Postgraduate Medical Journal最新文献

{"title":"Understanding uncertainty and ambiguity in medicine and medical education: a narrative review with implications for training.","authors":"Sarine Sarkis, Christian Raphael","doi":"10.1093/postmj/qgaf170","DOIUrl":"https://doi.org/10.1093/postmj/qgaf170","url":null,"abstract":"<p><p>Medical students face significant challenges, including managing uncertainty, impacting their education and careers. Effective doctors prioritize patient care, competence, relationships, and integrity, yet students frequently struggle emotionally and idealistically, especially during preclinical years. Clinical rotations expose the inherent uncertainty in medicine, requiring students to develop contextual, sufficient knowledge. Uncertainty arises from knowledge gaps, complex systems, ambiguous scenarios, emotional challenges, negative role models, and unclear team roles, often causing psychological distress. Differentiating between ambiguity (unclear answers) and uncertainty (individual responses) is essential. Medical education should cultivate traits such as curiosity, courage, empathy, and tolerance for ambiguity, which can be fostered through medical humanities and simulation-based learning. Emphasizing reflection, peer support, and addressing the hidden curriculum are vital strategies. Enhancing professional development and mentorship tailored to students' needs can better equip future doctors, making embracing uncertainty integral to their professional growth and resilience in medical practice.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252338","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":"A clinical staging system for panvascular disease.","authors":"Boyang Xiang, Junbo Ge, Xiang Zhou","doi":"10.1093/postmj/qgaf151","DOIUrl":"https://doi.org/10.1093/postmj/qgaf151","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252376","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":"Letter to the Editor in response to: \"Assessment of imposter syndrome among postgraduate residents using Clance imposter phenomenon scale: a multicentric, cross-sectional study\".","authors":"Fahmida Jumana Naznin Miah, Adib Nawar Tarafdar","doi":"10.1093/postmj/qgaf169","DOIUrl":"https://doi.org/10.1093/postmj/qgaf169","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239490","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":"Effect of acupuncture for type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials.","authors":"Na Li, Guangya Xu, Jiayi Lin, Hongling Li, Xingyu He, Jingjing Huang, Xinyue Du, Ziyan Xiang, Zheng Shi, Yao Wang","doi":"10.1093/postmj/qgaf132","DOIUrl":"https://doi.org/10.1093/postmj/qgaf132","url":null,"abstract":"<p><strong>Background: </strong>Previous studies suggest acupuncture may be effective for various chronic conditions, but its impact on type 2 diabetes (T2DM) remains debated.</p><p><strong>Objective: </strong>To evaluate the effect of acupuncture on blood glucose-related outcome indicators in T2DM.</p><p><strong>Methods: </strong>We searched four databases (PubMed, Embase, Web of Science, and Cochrane Library) from inception to 3 July 2025 to identify randomised controlled trials that enrolled patients with T2DM and compared acupuncture and non-acupuncture. The analysis employed standardized mean differences with 95% confidence intervals and incorporated Prediction Intervals (PI) for each outcome. Subgroup analysis, meta-regression, sensitivity analysis, and publication bias evaluation were also performed.</p><p><strong>Results: </strong>Twenty RCTs involved 1479 patients were included. The results demonstrated that the acupuncture group had significant reduction in FBG (SMD: -0.52; 95% CI:-0.91 to -0.13; P = 0.009), HbA1c (SMD:-0.76; 95% CI:-1.24 to -0.27; P = 0.002), 2hPG (SMD:-0.69; 95% CI:-1.00 to -0.39; P < 0.00001) and HOMA-IR (SMD:-1.72; 95% CI: -2.57 to -0.86; P < 0.0001), but not reveal statistically significant difference in insulin level (SMD:-1.16; 95% CI:-2.36 to 0.04; P = 0.06). The Hartung-Knapp adjustment showed consistent results, with the PI indicating potential variability in future studies.</p><p><strong>Conclusions: </strong>Acupuncture effectively reduces FBG, HbA1c, 2hPG, and HOMA-IR in patients with T2DM, but does not significantly affect insulin levels. Our study suggests that acupuncture may serve as a valuable complementary treatment for glycemic control in T2DM. Future research should focus on optimizing acupuncture protocols, assessing its long-term effects, and investigating the biological mechanisms behind its impact.