Postgraduate Medicine最新文献

{"title":"Endoscopic measurement of hiatal hernias: is it reliable and does it have a clinical impact? Results from a large prospective database.","authors":"Charles Christian Adarkwah,&nbsp;Oliver Hirsch,&nbsp;Merlissa Menzel,&nbsp;Joachim Labenz","doi":"10.1080/00325481.2023.2239135","DOIUrl":"https://doi.org/10.1080/00325481.2023.2239135","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of our study was to compare the results of endoscopy and manometry with regard to the presence and longitudinal size of hiatal hernias using a cohort of patients with PPI-refractory reflux symptoms. In addition, we aimed to investigate the clinical relevance of hiatal hernias and their size in relation to the occurrence of GERD.</p><p><strong>Methods: </strong>Five hundred patients with suspected GERD due to typical reflux symptoms (heartburn and regurgitation) and inadequate response to PPI therapy underwent standardized screening at a reflux center. After 2 weeks of PPI withdrawal, all patients underwent endoscopy, 24-h pH impedance measurement, and high-resolution manometry (HRM). Both endoscopy and HRM results were available for 487 patients.</p><p><strong>Results: </strong>There was a high correlation between the endoscopic and manometric measured longitudinal size of hernias (rho = .768 (<i>p</i> < .001)). Absolute differences differ on a small effect basis (Cohen's d = 0.23). The presence of hernias increases significantly with the severity of GERD, regardless of whether the hernia was diagnosed by endoscopy or manometry.</p><p><strong>Conclusion: </strong>In summary, endoscopically and manometrically measured hiatal hernia size are highly significantly correlated. Patients with refractory reflux symptoms and a hernia size of 4 cm are very likely to have GERD. In the future, this finding could greatly simplify the diagnosis of GERD.</p>","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 6","pages":"615-622"},"PeriodicalIF":4.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10048267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to revisit the true role of metformin in type 2 diabetes mellitus.","authors":"Angel Lopez-Candales,&nbsp;Scott Monte,&nbsp;Khalid Sawalha,&nbsp;Nicholas B Norgard","doi":"10.1080/00325481.2023.2224036","DOIUrl":"https://doi.org/10.1080/00325481.2023.2224036","url":null,"abstract":"Cardiovascular Medicine Division, University Health Truman Medical Center, University of Missouri-Kansas City, Missouri-Kansas, MO, USA; School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, NY, USA; Nutrition and Metabolism, Department of Medicine, University of Missouri-Kansas City, Kansas, MO, USA; Department of Medicine, University Health Truman Medical Center, University of Missouri-Kansas City, Kansas, MO, USA","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 6","pages":"539-542"},"PeriodicalIF":4.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10272064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New innovations and educational process in undergraduate neurology education in blended learning.","authors":"Siyu Mu,&nbsp;Jingman Hu,&nbsp;Fangxi Liu,&nbsp;Chuansheng Zhao,&nbsp;Yefei Sun","doi":"10.1080/00325481.2023.2234273","DOIUrl":"https://doi.org/10.1080/00325481.2023.2234273","url":null,"abstract":"<p><p>Many undergraduate students suffer from 'neurophobia,' which refers to a lack of knowledge or confidence in neurology, and this can influence their career choices. Various measures have been taken to address this issue, including the implementation of new technologies and methodologies. Significant advancements have been made in the development of blended learning, and the integration of student-centered learning modules, multimedia, and web-based devices has become a common teaching approach. Nonetheless, the optimal delivery form, as well as assessment for the selected learning format and teaching quality in both theory and clinical practice, are being investigated. The purpose of this review is to provide a summary of the current understanding of blended learning as well as innovative methods, technologies, and assessments of undergraduate neurology education. It aims to highlight opportunities for implementing a novel, comprehensive learning model with a suitable blended learning method within a framework of customized technology-assessment processes for future neurology classes, encompassing both theoretical and clinical training.</p>","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 6","pages":"551-561"},"PeriodicalIF":4.