Postgraduate Medical Journal最新文献

Risk of gastrointestinal rebleeding in direct oral anticoagulant-treated population. 直接口服抗凝治疗人群胃肠道再出血的风险。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2025-07-10 DOI: 10.1093/postmj/qgaf090

Bianca Codrina Morarasu, Victorita Sorodoc, Constantin Simiras, Stefan Morarasu, Catalina Lionte, Raluca Ecaterina Haliga, Cristina Bologa, Mihai Constantin, Alexandr Ceasovschih, Alexandra-Diana Diaconu, Raluca Elena Alexa, Andreea Asaftei, Emilia Adriana Marciuc, Mohammed Elsiddig, Laurentiu Sorodoc

{"title":"Risk of gastrointestinal rebleeding in direct oral anticoagulant-treated population.","authors":"Bianca Codrina Morarasu, Victorita Sorodoc, Constantin Simiras, Stefan Morarasu, Catalina Lionte, Raluca Ecaterina Haliga, Cristina Bologa, Mihai Constantin, Alexandr Ceasovschih, Alexandra-Diana Diaconu, Raluca Elena Alexa, Andreea Asaftei, Emilia Adriana Marciuc, Mohammed Elsiddig, Laurentiu Sorodoc","doi":"10.1093/postmj/qgaf090","DOIUrl":"https://doi.org/10.1093/postmj/qgaf090","url":null,"abstract":"Introduction: We performed a retrospective analysis of rebleeding events and their association with direct oral anticoagulant (DOAC) discontinuation versus resumption in patients admitted with an index episode of gastrointestinal bleeding (GIB) while on oral anticoagulants.Materials and methods: We included patients ≥18 years between January 2018 and December 2022. The cohort was divided into two groups, initially based on anticoagulant management at discharge, subsequently, according to bleeding events during follow-up, which ended at the time of death, last clinical contact, time of the event, or within 6 months since last patient was included.Results: A total of 120 patients were included. Those with HAS-BLED score > 3 were more likely discontinue DOAC (P = 0.0009). Significantly more patients with previous GIB had a rebleeding episode (29.6% vs. 6.4%, P = 0.002) and a 4-fold higher risk of rebleeding in the first 15.2 months (HR 4.070, CI [1.771-9.354], P = 0.001). A history of diabetes mellitus, malignancy, CHA2DS2-VASc, and HAS-BLED score > 3 was associated with an increased rebleeding risk, but without statistical significance.Conclusion: Previous episode of GIB is the most significant risk factor for recurrent bleeding in DOAC-treated patients. It leads to a four times higher risk of bleeding, particularly in the first 15 months. Patients aged ≥75, with a history of diabetes mellitus, malignancy, and HAS-BLED score > 3 should be closely followed-up. Timing of anticoagulation resumption and specific DOAC agent did not influence the rate of rebleeding, supporting their proven benefit.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609190","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}

引用次数: 0

A single-centre audit of early warning scores and medical emergency team activation in medical and surgical admissions at Wellington Regional Hospital. 对惠灵顿地区医院内科和外科住院病人的预警评分和医疗急救小组激活情况进行单一中心审计。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2025-07-10 DOI: 10.1093/postmj/qgaf106

Julie K Cook, Rowan Biggs, Allie Eathorne, Tanira Kingi, Nick Shortt, Neakiry Kivi, Christina Elder, Alex Psirides, Richard Beasley, Louis Kirton

{"title":"A single-centre audit of early warning scores and medical emergency team activation in medical and surgical admissions at Wellington Regional Hospital.","authors":"Julie K Cook, Rowan Biggs, Allie Eathorne, Tanira Kingi, Nick Shortt, Neakiry Kivi, Christina Elder, Alex Psirides, Richard Beasley, Louis Kirton","doi":"10.1093/postmj/qgaf106","DOIUrl":"https://doi.org/10.1093/postmj/qgaf106","url":null,"abstract":"Purpose: This single-centre retrospective audit evaluates the accuracy of nurse-documented vital signs and aggregated New Zealand's early warning scores (NZEWS) in high-acuity inpatients, and the proportion who appropriately received medical emergency team (MET) callouts.Methods: Eligible patients admitted to general medicine and surgery services in the first 2 days of each month starting January 2022 and ending August 2022 and February 2023, respectively, had every documented vital sign and NZEWS entered into a database until 100 patients with an NZEWS of 6 or greater in the first 24 hours of the admission, or 10 patients with MET callouts per service were identified. We examined NZEWS calculations and their association with MET callout activation. An agreement analysis examined discrepancies between nurse-calculated and audit-calculated NZEWS.Results: Of 491 screened admissions, 63 (12.8%) fulfilled criteria for inclusion and a total of 20 (4.1%) patients had at least 1 MET callout, of 23 who fulfilled MET criteria. Correct calculation and documentation occurred in three quarters (75.8%) of all NZEWS audited. Approximately half (46.8%) of the 47 individual NZEWS instances mandating MET activation resulted in a MET callout and only one in eight (12.8%) had a documented and accurately calculated NZEWS. The mean difference between nurse and audit-calculated NZEWS was -0.19 (nurse minus audit-calculated, with 95% confidence intervals of -0.28 to -0.09) with limits of agreement -3.64 to 3.26.Conclusions: When dependent on manual processes, NZEWS documentation, calculation, and MET activation is suboptimal. Automation of NZEWS and MET callouts requires prioritization.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609189","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}