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239335","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":"Immune-mediated hepatitis requiring second-line immunosuppression: how long is required? An observational study.","authors":"Tim Cooksley, Jamie M J Weaver, Safwaan Adam, Daniel Lasserson, Rebecca Lee, Paul Lorigan","doi":"10.1093/postmj/qgaf167","DOIUrl":"https://doi.org/10.1093/postmj/qgaf167","url":null,"abstract":"<p><strong>Background: </strong>Immune-mediated hepatitis is a common toxicity and accounts for ⁓20% of immune checkpoint inhibitor (ICI) related deaths. There is broad consensus as to the current approach for acute management for immune-mediated hepatitis. There is little data regarding the duration of immunosuppression in severe immune-mediated hepatitis.</p><p><strong>Methods: </strong>A prospective observational analysis was performed at a specialist oncology hospital in England from 20th May 2018 to 19th April 2024. The need for second-line immunosuppression, the agents used and their duration were analyzed. The primary outcome was duration of second-line immunosuppression and whether there was a relapse in immune-mediated hepatitis following their cessation.</p><p><strong>Results: </strong>During the study period, 82 patients presented with grade ≥3 immune-mediated hepatitis. Thirty-five (42.7%) had grade 3 hepatitis with 47 (57.3%) having grade 4 hepatitis. All patients received corticosteroids as first line treatment. Twenty-six (31.7%) patients required second-line immunosuppression therapy with mycophenolate mofetil. Four of those required further immunosuppression with a calcineurin inhibitor. The cohort requiring second-line immunosuppression had higher transaminases (mean alanine aminotransferase (ALT) = 889 u/L vs 677 u/L) at presentation. The median duration of therapy was 3 months (6 weeks to 22 months); all patients except for one had stopped their immunosuppression at 6 months. Ten patients who initially received combination ICI therapy had a rechallenge with maintenance nivolumab without a relapse of their hepatitis.</p><p><strong>Conclusion: </strong>Most patients with ICI-mediated hepatitis respond to first line immune suppression but approximately one third require second line therapy. Most patients discontinued immune suppression within 3 months. Key messages What is already known on this topic: Hepatitis is a common complication of immune checkpoint inhibition often requiring treatment with steroids and immunosuppression. What this study adds: This prospective observational study of patients presenting with severe ICI induced hepatitis found 26 (31.7%) patients required second-line immunosuppression therapy with a further four requiring third-line agents. The median duration of therapy was 3 months. How this study might affect practice: Most patients with ICI induced hepatitis respond to first line immune suppression but approximately one third require second line therapy, which can often be stopped 3 months post initiation.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192475","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":"The reconstruction of young physicians' professional roles in the era of artificial intelligence.","authors":"Hongnan Ye","doi":"10.1093/postmj/qgaf162","DOIUrl":"https://doi.org/10.1093/postmj/qgaf162","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192572","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":"Letter to the Editor in response to \"How to write a good discharge summary: a primer for junior physicians\".","authors":"Alice Scholfield","doi":"10.1093/postmj/qgaf168","DOIUrl":"https://doi.org/10.1093/postmj/qgaf168","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192395","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":"Application of incision-based precision multipoint rectus sheath block and bilateral rectus sheath block in laparoscopic-assisted colorectal surgery: a randomized, controlled trial.","authors":"Sihui Zhu, Xin Da, Jiawei Wang, Yulu Hu, Xinyue Wang, Yang Liu, Guanghong Xu","doi":"10.1093/postmj/qgaf166","DOIUrl":"https://doi.org/10.1093/postmj/qgaf166","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated whether the innovative multipoint incision-based rectus sheath block (IBRSB) tailored to surgical site and trauma level, could reduce opioid use and improve analgesia in laparoscopic-assisted colorectal surgery (LACS) compared to bilateral rectus sheath block (RSB).