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10419269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exertional leg pain represents a severe disease phenotype in childhood familial Mediterranean fever.","authors":"Fatma Aydın,&nbsp;Zeynep Birsin Özçakar,&nbsp;Pınar Özge Avar Aydın,&nbsp;Ece Mekik Akar,&nbsp;Nilgün Çakar","doi":"10.1080/00325481.2023.2224649","DOIUrl":"https://doi.org/10.1080/00325481.2023.2224649","url":null,"abstract":"<p><strong>Objectives: </strong>Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease. Recurrent fever, serositis, and arthritis are common findings of the disease. In addition, musculoskeletal complaints such as exertional leg pain can be overlooked, although they are common and affect patients' quality of life. The aim of this study was to evaluate the frequency of exertional leg pain in pediatric FMF patients and to analyze the association of this finding with other characteristics of FMF.</p><p><strong>Methods: </strong>The files of FMF patients were retrospectively evaluated. The clinical characteristics and disease severity of the patients with exertional leg pain were compared with the patients without exertional leg pain. International severity scoring system for FMF (ISSF) and Mor severity score were used for assessment.</p><p><strong>Results: </strong>The study included 541 FMF patients (287 females), 149 (27.5%) with exertional leg pain. The median colchicine dosage was significantly higher in patients with exertional leg pain (<i>p</i> = 0.02), arthritis (<i>p</i> = 0.001) and arthralgia (p˂0.001) were encountered more frequently in the attacks of these patients. The median disease severity scores calculated by both Mor severity scale and ISSF were significantly higher in patients with exertional leg pain compared to those without (p˂0.001). In the group of patients with exertional leg pain, the <i>M694V</i> mutation, either in one allele or in two alleles, was found to be significantly more common (<i>p</i> = 0.006 and p˂0.001, respectively).</p><p><strong>Conclusions: </strong>Exertional leg pain in pediatric FMF patients is the component of moderate-to-severe disease course, and this may be considerably associated with the presence of <i>M694V</i> mutation.</p>","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 6","pages":"588-592"},"PeriodicalIF":4.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10101530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of catheter ablation for atrial fibrillation in patients with cancer: a nationwide cohort study.","authors":"Sahith Reddy Thotamgari,&nbsp;Aakash R Sheth,&nbsp;Harsh P Patel,&nbsp;Harigopal Sandhyavenu,&nbsp;Bhavin Patel,&nbsp;Udhayvir S Grewal,&nbsp;Mohammad Alfrad Nobel Bhuiyan,&nbsp;Sourbha S Dani,&nbsp;Paari Dominic","doi":"10.1080/00325481.2023.2218188","DOIUrl":"https://doi.org/10.1080/00325481.2023.2218188","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is the most common arrhythmia in patients with cancer, especially breast, gastrointestinal, respiratory, urinary tract, and hematological malignancies. Catheter ablation (CA) is a well-established, safe treatment option in healthy patients; however, literature regarding safety of CA for AF in patients with cancer is limited and confined to single centers.</p><p><strong>Objective: </strong>We aimed to assess the outcomes and peri-procedural safety of CA for AF in patients with certain types of cancer.</p><p><strong>Methods: </strong>The NIS database was queried between 2016 and 2019 to identify primary hospitalizations with AF and CA. Hospitalizations with secondary diagnosis of atrial flutter and other arrhythmias were excluded. Propensity score matching was used to balance the covariates between cancer and non-cancer groups. Logistic regression was used to analyze the association.</p><p><strong>Results: </strong>During this period, 47,765 CA procedures were identified, out of which 750 (1.6%) hospitalizations had a diagnosis of cancer. After propensity matching, hospitalizations with cancer diagnosis had higher in-hospital mortality (OR 3.0, 95% CI 1.5-6.2, <i>p</i> = 0.001), lower home discharge rates (OR 0.7, 95% CI 0.6-0.9, <i>p</i> < 0.001) as well as other complications such as major bleeding (OR 1.8, 95% CI 1.3-2.7, <i>p</i> = 0.001) and pulmonary embolism (OR 6.1, 95% CI 2.1-17.8, <i>p</i> < 0.001) but not associated with any major cardiac complications (OR 1.2, 95% CI 0.7-1.8, <i>p</i> = 0.53).</p><p><strong>Conclusion: </strong>Patients with cancer who underwent CA for AF had significantly higher odds of in-hospital mortality, major bleeding, and pulmonary embolism. Further larger prospective observational studies are needed to validate these findings.</p>","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 6","pages":"562-568"},"PeriodicalIF":4.