引用次数: 0

Does work-family conflict predict allostatic load? A 4-year longitudinal study. 工作-家庭冲突能预测适应负荷吗？一项为期4年的纵向研究。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2025-07-07 DOI: 10.1093/postmj/qgaf101

Mayumi Saiki, Adrian Loerbroks, Jian Li

{"title":"Does work-family conflict predict allostatic load? A 4-year longitudinal study.","authors":"Mayumi Saiki, Adrian Loerbroks, Jian Li","doi":"10.1093/postmj/qgaf101","DOIUrl":"https://doi.org/10.1093/postmj/qgaf101","url":null,"abstract":"Objective: A growing number of studies have reported that occupational psychosocial factors increase the risk of cardiovascular disease. Allostatic load (AL) is a main biological mechanism that explains the pathway from stress to disease. This study examined whether work-to-family conflict (WFC) and family-to-work conflict (FWC) at baseline would be associated with changes in the AL index (ALI) across four years.Methods: We used the Midlife in Japan survey, Wave I, and the biomarker projects, Waves I and II. This study included 152 participants with paid jobs and variables of interest at baseline and target biomarkers at baseline and follow-up. We examined the four-year longitudinal changes in the ALI using two methods: comparing ALI scores at baseline and follow-up, named \"Two ALI approach,\" and creating one ALI score considering changes at baseline and follow-up, named \"One ALI approach.\" Negative binomial regression analysis and generalized estimating equations were used for analyses. The results were reported by count ratios (CRs) and 95% confidence intervals (CIs).Results: In the final model, our results demonstrated that WFC at baseline was significantly associated with increased ALI using the \"Two ALI approach\" (CR 1.15, 95% CIs: 1.03, 1.28) and \"One ALI approach\" (CR 1.15, 95% CIs: 1.01, 1.32), whereas FWC did not show statistical significance in both methods.Conclusions: WFC was longitudinally associated with increased ALI. It is crucial to mitigate the effects of work-to-family conflict.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576039","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}

引用次数: 0

Is quality sleep a privilege reserved for the affluent? 高质量的睡眠是富人的特权吗？

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2025-07-07 DOI: 10.1093/postmj/qgaf105

Yung-Yi Lan, Rujith Kovinthapillai, Katarzyna Wieczorowska-Tobis

引用次数: 0

Machine learning approaches for predicting heart failure readmissions. 预测心力衰竭再入院的机器学习方法。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2025-07-06 DOI: 10.1093/postmj/qgaf102

Amaia Pikatza-Huerga, Aitor Almeida, Raul Quiros, Nere Larrea, Mari Jose Legarreta, Unai Zulaika, Rodrigo Garcia, Susana Garcia

{"title":"Machine learning approaches for predicting heart failure readmissions.","authors":"Amaia Pikatza-Huerga, Aitor Almeida, Raul Quiros, Nere Larrea, Mari Jose Legarreta, Unai Zulaika, Rodrigo Garcia, Susana Garcia","doi":"10.1093/postmj/qgaf102","DOIUrl":"https://doi.org/10.1093/postmj/qgaf102","url":null,"abstract":"Purpose: This study aims to develop and evaluate machine learning (ML) models to predict the likelihood of hospital readmission within 30 days after discharge for patients with heart failure (HF). The goal is to compare the predictive accuracy of ML models with traditional methods such as those based on Cox proportional hazards and logistic regression, to improve clinical outcomes and reduce hospital costs.Methods: We conducted a prospective cohort study of patients discharged from five hospitals following admission for HF. Data were collected on variables including sociodemographic characteristics, medical history, admission details, patient-reported outcomes, and clinical parameters. ML techniques were employed to analyse the data and predict readmission risk, incorporating strategies to handle class imbalance and missing data. Model performance was assessed based on accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and F1 score.Results: Ensemble methods with Synthetic Minority Over-sampling Technique balancing and bagging improved the predictive performance of ML models compared with traditional models. The best-performing ensemble model, using decision trees, Gaussian Naïve Bayes, and neural networks, achieved an AUC of 0.81. In contrast, Cox and logistic regression models showed significantly poorer performance (AUC of 0.58 and 0.50, respectively). SHapley Additive exPlanations analysis revealed that frailty, anxiety, and depression were critical in predicting readmission.Conclusion: ML models, particularly those using ensemble methods, significantly outperform traditional models in predicting short-term readmission for patients with HF. These findings highlight the potential of ML to improve clinical decision-making and resource allocation in HF management.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567712","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}

