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Listening to the patient, listening to the data

Anton Emmanuel
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DOI: https://doi.org/10.7861/clinmed.ed.23.3.1
Clin Med May 2023
Anton Emmanuel
Roles: Editor-in-chief
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Without data, there is little information, and without information there is little insight. Original research papers are being increasingly submitted to ClinMed, and in this edition of the journal we are delighted to include some original research studies including large patient numbers and hence allowing robust statistical analysis to deal with potential confounders and generate insight.

A research collaborative of trainee hepatologists report on over 1,000 admissions of patients with decompensated chronic liver disease from more than 100 hospitals.1 The study identifies poor utilisation of care bundles in patients with cirrhosis, possibly related to failure to identify patients with chronic liver disease in the busy acute care setting. When they were used, standardised care bundles were associated with improved alcohol and acute kidney injury care as well as ordering of initial investigations. There is much left to do to improve inpatient care of decompensated liver disease, and the paper points to the directions for this.

Another large study described the association between the fall in haemoglobin level and acute inflammation in patients hospitalised with COVID-19 infection.2 Such anaemia of acute inflammation shines a light on the extrapulmonary effects of COVID-19, and raises the possibility of novel therapies to preserve red blood cell production.

Mukhtyar and colleagues describe the occurrence of visual complications in the largest cohort of patients with giant cell arteritis, identifying that almost one-third of patients have visual symptoms, approximately half of whom experienced sight loss.3 Introducing a fast-track pathway had a positive effect on reducing the likelihood of visual loss. The predictive risk factor of age may not be surprising, but the ‘protective’ effect of headache is more so.

In addition to the original research there are definitive reviews. Schneider et al review posterior circulation stroke, which is frequently misdiagnosed due to its non-specific features and being less common than anterior circulation events.4 The article reviews the symptoms, the emerging advanced imaging modalities, the developments in mechanical thrombectomy and their contribution to reducing treatment delays. Craus et al from Malta summarise the epidemiology and risk assessment of diabetic foot disease.5 They provide a pathophysiological and clinical update on the Charcot foot and give a practical update on managing the complications of the diabetic foot. Schofield and Toh review acute thrombosis and thrombocytopaenia through a sequence of exemplar cases to illustrate the range of pathologies that may underlie this scenario.6 There is also a concise guidance update on the management of catatonia in this edition of ClinMed.7 In a clinical area with low clinical evidence base, the development of consensus guidance is both difficult but crucial for successful case identification and treatment.

This month's CME topic is on renal medicine, presenting the customary high quality up-to-date reviews on a range of topics.8–11 Allied to opinion pieces on ChatGPT12 and the usual range of clinical cases and images, this edition of the journal reflects the breadth of clinical content that is the hallmark of ClinMed.

  • © Royal College of Physicians 2023. All rights reserved.

References

  1. ↵
    The Trainee Collaborative for Research and Audit in Hepatology UK. Admission care bundles for decompensated cirrhosis are poorly utilised across the UK: results from a multi-centre retrospective study. Clin Med 2023;23:193–200.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Crooks CJ
    , West J, Morling JR, et al. Anaemia of acute inflammation: a higher acute systemic inflammatory response is associated with a larger decrease in blood haemoglobin levels in patients with COVID-19 infection. Clin Med 2023;23:201–5.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    1. Mansfield Smith CS
    , Al-Hashimi MR, Jones CD, Mukhtyar CB. Frequency of visual involvement in a 10-year interdisciplinary cohort of patients with giant cell arteritis. Clin Med 2023;23:206–12.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Schneider AM
    , Neuhaus AA, Hadley G, et al. Posterior circulation ischaemic stroke diagnosis and management. Clin Med 2023;23:219–27.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Craus S
    , Mula A, Coppini B. The foot in diabetes – a reminder of an ever-present risk. Clin Med 2023;23:228–33.
    OpenUrlAbstract/FREE Full Text
  6. ↵
    1. Schofield J
    , Toh C-H. How to approach acute thrombosis and thrombocytopaenia. Clin Med 2023;23:234–41.
    OpenUrlAbstract/FREE Full Text
  7. ↵
    1. Rogers JP
    , Zandi MS, David AS. The diagnosis and treatment of catatonia. Clin Med 2023;23:242–5.
    OpenUrlAbstract/FREE Full Text
  8. ↵
    1. Doctor GT
    , Gale P, Chan MMY. Genomics in the kidney clinic. Clin Med 2023;23:246–9.
    OpenUrlAbstract/FREE Full Text
  9. ↵
    1. Gnanasampanthan S
    , Kousios A. Monoclonal gammopathies of renal significance. Clin Med 2023;23:250–3.
    OpenUrlAbstract/FREE Full Text
  10. ↵
    1. Wonnacott A
    . The emerging pillars of chronic kidney disease: no longer a bystander in metabolic medicine. Clin Med 2023;23:254–58.
    OpenUrlAbstract/FREE Full Text
  11. ↵
    1. Corbett RW
    . Home dialysis therapies. Clin Med 2023;23:259–261.
    OpenUrlAbstract/FREE Full Text
  12. ↵
    1. Sedaghat S
    . Early applications of ChatGPT in medical practice, education, and research. Clin Med 2023;23:278–9.
    OpenUrlAbstract/FREE Full Text
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Listening to the patient, listening to the data
Anton Emmanuel
Clinical Medicine May 2023, 23 (3) 192; DOI: 10.7861/clinmed.ed.23.3.1

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Listening to the patient, listening to the data
Anton Emmanuel
Clinical Medicine May 2023, 23 (3) 192; DOI: 10.7861/clinmed.ed.23.3.1
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