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Journals Clinical Medicine : Journal of...

Clinical Medicine : Journal of the Royal College of Physicians of London

https://read.qxmd.com/read/38377730/extending-the-reach-of-expert-amyloidosis-care-a-feasibility-study-exploring-the-staged-implementation-of-a-uk-amyloidosis-network
#21
JOURNAL ARTICLE
Chern Hsiang Choy, Richard P Steeds, Jennifer Pinney, Shanat Baig, Lauren Turvey-Haigh, Yasmin Wahid, Helen Cox, Alex Zaphiriou, Venkataramanan Srinivasan, David Wilson, John Fryearson, Mubarak Ahamed, Sern Lim, Colin Chue, Guy Pratt, Marianna Fontana, Julian D Gillmore, William E Moody
There has been an exponential increase in the diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CA). In response, the Midlands Amyloidosis Service was launched with the aim of providing patients with a timely diagnosis, remote expertise from the National Amyloidosis Centre and access to emerging transthyretin (TTR)-directed therapies. This was a descriptive study of a pilot hub-and-spoke model of delivering specialist amyloidosis care. Patients with suspected amyloidosis were referred from the wider Midlands region, and seen in a consultant-led multidisciplinary clinic...
January 19, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38354621/the-role-of-medical-support-workers-during-the-covid-19-pandemic-in-the-nhs-in-the-uk-a-qualitative-service-evaluation-at-the-oxford-university-hospitals-nhs-foundation-trust
#22
JOURNAL ARTICLE
Samprita Chakma, Hanyu Wang, Mike English, Mesulame Namedre, Elaine Hill, Shobhana Nagraj
We conducted a service evaluation of the medical support worker (MSW) role at Oxford University Hospitals NHS Foundation Trust following the Coronavirus 2019 (COVID-19) pandemic. The aim was to explore the roles of MSWs, their contributions to the NHS, factors influencing their career choices, and the goals of the MSW position, to inform quality improvement in relation to their integration into the Trust. The perspectives of MSWs, their supervisors and recruiters were analysed through nine semi-structured interviews and two focus group discussions involving 18 participants...
January 19, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38354620/when-a-little-flutter-gets-a-bit-too-exciting%C3%A2
#23
Mohamed Ali, Ifeoluwade Osiyemi, Matthew Jackson
A middle-aged man with no previous cardiac history was admitted to the hospital being treated for thigh cellulitis, during his stay he developed palpitations and tachycardia which on initial ECG showed atrial flutter with a 2:1 AV block and evidence of an accessory pathway. He was subsequently given AV nodal blocking agents in the form of beta-blockers (bisoprolol) to slow his heart rate down; unfortunately, this led to hemodynamic instability due to 1:1 conduction of the atrial flutter down the accessory pathway...
January 18, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38350407/the-diagnosis-is-obvious%C3%A2-or-is-it-a-case-of-idiopathic-segmental-anhidrosis
#24
JOURNAL ARTICLE
Shahzaib Rehan, Mohamed Ahamed
No abstract text is available yet for this article.
January 18, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38387208/emerging-therapies-and-respiratory-infections-focus-on-the-impact-of-immunosuppressants-and-immunotherapies
#25
REVIEW
Caroline M Patterson, Timothy D Shaw, Vicky Gerovasili, Usman Khatana, Ricardo J Jose
Host defences to infection are based upon an integrated system of physical and biochemical barriers, innate and adaptive immunity. Weakness in any of these defensive elements leads to increased susceptibility to specific pathogens. Understanding how medical therapies disrupt host defences is key to the successful prevention, diagnosis and management of respiratory infection in the immunocompromised host.
January 17, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38387207/non-tuberculous-mycobacterial-pulmonary-disease-ntm-pd-epidemiology-diagnosis-and-multidisciplinary-management
#26
REVIEW
Kartik Kumar, Aravind Ponnuswamy, Toby Gd Capstick, Christabelle Chen, Douglas McCabe, Rhys Hurst, Lisa Morrison, Fiona Moore, Matt Gallardo, Jennie Keane, Shirley Harwood, Tanya Sinnett, Sarah Bryant, Ronan Breen, Onn Min Kon, Marc Lipman, Michael R Loebinger, Devesh J Dhasmana
Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms that can cause significant disease in both immunocompromised and immunocompetent individuals. The incidence of NTM pulmonary disease (NTM-PD) is rising globally. Diagnostic challenges persist and treatment efficacy is variable. This article provides an overview of NTM-PD for clinicians. We discuss how common it is, who is at risk, how it is diagnosed and the multidisciplinary approach to its clinical management.