引用次数: 0

Multi-GWAS analysis illuminates druggable targets for rheumatoid arthritis. 多重gwas分析阐明类风湿关节炎的药物靶点。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2025-07-06 DOI: 10.1093/postmj/qgaf100

Guojie Liu, Roslida A Hamid, Jun Zhang, Qin Zhang, Jun Lin

{"title":"Multi-GWAS analysis illuminates druggable targets for rheumatoid arthritis.","authors":"Guojie Liu, Roslida A Hamid, Jun Zhang, Qin Zhang, Jun Lin","doi":"10.1093/postmj/qgaf100","DOIUrl":"https://doi.org/10.1093/postmj/qgaf100","url":null,"abstract":"Objective: Despite the treatment choices for rheumatoid arthritis (RA) increasing, there remain unmet preventive and therapeutic needs for RA. This study aimed to identify effective drug target genes to reduce RA risk through the multi-genome-wide association studies analysis.Methods: A Mendelian randomization (MR) analysis was conducted to investigate the causal effects of druggable expression quantitative trait loci (eQTLs) in the blood on RA. Colocalization analysis assessed the shared causal genetic variants between the identified drug target genes and RA. Furthermore, eQTLs analysis of B and T cells in different states provided valuable insights into gene regulation in RA at a single-cell resolution. Summary-data-based MR (SMR) was performed to explore the casual relationship between the methylation levels of druggable genes and RA. The impact of druggable genes on RA biomarkers and other autoimmune diseases with available genome-wide association data was also evaluated.Results: Five drug target genes (CCR6, CTLA4, EDN3, FCRL3, STAT4) were identified to be causally related to RA. At single-cell resolution, CCR6 in Th1/17, Th17, and CD4 follicular helper T cells (TFH), EDN3 in Th1/17, Th17, and Th2, and FCRL3 in active naive CD8 and naive B cells were found to be associated with RA. The SMR analyses revealed that seven methylation probes of CCR6 and thirteen methylation probes of EDN3 were associated with RA. Further investigation showed no noticeable side effect of identified druggable genes.Conclusion: This study identifies five promising druggable target genes for RA treatment, offering valuable insights for prioritizing drug development strategies in RA.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567713","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}

引用次数: 0

Application of the wireless wearable monitoring system improves the turnaround time in gastrointestinal endoscopy center. 无线可穿戴监控系统的应用，提高了胃肠内镜中心的周转时间。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2025-06-30 DOI: 10.1093/postmj/qgaf103

Bo Zhu, Yu Huang, Yi Liu, Min Wang, Ling Liu

{"title":"Application of the wireless wearable monitoring system improves the turnaround time in gastrointestinal endoscopy center.","authors":"Bo Zhu, Yu Huang, Yi Liu, Min Wang, Ling Liu","doi":"10.1093/postmj/qgaf103","DOIUrl":"https://doi.org/10.1093/postmj/qgaf103","url":null,"abstract":"Objectives: To investigate whether the wireless monitoring system can reduce the turnaround time in gastrointestinal endoscopy center.Methods: Enrolled patients were randomly allocated to the study or control group. The primary outcome was the turnaround time. The secondary outcomes included the total time from entering examination room to discharge (T1), the total time of monitoring mean arterial pressure (T5), incidences of hypotension, bradycardia, and hypoxia, evaluation of the medical staff, and rate of effective monitoring.Results: 166 patients were analyzed. The turnaround time of study group was significantly shorter than that of control group (1.49 ± 1.82 vs. 4.78 ± 3.77 min, P < .001). The study group had a significantly shorter T1 (44.69 ± 4.54 vs. 49.49 ± 5.53 min, P < .001), but a longer T5 (44.39 ± 4.38 vs. 42.21 ± 4.97 min, P = .012). The medical staff gave higher scores to the wireless monitoring system in terms of practicability and application value (P < .05), but gave equally high evaluations on data reliability (P > .05). The rate of effective monitoring was acceptable in both groups.Conclusion: Application of the wireless monitoring system in an endoscopy center is feasible and acceptable, and improves the turnaround time.Trial registration: This study was registered at the Chinese Clinical Trial Registry on 19 April 2024 (ChiCTR2400083277).","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529398","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}

