Postgraduate Medical Journal最新文献

{"title":"Loperamide overdose-associated euphoria and delirium.","authors":"Ina Dubin, Ami Schattner","doi":"10.1093/postmj/qgag140","DOIUrl":"https://doi.org/10.1093/postmj/qgag140","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224805","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":"From perceived empathy to adherence: what do virtual physician ratings tell us about patient behaviour?","authors":"Eashum Rehman","doi":"10.1093/postmj/qgag147","DOIUrl":"https://doi.org/10.1093/postmj/qgag147","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183921","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":"On reflection: neurological factors underlying false perceptions.","authors":"Philip D Welsby","doi":"10.1093/postmj/qgag149","DOIUrl":"https://doi.org/10.1093/postmj/qgag149","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183919","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":"NSAID-induced colonic diaphragm-like strictures: a rare adverse reaction to commonly used drugs.","authors":"Qingyang Zhou, Bo Lu, Huijun Shu","doi":"10.1093/postmj/qgag144","DOIUrl":"https://doi.org/10.1093/postmj/qgag144","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167450","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":"Conflict of interest: a declaration in search of clarity.","authors":"Dhananjaya Sharma","doi":"10.1093/postmj/qgag145","DOIUrl":"https://doi.org/10.1093/postmj/qgag145","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170360","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 MENTOR study: a national cross-sectional study of mentorship, engagement, networking, and training opportunities in research among UK medical students and resident doctors.","authors":"Kai Jian Chin, Umar Rehman, Shireen S Gohari, Luke Mattey, Lawson Faulkner, Daniella C Reyes, Mohammad Sohaib Sarwar, Carly Nichola Bisset, Ricky Ellis, Naveen Cavale, Simon Filson, Peter A Brennan, Bukprc Collaborators","doi":"10.1093/postmj/qgag123","DOIUrl":"https://doi.org/10.1093/postmj/qgag123","url":null,"abstract":"<p><strong>Background: </strong>Despite sustained research interest among medical students and resident doctors, the UK clinical academic workforce is declining. The current study examined associations between mentorship, childhood socioeconomic disadvantage, research access, and early engagement in clinical academia.</p><p><strong>Methods: </strong>A nationwide cross-sectional survey of UK medical students and resident doctors from January to April 2026, assessing mentorship, perceived research barriers, confidence, academic outputs, and awareness of formal academic pathways. Indices of childhood socioeconomic disadvantage and research barrier burden were developed. Multivariable logistic regression identified factors associated with a high perceived research barrier burden.</p><p><strong>Results: </strong>A total of 1255 responses was included: 848 medical students and 407 resident doctors. Among 824 respondents with complete socioeconomic data, 7% (n = 58) had high childhood socioeconomic disadvantage. Current mentorship was reported by 31% of medical students (n = 260) and 43% of resident doctors (n = 174). The most common barriers were time constraints or clinical demands (59.1%, n = 742), limited access to research-active supervisors (39.9%, n = 501), and perceived high financial costs (34.7%, n = 436). High perceived research barrier burden was more common among respondents with high childhood socioeconomic disadvantage than those with low disadvantage (34.5% vs 18.1%). After adjustment, high childhood socioeconomic disadvantage remained associated with higher perceived research barrier burden (OR 2.42, 95% CI 1.20 to 4.81, P = .012), whereas current mentorship was associated with a lower perceived research barrier burden (OR 0.21, 95% CI 0.12 to 0.34, P < .001).</p><p><strong>Conclusion: </strong>Despite research interest, access remains uneven. Structured mentorship, transparent opportunities, financial support, and practical research training may widen access to clinical academic careers.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168578","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 in response to 'Tuina and Baduanjin for chronic nonspecific low back pain: a randomized controlled trial and clinical considerations'.","authors":"Hao Ye, Shengqiang Zhang","doi":"10.1093/postmj/qgag137","DOIUrl":"https://doi.org/10.1093/postmj/qgag137","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138031","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":"Physician-level variation exceeds time-of-day variation in diagnostic resource utilization in low-acuity emergency department care.","authors":"Mehmet Şirin Büyükkaya, Mesut Kina, Mahmut Şahin, Mehmet Tatli, Ramazan Sami Aktaş","doi":"10.1093/postmj/qgag142","DOIUrl":"https://doi.org/10.1093/postmj/qgag142","url":null,"abstract":"<p><strong>Background: </strong>Emergency physicians working prolonged shifts may show temporal variation in clinical practice. We examined whether diagnostic resource utilization differed across scheduled shift periods in a structured low-acuity emergency department setting.