Listening to the patient, listening to the data

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.