引用次数: 0

Watching five colours become six. 看着五种颜色变成六种。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2025-06-30 DOI: 10.1093/postmj/qgaf099

Sam Woodworth, Christopher Smith

引用次数: 0

High-sensitivity C-reactive protein and its role in coronary atherosclerotic disease: a review of current literature. 高敏c反应蛋白及其在冠状动脉粥样硬化疾病中的作用：当前文献综述

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2025-06-30 DOI: 10.1093/postmj/qgaf093

Dilusha Lamabadusuriya, Piyumika Jayawardene, F Aaysha Cader, Upul Wickramarachchi

{"title":"High-sensitivity C-reactive protein and its role in coronary atherosclerotic disease: a review of current literature.","authors":"Dilusha Lamabadusuriya, Piyumika Jayawardene, F Aaysha Cader, Upul Wickramarachchi","doi":"10.1093/postmj/qgaf093","DOIUrl":"https://doi.org/10.1093/postmj/qgaf093","url":null,"abstract":"Objective: To review the role of high-sensitivity C-reactive protein (hsCRP) as a biomarker of inflammation in coronary atherosclerotic disease and its potential clinical applications.Methods: A narrative review of key clinical trials, meta-analyses, and guideline recommendations was performed to evaluate the association between hsCRP levels, cardiovascular risk, and therapeutic interventions.Results: Elevated hsCRP levels are associated with increased risk of coronary events, both in primary and secondary prevention settings. Statins, independent of their lipid-lowering effects, significantly reduce hsCRP levels and associated cardiovascular events. Anti-inflammatory agents such as canakinumab and colchicine also demonstrate benefit in reducing major adverse cardiovascular events, while newer agents like bempedoic acid show promising hsCRP-lowering effects. Current guidelines recommend selective hsCRP use for risk stratification, particularly in intermediate-risk patients.Conclusion: hsCRP is a valuable biomarker reflecting residual inflammatory risk in coronary atherosclerosis. Incorporating hsCRP into routine clinical practice may enhance cardiovascular risk stratification and guide therapeutic decisions.Categories: Cardiology, Internal medicine.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529401","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}

引用次数: 0

Carbon emissions in gastrointestinal endoscopy practice. 胃肠道内窥镜检查实践中的碳排放。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2025-06-24 DOI: 10.1093/postmj/qgaf098

Yifei Liu, Bin Liu, Yutong Jin, Luning Wang, Hong Jin, Junming Miao, Zelin Feng, Yulin Ye, Limin Liu, Xiaoli Wang, Wei Zhao, Hanjie Wang, Xiaocang Cao

{"title":"Carbon emissions in gastrointestinal endoscopy practice.","authors":"Yifei Liu, Bin Liu, Yutong Jin, Luning Wang, Hong Jin, Junming Miao, Zelin Feng, Yulin Ye, Limin Liu, Xiaoli Wang, Wei Zhao, Hanjie Wang, Xiaocang Cao","doi":"10.1093/postmj/qgaf098","DOIUrl":"https://doi.org/10.1093/postmj/qgaf098","url":null,"abstract":"Background: Gastrointestinal endoscopy is acknowledged to have a considerable environmental footprint, driven by substantial greenhouse gas emissions and waste generation, yet it also presents opportunities for enhanced sustainability.Objective: This review provides a comprehensive evaluation of the interventions currently feasible within existing endoscopy units, offering targeted recommendations to overcome identified barriers.Methods: We systematically reviewed literature retrieved from PubMed, Google Scholar, and Web of Science using keywords: \"green endoscopy\", \"sustainability\", and \"carbon footprint\".Results: Central to this effort is the early integration of Green Endoscopy principles into training, which can expedite the adoption of sustainable practices and ensure long-term success. Various measures that can be implemented to reduce carbon emissions are discussed. Furthermore, this review examines the transformative potential of the emerging digital landscape in promoting sustainable endoscopic practices, discussing the substantial environmental benefits that can be realized through the integration of artificial intelligence and the expansion of telemedicine.Conclusion: Ultimately, an optimized framework is proposed, emphasizing education, quantification and targeted improvements at systemic level to significantly reduce the carbon footprint of gastrointestinal endoscopy.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529400","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}

引用次数: 0