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10400313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring a case for education about sexual and gender minorities in postgraduate emergency medicine training: forming recommendations for change.","authors":"Adam Burcheri,&nbsp;Alexandre Coutin,&nbsp;Blair L Bigham,&nbsp;Michael I Kruse,&nbsp;Kelly Lien,&nbsp;Rodrick Lim,&nbsp;Hilary MacCormick,&nbsp;Judy Morris,&nbsp;Victor Ng,&nbsp;Nadia Primiani,&nbsp;Scott Odorizzi,&nbsp;Vincent Poirier,&nbsp;Suneel Upadhye,&nbsp;Robert Primavesi","doi":"10.1080/00325481.2023.2225329","DOIUrl":"https://doi.org/10.1080/00325481.2023.2225329","url":null,"abstract":"<p><p>Social medicine and health advocacy curricula are known to be uncommon in postgraduate medical education. As justice movements work to unveil the systemic barriers experienced by sexual and gender minority (SGM) populations, it is imperative that the emergency medicine (EM) community progress in its efforts to provide equitable, accessible, and competent care for these vulnerable groups. Given the paucity of literature on this subject in the context of EM in Canada, this commentary borrows evidence from other specialties across North America. Trainees across specialties and of all stages are caring for an increasing number of SGM patients. Lack of education at all levels of training is identified as a significant barrier to adequately caring for these populations, thereby precipitating significant health disparities. Cultural competency is often mistakenly attributed to a willingness to treat rather than the provision of quality care. However, positive attitudes do not necessarily correlate with trainee knowledge. Barriers to creating and implementing culturally competent curricula are plentiful, yet facilitating policies and resources are rare. While international bodies continuously publish position statements and calls to action, concrete change is seldom made. The scarcity of SGM curricula can be attributed to the universal absence of formal acknowledgment of SGM health as a required competency by accreditation boards and professional membership associations. This commentary synthesizes hand-picked literature in an attempt to inform healthcare professionals on their journey toward developing culturally competent postgraduate medical education. By thematically organizing evidence into a stepwise approach, the goal of this article is to borrow ideas across medical and surgical specialties to inform the creation of recommendations and make a case for an SGM curriculum for EM programs in Canada.</p>","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 6","pages":"623-632"},"PeriodicalIF":4.2,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10400350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Possible cardiovascular risks of white coat hypertension: updated.","authors":"Steven G Chrysant","doi":"10.1080/00325481.2023.2210934","DOIUrl":"https://doi.org/10.1080/00325481.2023.2210934","url":null,"abstract":"<p><p>White-coat hypertension (WCH) has been defined as an increased blood pressure (BP) in the doctor's office and a normal BP outside the office by 24 hr ambulatory BP monitoring (ABPM) or home BP measurement. It is generated by fear and anxiety of whether an abnormal value could be found and indicate the existence of hypertension. When first described, it was defined as a neuro-defense reaction related to the presence of the doctor in their office or clinic and associated with an increase in heart rate. Initially it was considered a benign condition, not associated with the hypertension mediated organ damage (HMOD) and not requiring treatment. However, recent studies have shown that WCH is not a benign condition and is associated with HMOD and cardiovascular (CV) events (CVE). According to recent ACC/AHA guidelines, the outside of office normal BP should be < 130/80 mmHg and according to the ESC/ESH guidelines, the outside of office normal BP should be < 135/85 mmHg. The prevalence of WCH varies by different studies from 15% to 40% and up to 50% in older subjects. Currently, the management of WCH if not associated with CV risk factors should be conservative with healthy lifestyle changes and exercise. Drug therapy should be considered if these measures do not work or in the presence of CV risk factors, HMOD, or preexisting cardiovascular disease.</p>","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 5","pages":"466-471"},"PeriodicalIF":4.2,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10002814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advantages and feasibility of intercostal nerve block in uniportal video-assisted thoracoscopic surgery (VATS).","authors":"Linlin Wang,&nbsp;Lihui Ge,&nbsp;Yi Ren","doi":"10.1080/00325481.2023.2187959","DOIUrl":"https://doi.org/10.1080/00325481.2023.2187959","url":null,"abstract":"ABSTRACT Objectives Uniportal video-assisted thoracic surgery (VATS) has been successfully used worldwide as a minimally invasive method of thoracoscopic surgery. Although pain was significantly reduced after VATS, acute postoperative pain was still significant. This study aimed to assess the advantages and feasibility of intercostal nerve block in uniportal VATS. Methods We conducted a retrospective analysis of perioperative data from 280 consecutive patients who underwent uniportal VATS at our institution between May 2021 and February 2022. The patients were assigned to either Group A (142 patients with 3 intercostal nerves blocked) or Group B (138 patients with 5 intercostal nerves blocked). We analyzed the perioperative data of both groups and utilized repeated measures ANOVA to determine the difference in postoperative pain between the two groups across