</p><p><strong>Methods: </strong>This retrospective observational study included 11 032 visits for upper respiratory tract infection, myalgia, abdominal pain, or headache across 12 nonconsecutive 24-hour shifts (5 December 2025-19 January 2026) in a high-volume tertiary emergency department in Turkey. Visits were classified as early (0-5 h; 08:30-13:30), mid (5-10 h; 13:30-18:30), or late (10-16 h; 18:30-00:30) based on elapsed time since the scheduled shift start at 08:30. Multivariable logistic regression with physician-level clustered standard errors (19 clusters) adjusted for age, sex, and diagnostic category.</p><p><strong>Results: </strong>Laboratory testing rates were 9.5% across all periods (P = .997); imaging rates were 13.5%, 12.8%, and 12.6% (P = .485). The composite utilization score did not differ significantly (P = .682). Late-period consultation was lower than in the early period (odds ratio = 0.541, 95% confidence interval: 0.306-0.957), although this finding was limited by the low event count (n = 82). Inter-physician variation substantially exceeded shift-period variation, with laboratory rates ranging from 3.5% to 21.5% and imaging rates from 6.3% to 28.7%.</p><p><strong>Conclusion: </strong>In this low-acuity emergency department setting, scheduled shift period was not measurably associated with increased laboratory or imaging utilization. Physician-level variation appeared more prominent than shift-period variation, supporting prospective studies incorporating fatigue, workload, and decision-quality measures.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127899","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":"Feedback, neurodivergence and rejection sensitivity dysphoria in medical education.","authors":"Mathilde Suffolk-Hickman, Kirsty Alexander, Chris Isles","doi":"10.1093/postmj/qgag131","DOIUrl":"https://doi.org/10.1093/postmj/qgag131","url":null,"abstract":"<p><p>Rejection Sensitivity Dysphoria (RSD) is an intense, deep rooted feeling of embarrassment, anxiety and failure that can be all-consuming and deeply impactful. RSD is common in neurodivergent learners, particularly those with autism and ADHD. It is essential that medical educators' feedback strategies recognize and support those with RSD, so that distress may be reduced and these learners can rightfully flourish in medical training. Moreover, by adopting a relational and inclusive approach to feedback, other learners will also benefit, particularly those who are anxious, highly self-critical or perfectionist. This paper supports educators to understand and recognize RSD before discussing approaches to adapting feedback. Addressing a mismatch between learner needs and the feedback process or environment is key. Utilizing alternative feedback models, prioritizing rapport, providing written feedback and supporting learners to manage their emotional dysregulation are practical strategies.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081843","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":"Closure debt: the hidden educational deficit of fragmented clinical training.","authors":"Waseem Jerjes, Azeem Majeed","doi":"10.1093/postmj/qgag139","DOIUrl":"https://doi.org/10.1093/postmj/qgag139","url":null,"abstract":"<p><strong>Background: </strong>Clinical trainees often make decisions without ever learning how the patient's story ended. We call the cumulative educational deficit created by these unfinished cases closure debt. It is distinct from continuity of care, continuity of supervision, feedback, and diagnostic error education. Closure debt emerges when contemporary training systems separate decisions from endings through shift work, frequent rotations, handovers, shared ownership, weak case attribution, and poorly designed access to outcome information.</p><p><strong>Argument: </strong>We argue that missing endings weaken diagnostic calibration, reflective practice, professional accountability, and systems learning. We also advise against indiscriminate follow-up. Outcome information can create hindsight bias, distort assessment, overload learners, and become punitive if returned without structure, context, and psychological safety. We propose a selective closure system for postgraduate training: identify high-yield cases, attribute them meaningfully to learners or teams, generate concise outcome digests, prompt brief structured reflection, provide coached interpretation when needed, and separate developmental closure from summative scoring.</p><p><strong>Conclusion: </strong>Closure should be treated as a designed feature of clinical education rather than a matter of individual curiosity or chance. Medical education does not require universal follow-up of every patient; it requires reliable closure for the right cases, in the right format, protected from the wrong uses. Designing for closure may help training programmes reconnect exposure with consequence and make clinical learning more honest, developmental, and more aware of system effects across rotations, placements, and busy clinical learning environments.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064150","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}