Brit J Hosp Med
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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. ⋯ 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.
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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. ⋯ 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.
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Aims/Background Lung cancer (LC) remains one of the most common malignant tumours worldwide, and assessment of its progression is important for ensuring better prognostic outcomes for patients. This study was designed to explore the prognostic role of certain indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and prognostic nutritional index (PNI) in patients with LC, to help clinics to better determine the prognosis of patients with LC, and to allow them to intervene in a timely manner. Methods A retrospective analysis of 116 initially diagnosed patients with LC in China from 2018 to 2020 was conducted. ⋯ Results Multivariate Cox regression demonstrated that the PNI (hazard ratio (HR): 0.513, 95% confidence interval (CI): 0.288-0.917, p = 0.024), NLR (HR: 2.038, 95% CI: 1.128-3.682, p = 0.018), and tumour type (small cell lung cancer vs. non-small cell lung cancer) (HR: 2.145, 95% CI: 1.308-3.520, p = 0.003) were significantly associated with PFS. The median PFS for patients with low and high PNI was 10 and 11.5 months, respectively. Conclusion The NLR, PLR, and PNI are all significantly associated with the prognostic survival of LC patients.
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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.
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Randomized Controlled Trial
Wisdom Tooth Extraction Training for Dental Students: Step-by-Step or All-in-One?
Aims/Background For inexperienced dental students, impacted wisdom tooth extraction is a complex procedure involving a series of intricate steps. This study compared the effectiveness of step-by-step and all-in-one teaching methods for dental students learning impacted wisdom tooth extraction, by evaluating their practical abilities, understanding, and learning satisfaction. Methods Fifty dental students were randomly assigned to either a step-by-step teaching group (Group S) or an all-in-one teaching group (Group A) for impacted wisdom tooth extraction training. ⋯ The results also showed that satisfaction toward hands-on practice and teaching sessions significantly contributed to general satisfaction, while satisfaction with mastery of clinical skills did not. Conclusion The step-by-step teaching method was more effective in improving students' clinical skills and augmenting their satisfaction during impacted wisdom tooth extraction training. Our findings support the use of incremental learning approaches in dental education to enhance both clinical competencies and students' learning experiences.