</p><p><strong>Methods: </strong>A total of 72 patients undergoing LACS, with quantium consciousness index monitoring were randomized to receive either IBRSB or bilateral RSB using 40 ml of 0.4% ropivacaine (n = 36 for both). The primary outcome was intraoperative dosage of remifentanil.</p><p><strong>Results: </strong>Seventy patients completed the study, with 35 in each group. The IBRSB group had significantly lower remifentanil use (mean [SD]: 4.42 [2.01] vs 5.92 [2.53] μg/kg/h; 95% confidence intervals: -2.59 to -0.41; P = 0.008) and less postoperative sufentanil use via patient-controlled intravenous analgesia within 24 h. Intraoperative hemodynamics were more stable in the IBRSB group. Pain scores at rest and with movement similar between groups at all six postoperative time points. No block-related complications occurred.</p><p><strong>Conclusion: </strong>Compared to bilateral RSB, IBRSB based on incision location and trauma severity significantly reduced intraoperative and postoperative opioid requirements, improved hemodynamic stability, and showed no increase in complications in patients undergoing LACS. Key messages What is already known on this topic: Laparoscopic surgery requires small midline incisions and multiple trocars, resulting in scattered wounds. An incision-based precision multipoint rectus sheath block (RSB), tailored to the surgical site and providing dual analgesia through local infiltration and nerve blockade, may be more suitable for laparoscopic-assisted colorectal surgery than bilateral RSB. What this study adds: The main finding was that ultrasound-guided incision-based precision multipoint RSB, compared to bilateral RSB, significantly reduced intraoperative and postoperative morphine equivalents in patients undergoing laparoscopic-assisted colorectal surgery. How this study might affect research, practice, or policy: The incision-based precision multipoint represents a safe and efficacious technique, which is recommended for routine implementation in patients subjected to laparoscopic-assisted colorectal surgery.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192417","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":"Pneumoconiosis and the subsequent risk of dementia: a retrospective cohort study.","authors":"Tsai-Ling Yu, Katharine Ching Chung, Hui-Chun Huang, Ya-Chun Chuang, Yu-Ru Lai, Ya-An Tsai, Chen-Yu Wang, Cheng-Li Lin, Te-Chun Shen, Der-Yang Cho","doi":"10.1093/postmj/qgaf165","DOIUrl":"https://doi.org/10.1093/postmj/qgaf165","url":null,"abstract":"<p><strong>Background: </strong>Pneumoconiosis has been recognized as a risk factor for systemic diseases; however, its association with dementia remains unclear. This study aims to investigate the association of pneumoconiosis with the subsequent risk of dementia.</p><p><strong>Methods: </strong>This retrospective cohort study used data from Taiwan's National Health Insurance database. The pneumoconiosis cohort included 17 871 patients diagnosed with pneumoconiosis from 2009 to 2020. A comparison cohort of 71 484 individuals without pneumoconiosis was matched in a 1:4 ratio in terms of age, sex, and diagnostic date. All study participants were followed up until the end of 2020 to evaluate dementia incidence.</p><p><strong>Results: </strong>The incidence of dementia in the pneumoconiosis cohort was 17.6 per 1000 person-years, which was significantly higher than the 12.3 per 1000 person-years in the control group. Age-stratified analysis revealed that patients aged 65-74 years (aHR = 1.26, 95% CI = 1.15-1.38) and ≥75 years (aHR = 1.49, 95% CI = 1.38-1.60) demonstrated a significantly increased risk. Sex-specific analysis revealed that both men (aHR = 1.39, 95% CI = 1.31-1.48) and women (aHR = 1.30, 95% CI = 1.11-1.51) exhibited a significantly increased risk. Further, the frequency of emergency department visits among patients with pneumoconiosis was positively associated with dementia risk.