January 17, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38382183/mental-health-stigma-in-the-medical-profession-where-do-we-go-from-here
#27
JOURNAL ARTICLE
Isaac Ks Ng, Bill Cornelius Tan, Sabrina Goo, Zaid Al-Najjar
Mental health conditions are highly prevalent among physicians with high rates of depression, anxiety, stress-related disorders, suicidal ideation and burnout reported among medical practitioners at all levels of training and practice. This phenomenon is in part contributed by a highly stressful clinical environment with an often suboptimal support system for doctors. Concerningly, there is hitherto a striking reluctance amongst medical trainees/practitioners to seek treatment/help for mental health-related conditions due to fear of associated stigma and negative career repercussions...
January 17, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38382180/-i-don-t-belong-anywhere-identity-and-professional-development-in-sas-doctors
#28
JOURNAL ARTICLE
Michael Page, Dawn Jackson, Elizabeth Carty
Specialist, associate specialist and specialty (SAS) doctors constitute a marginalised professional group who can struggle to achieve the professional development they desire. Our primary objective was to understand, from a theoretically informed perspective, the ways in which the professional identity of SAS doctors influences their professional development opportunities, including through appraisal. Ten UK SAS doctors participated in in-depth, narrative interviews. Participants were drawn from six medical specialities, and ranged in experience (2...
January 17, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38377731/pneumocystis-jirovecii-pneumonia-presenting-with-severe-refractory-hypercalcaemia-in-an-immunosuppressed-renal-transplant-patient-review-of-the-literature-and-novel-biochemical-insights
#29
JOURNAL ARTICLE
Lucy Hong, Lewis D Witton, Elaine C Jolly
Pneumocystis jirovecii pneumonia (PJP) is a rare but serious complication of immunosuppression post-solid organ transplantation. We present a case of refractory, severe hypercalcaemia due to PJP in a renal transplant recipient. Treatment of PJP led to normalisation of the patient's calcium levels, and clinical improvement. To further explore the proposed calcitriol-driven mechanism leading to hypercalcaemia in PJP, we performed biochemical analysis on pre- and post-treatment serum and bronchoalveolar lavage sample at the time of PJP diagnosis...
January 8, 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38382181/supporting-patients-with-hypercapnia
#30
REVIEW
Laura Tregidgo, Rebecca F D'Cruz
Hypercapnia is commonly encountered by general and specialist respiratory clinicians. Patients at risk of developing hypercapnic respiratory failure include those with chronic obstructive pulmonary disease (COPD), obesity and neuromuscular disease. Such patients may present to clinicians acutely unwell on the acute medical take or during an inpatient deterioration, or be identified in the stable outpatient setting. In this review, we provide a practical guide to develop clinicians' knowledge, skills and confidence in promptly recognising and managing hypercapnic respiratory failure, and to promote national ventilation quality standards to encourage consistent delivery of high-quality care and optimise outcomes for patients...
January 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38350409/extrapulmonary-nontuberculous-mycobacterial-infections-a-guide-for-the-general-physician
#31
REVIEW
Akanksha Mimi Malhotra, Mauricio Arias, Matthijs Backx, Jessica Gadsby, Anna Goodman, Ysobel Gourlay, Heather Milburn, Olga Lucia Moncayo-Nieto, Deirdre Shimmin, Martin Dedicoat, Heinke Kunst
Non-tuberculous mycobacteria (NTM) infections predominantly present as pulmonary disease. Although relatively rare, 20-30 % originate from extrapulmonary sites resulting in a wide range of clinical syndromes. Immunocompromised individuals are particularly susceptible. Clinical manifestations include skin and soft-tissue infections, lymphadenitis, musculoskeletal infections and disseminated disease. Diagnosing extrapulmonary NTM is challenging, and management is complex, often involving multiple radiological and microbiological investigations, long courses of combination antibiotic regimens and may require adjuvant surgical interventions...