time. Results A total of 280 patients underwent successful uniportal VATS during the study period. There were no significant differences between Group A and Group B in terms of age, gender, pulmonary function, arterial blood gas analysis, laterality, incision location, nodule size, nodule location, operative time, blood loss, drainage time, length of hospital stays, tumor stage, or postoperative complications. Furthermore, no surgical or 30-day postoperative mortalities occurred. Using repeated measures ANOVA, we found that the intercostal nerve block had significant effects on the group, time, and interaction terms group × time (P < 0.05). Conclusion Intercostal nerve block is safe and effective, and is associated with simple, accurate, and high patient satisfaction as opposed to other postoperative analgesics in uniportal VATS. Blocking five intercostal nerves may be more beneficial for effective postoperative pain management. Nevertheless, further confirmation through prospective randomized controlled trials is required.","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 5","pages":"472-479"},"PeriodicalIF":4.2,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10001786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recommendations for the prevention and management of obesity in the Iraqi population.","authors":"Hussein Ali Nwayyir,&nbsp;Esraa Majid Mutasher,&nbsp;Osama Mohammed Alabid,&nbsp;Muthana Abdulrazzaq Jabbar,&nbsp;Wefak Hasan Abdulraheem Al-Kawaz,&nbsp;Haider Ayad Alidrisi,&nbsp;Majid Alabbood,&nbsp;Muhammed Chabek,&nbsp;Munib AlZubaidi,&nbsp;Lujain Anwar Al-Khazrajy,&nbsp;Ibtihal Shukri Abd Alhaleem,&nbsp;Ali Dawood Abdulwahhab Al-Hilfi,&nbsp;Falih Mohssen Ali,&nbsp;Ali AlBayati,&nbsp;Hilal Bahjet Al Saffar,&nbsp;Faris Abdul Kareem Khazaal","doi":"10.1080/00325481.2023.2172914","DOIUrl":"https://doi.org/10.1080/00325481.2023.2172914","url":null,"abstract":"<p><p>Obesity is a chronic metabolic disease that has become one of the leading causes of disability and death in the world, affecting not only adults but also children and adolescents. In Iraq, one third of the adult population is overweight and another third obese. Clinical diagnosis is accomplished by measuring body mass index (BMI) and waist circumference (a marker for intra-visceral fat and higher metabolic and cardiovascular disease risk). A complex interaction between behavioral, social (rapid urbanization), environmental and genetic factors underlies the etiology of the disease. Treatment options for obesity may include a multicomponent approach, involving dietary changes to reduce calorie intake, an increase in physical activity, behavioral modification, pharmacotherapy and bariatric surgery. The purpose for these recommendations is to develop a management plan and standards of care that are relevant to the Iraqi population and that can prevent/manage obesity and obesity-related complications, for the promotion of a healthy community.</p>","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 5","pages":"425-439"},"PeriodicalIF":4.2,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9620567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metaverse applied to musculoskeletal pathology: Orthoverse and Rehabverse.","authors":"Juan M Román-Belmonte,&nbsp;E Carlos Rodríguez-Merchán,&nbsp;Hortensia De la Corte-Rodríguez","doi":"10.1080/00325481.2023.2180953","DOIUrl":"https://doi.org/10.1080/00325481.2023.2180953","url":null,"abstract":"<p><p>The Metaverse is <i>'an integrated network of 3D virtual worlds.'</i> It incorporates digitally created realities into the real world, involves virtual copies of existing places and changes the physical reality by superimposing digital aspects, allowing its users to interact with these elements in an immersive, real-time experience. The applications of the Metaverse are numerous, with an increasing number of experiences in the field of musculoskeletal disease management. In the field of medical training, the Metaverse can help facilitate the learning experience and help develop complex clinical skills. In clinical care, the Metaverse can help clinicians perform orthopedic surgery more accurately and safely and can improve pain management, the performance of rehabilitation techniques and the promotion of healthy lifestyles. Virtualization can also optimize aspects of healthcare information and management, increasing the effectiveness of procedures and the functioning of organizations. This optimization can be especially relevant in departments that are under significant care provider pressure. However, we must not lose sight of the fundamental challenges that still need to be solved, such as ensuring patient privacy and fairness. Several studies are underway to assess the feasibility and safety of the Metaverse.</p>","PeriodicalId":20329,"journal":{"name":"Postgraduate Medicine","volume":"135 5","pages":"440-448"},"PeriodicalIF":4.2,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9620557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}