</p><p><strong>Conclusion: </strong>Utilizing a large-scale medical database, this study reveals that patients with pneumoconiosis demonstrated a significantly increased risk of developing dementia. Early cognitive function screening is recommended for this population to reduce disability and improve long-term outcomes. Key messages What is already known on this topic: Pneumoconiosis has considerable comorbidities, particularly pulmonary and cardiovascular diseases. However, the association between pneumoconiosis and dementia is largely unknown. What this study adds: The nationwide, population-based, retrospective cohort study revealed that patients with pneumoconiosis had a significantly higher risk of dementia than those without pneumoconiosis. How this study might affect research, practice, or policy: Greater emphasis on early cognitive function screening in this population may help to reduce disability rates and enhance long-term outcomes.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186495","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":"Association between rivaroxaban and the prognosis of patients with acute myocardial infarction and new-onset atrial fibrillation.","authors":"Yi Zheng, Ying Liu, Xinyu Zheng, Gary Tse, Gregory Y H Lip, Kang-Yin Chen, Tong Liu","doi":"10.1093/postmj/qgaf163","DOIUrl":"https://doi.org/10.1093/postmj/qgaf163","url":null,"abstract":"<p><strong>Background: </strong>New-onset atrial fibrillation (AF) in the setting of acute myocardial infarction (AMI) is associated with higher risks of stroke and mortality. However, current guidelines lack specific antithrombotic recommendations for this population. This study aimed to explore the association between rivaroxaban and the prognosis of patients with AMI and new-onset AF.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with AMI and new-onset AF receiving dual antiplatelet therapy between August 2016 and June 2023 in Tianjin, China. New-onset AF (transient or nontransient) was defined as the first diagnosis of AF following AMI. The primary outcome was stroke.</p><p><strong>Results: </strong>2477 patients were identified, including 141 rivaroxaban users and 2336 patients without oral anticoagulants (OAC). Over a median follow-up of 922 days, rivaroxaban users had a 5.7% lower risk of stroke than non-OAC users, although this was not statistically significant (19.9% vs. 25.6%; P = .152). Despite the suggestion of a protective trend, multivariable Cox regression showed that rivaroxaban use was not associated with a lower risk of stroke (hazard ratio, 0.77; 95% confidence interval, 0.52-1.13, P = .187). After propensity score matching, 155 transient (rivaroxaban: 42; non-OAC: 113) and 295 nontransient AF patients (rivaroxaban: 85; non-OAC: 210) were included. No significant association was observed between rivaroxaban and stroke, ischemic stroke, hemorrhagic stroke, all-cause mortality, cardiovascular mortality, bleeding, or major bleeding.</p><p><strong>Conclusion: </strong>No significant association was observed between rivaroxaban and clinical outcomes in patients with AMI and new-onset AF. Given the small sample size and limited statistical power, the findings are exploratory and require further validation. Key messages  What is already known on this topic: Evidence from previous studies indicates that acute myocardial infarction (AMI) patients with new-onset atrial fibrillation (AF) are associated with higher risks of ischemic stroke and mortality. However, the association between rivaroxaban and the prognosis of patients with AMI and new-onset AF remains uncertain.  What this study adds: Among patients with AMI and new-onset AF receiving dual antiplatelet therapy, no significant differences were observed between rivaroxaban users and non-oral anticoagulant users in terms of the risks of stroke, ischemic stroke, hemorrhagic stroke, all-cause mortality, cardiovascular mortality, bleeding, or major bleeding. However, these results should be interpreted with caution due to the small sample size and limited statistical power of the study.  How this study might affect research, practice or policy: Future prospective large-scale studies and randomized controlled trials are needed to further examine the role of rivaroxaban and other types of oral anticoagulants in patients with AMI and new-onset AF.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186476","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}