Formalised curiosity

A new year brings an element of planning ahead and improving from the past. 2023 is set to be a year of change for ClinMed as the journal builds on its research content while remaining rooted as a go-to journal for those seeing general medical patients as well as specialists. The title of this editorial is derived from a paragraph by the author Zora Neale Hurston, who termed research as ‘formalised curiosity... prying with a purpose’. And that is the spirit of the content we will be publishing in the years ahead.

All clinicians deal with patients with cancer, with over 18 million cancers diagnosed each year, and over 1,000 patients a day receiving the diagnosis in the UK. And oncology practice is a strong theme of this edition of the journal. The CME section, curated by guest editor and eminent clinical oncologist Amen Sibtain, is an excellent blend of the emerging science around cancer and how this is influencing management. The articles cover common clinical scenarios in acute oncology^1,2 and complications of therapy³ while also reviewing the emergent therapies.^4,5 The shift towards more comprehensive genomic profiling of tumours has the potential to identify greater treatment options for patients. Simultaneously, the emergence of drugs that can be used to treat any kind of cancer, regardless of tissue of origin, heralds the potential for greater ‘precision medicine’ in oncology practice.

A survey article by Opensha and colleagues⁶ identifies some challenges in the journey ahead, however. Selecting these targeted therapies requires sound understanding of tumour genetics, linked to identification of patients with inherited genetic errors (eg BRCA1/2). A nationwide survey of oncologists’ understanding of genomics survey reveals knowledge gaps in understanding and application of genomics and the need for improvement of training in cancer genomics.

Another paper identifying a knowledge gap and variability in training on a topic of significant importance is from Ismael et al.⁷ The UK-CoPACK study assessed knowledge and confidence in the use of personal protective equipment (PPE) among healthcare workers. The study also evaluated levels of anxiety among staff, and contributors to that. Confidence and anxiety about the efficacy of PPE emerges as strongly related to adequacy of information and training offered, with clear lessons for the future.

A commonly occurring practical question is answered by Sievänen et al:⁸ how soon after a traumatic lumbar puncture (LP) is it safe to perform another LP if trying to avoid more trauma and artefactual results? The answer... do read the article to find out.

One other piece to highlight is by Hutchison et al,⁹ on how skin colour is classified and how inflammation presents in skin of colour. Previous studies have highlighted the under-representation of skin of colour in dermatological teaching, resulting in clinicians lacking confidence to safely diagnose and manage dermatological disease in patients with darker skin tones. The authors outline key conditions that physicians of all specialties should be able to identify and how these present in patients with skin of colour.