROC) curve analysis. Results Multivariate analysis identified sequential organ failure assessment (SOFA) score (OR = 6.566), interleukin-6 (IL-6) (OR = 2.568), HDL (OR = 0.864), and RDW (OR = 4.052) as independent predictors of sepsis severity (p < 0.05 for all). ROC analysis demonstrated that HDL combined with RDW yielded the highest diagnostic accuracy for sepsis severity, with an area under curve (AUC) of 0.962, sensitivity of 97.56%, and specificity of 91.94%. Additionally, SOFA score (OR = 2.354), interleukin-6 (IL-6) (OR = 1.446), HDL (OR = 0.870), and RDW (OR = 3.502) were independent prognostic indicators (p < 0.05 for all). ROC analysis for prognosis showed that HDL combined with RDW had the highest predictive efficacy for the prognosis of sepsis, with an AUC of 0.922, sensitivity of 79.31%, and specificity of 93.24%. Conclusion The combination of HDL and RDW is a robust indicator for the evaluation of sepsis severity and is a valuable prognostic tool for assessing 30-day mortality risk in sepsis patients.

Health inequities exist in cardiovascular care and outcomes, especially among women, older people, individuals from racial and ethnic minorities, lower income and rural communities often those most vulnerable to adverse health outcomes. Such diverse groups form most of the patient population but they are rarely reflected in the composition of the cardiovascular care workforce. Yet a diverse cardiovascular health care workforce can enhance access to care, reduce health disparities and inequities, and improve quality of care and research for such underserved populations. Such diversity also benefits student and staff development and strengthens organizational performance. A work environment and culture that embraces and celebrates diversity will likely advance health equity.

Workplace-based assessments (WPBAs) in postgraduate training may not always provide an accurate representation of a trainee's capability to perform a given task, or a true measure of a trainee's overall competence in clinical practice settings. This article describes how trainers can use a theory-driven and evidence-based intervention called dynamic assessment for providing an individual with the best opportunity to demonstrate a more accurate representation of their performance, and ultimately present the best version of themselves when undergoing an observed WPBA, such as a Direct Observation of Procedural Skills (DOPS) or Mini Consultation Evaluation Exercise (MiniCEX). Dynamic assessment simultaneously combines educational support with assessment as the trainee undergoes the WPBA by using focussed questions as prompts to facilitate an individual trainee's essential coordination of their motivational and thinking processes since this is often challenged during assessments. In addition, the response to the prompts can also provide trainers with information to inform specific feedback for future professional development.