January 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38281665/chronic-pulmonary-aspergillosis-a-guide-for-the-general-physician
#32
REVIEW
Charlotte Carter, Rasleen Kahai, Josie Cunningham, Jennifer Kilduff, Natasha Hough, Caroline Baxter, David Connell, Anand Shah
This collaborative article presents a review of chronic pulmonary aspergillosis (CPA) from the perspective of a multidisciplinary team comprising of respiratory physicians, radiologists, mycologists, dietitians, pharmacists, physiotherapists and palliative care specialists. The review synthesises current knowledge on CPA, emphasising the intricate interplay between clinical, radiological, and microbiological aspects. We highlight the importance of assessing each patient as multidisciplinary team to ensure personalised treatment strategies and a holistic approach to patient care...
January 2024: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38052466/evidence-based-appraisal-of-the-role-of-sjts-in-selection
#33
JOURNAL ARTICLE
Gurvinder Sahota, John McLachlan, Fiona Patterson, Paul Tiffin
A recent opinion article in Clinical Medicine promoted a new preference-based algorithm to allocate training places for the UK Foundation Programme Office (UKFPO). This replaced the previous process, which ranked candidates based on medical school academic achievement (the educational performance measure; EPM) and the score on a situational judgement test (SJT). Although not without risks, we believe that the new system has positive potential. In presenting their case, Sam et al summarised evidence relating to the UKFPO in an unbalanced way, leading to what we believe are erroneous inferences, particularly with regard to differential attainment...
December 5, 2023: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38052465/patients-with-cancer-and-sepsis-trials-an-unfair-representation
#34
JOURNAL ARTICLE
Elizabeth Nelmes, Luke Edwards, Shaman Jhanji, David B Antcliffe, Kate C Tatham
Approximately 20% of sepsis cases are thought to occur in patients with cancer. Thus, such patients are an important cohort to be represented and characterised among sepsis trials. However, patients with cancer are commonly excluded from sepsis trials, although the extent to which is unknown. In this opinion article, we discuss our findings that suggest that patients with cancer are being under-represented in sepsis trials, often with an unclear rationale. We question the validity of generalising results from sepsis trials to heterogenous cancer populations and call for wider inclusion of patients with cancer to bridge this knowledge gap in sepsis management...
December 5, 2023: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38052464/research-activity-among-physicians-in-the-united-kingdom-results-from-the-royal-college-of-physicians-census-2022
#35
JOURNAL ARTICLE
Subashini Chandrapalan, Chris Phillips, Nina Newbery, Sarah Logan, Ramesh Arasaradnam
We present the results of the 2022 Census of the Federation of Royal Colleges of Physicians of Edinburgh, Glasgow and London on whether physicians undertake research and the barriers they have encountered. 40% of physicians reported that they undertook research alongside their clinical work. Multivariate analysis of the responses showed that men were 1.6 times more likely to say they undertake research than women. The main barriers to undertaking research were having enough time, organisational factors and a lack of confidence...
December 5, 2023: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38494334/addressing-obesity-and-homelessness-via-chatgpt
#36
LETTER
Shahab Saquib Sohail
No abstract text is available yet for this article.
November 2023: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38494333/the-situational-judgement-test-not-the-right-answer-for-uk-foundation-programme-allocation
#37
LETTER
Amir H Sam, Celia A Brown, David Kluth, Paul Wilkinson, Kamila Hawthorne, Chee Yeen Fung, Malcolm Wr Reed, Elizabeth Hughes, Karim Meeran, Mark Gurnell
No abstract text is available yet for this article.
November 2023: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38494332/updates-in-heart-failure
#38
LETTER
Lucy Pollock
No abstract text is available yet for this article.
November 2023: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38494331/covid-19-infection-as-a-parameter-in-the-cha2ds2-vascular-risk-assessment-tool
#39
LETTER
Oscar M P Jolobe
No abstract text is available yet for this article.
November 2023: Clinical Medicine: Journal of the Royal College of Physicians of London
https://read.qxmd.com/read/38494330/time-to-treat-the-climate-and-nature-crisis-as-one-indivisible-global-health-emergency
#40
EDITORIAL
Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Paul Yonga, Chris Zielinski
No abstract text is available yet for this article.
November 2023: Clinical Medicine: Journal of the Royal College of Physicians of London
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