Postgraduate Medical Journal最新文献_第10页

Correction to: Yin and Yang of medical education. 更正：医学教育的阴阳。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-08-14 DOI: 10.1093/postmj/qgag118

引用次数: 0

Understanding chronic itch: a mechanistic framework for primary care. 理解慢性瘙痒：初级保健的机制框架。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-08-11 DOI: 10.1093/postmj/qgag097

Jawad Mahmood

{"title":"Understanding chronic itch: a mechanistic framework for primary care.","authors":"Jawad Mahmood","doi":"10.1093/postmj/qgag097","DOIUrl":"https://doi.org/10.1093/postmj/qgag097","url":null,"abstract":"Background: Chronic itch is common in primary care but is often under-examined, partly because clinicians lack a clear mechanistic framework for interpreting its diverse presentations.Aim: To provide generalists with a practical, mechanism-based model for assessing and managing chronic itch.Methods: Evidence from neurobiology, dermatology, and internal medicine was synthesised into a four-driver framework describing skin-generated, systemic, peripheral nerve, and centrally mediated itch. Clinical patterns, mechanistic pathways, and aligned treatments were integrated into a unified model for primary care.Results: Most chronic itch can be understood through a small number of mechanisms: keratinocyte stress and inflammatory cytokines in skin-generated itch; circulating mediators and neurohumoral imbalance in systemic itch; focal nerve injury in neuropathic itch; and sensitisation, amplification and conditioned scratching in centrally mediated itch. These mechanisms map to distinct clinical patterns and targeted therapeutic strategies.Conclusion: A structured assessment focusing on tempo, distribution, skin findings, systemic clues, and sensory change supports clearer diagnosis and more effective management of chronic itch in primary care.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713593","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

Vulnerability assessment in the emergency department: operational challenges and external validity. 急诊科脆弱性评估：操作挑战和外部有效性。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-08-09 DOI: 10.1093/postmj/qgag113

Huiya Li

引用次数: 0

From mechanization to cognitive autonomy: the journey of healthcare evolution from Industry 1.0 to 6.0. 从机械化到认知自主：医疗保健从工业1.0到工业6.0的演进之旅。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-08-08 DOI: 10.1093/postmj/qgag108

Shashank Chapala, Ramya Munnur, Jonathan Gibson, Karthikeyan P Iyengar, Jwalant Mehta, Rajesh Botchu

{"title":"From mechanization to cognitive autonomy: the journey of healthcare evolution from Industry 1.0 to 6.0.","authors":"Shashank Chapala, Ramya Munnur, Jonathan Gibson, Karthikeyan P Iyengar, Jwalant Mehta, Rajesh Botchu","doi":"10.1093/postmj/qgag108","DOIUrl":"https://doi.org/10.1093/postmj/qgag108","url":null,"abstract":"Background: The symbiotic relationship between industrial advancement and healthcare delivery has fundamentally shaped modern medicine. This comprehensive review article explores the historical and technological trajectory from the First Industrial Revolution (Industry 1.0) to the rapidly emerging Sixth Industrial Revolution (Industry 6.0), meticulously mapping distinct industrial milestones to their concurrent evolutions in clinical practice.Methods: An exhaustive electronic search was conducted across multiple premier academic and clinical databases, including PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library using specific technological enablers, clinical application domains and reported barriers to implementation.Results: While Industry 1.0 through 3.0 focused on mechanization, mass production, and rudimentary automation, resulting in the institutionalization and digitization of medicine, the advent of Industry 4.0 introduced cyber-physical systems and the Medical Internet of Things/Internet of Medical Things. Subsequently, Industry 5.0 emerged to address the depersonalization of hyper-automation by reintegrating human-centricity, ethical governance, and mass personalization.Conclusion: This review posits that the global ecosystem is now transitioning into Industry 6.0, an era characterized by antifragile manufacturing, quantum computing, deep digital twins, and autonomous cognitive systems. By examining specific applications across diagnosis, treatment, screening, monitoring, prevention, and rehabilitation--with a particular focus on hightechnology fields such as orthopaedics--this paper illustrates a paradigm shift from reactive, standardized interventions to proactive, hyper-personalized, and autonomous healthcare delivery models.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697772","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

Association between pulse wave velocity and extracoronary arterial calcification: a systematic review and meta-analysis. 脉搏波速度与冠状动脉钙化之间的关系：一项系统回顾和荟萃分析。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-08-07 DOI: 10.1093/postmj/qgag107

Carla-Geovanna Lever-Megina, Nerea Moreno-Herraiz, Alicia Saz-Lara, Iris Otero-Luis, Andrea Del Saz-Lara, Candela Calvo-Utrilla, Iván Cavero-Redondo

{"title":"Association between pulse wave velocity and extracoronary arterial calcification: a systematic review and meta-analysis.","authors":"Carla-Geovanna Lever-Megina, Nerea Moreno-Herraiz, Alicia Saz-Lara, Iris Otero-Luis, Andrea Del Saz-Lara, Candela Calvo-Utrilla, Iván Cavero-Redondo","doi":"10.1093/postmj/qgag107","DOIUrl":"https://doi.org/10.1093/postmj/qgag107","url":null,"abstract":"Cardiovascular diseases remain the leading cause of mortality worldwide. Their increasing prevalence has focused attention on new promising biomarkers such as vascular calcification, although its assessment involves radiation exposure. Thus, this systematic review and meta-analysis aimed to examine the association between arterial stiffness, assessed through pulse wave velocity (PWV) and extracoronary arterial calcification (ECC), in addition to identifying possible factors influencing this relationship. A systematic search was conducted in PubMed, Scopus, and Web of Science according to PRISMA and MOOSE guidelines. Data extraction, quality assessment, and statistical analyses were performed according to predefined criteria. A total of 41 studies with 19 300 participants were included. Higher central PWV was associated with higher presence of ECC in both unadjusted and adjusted models (p-OR = 2.84; 95% CI: 2.25-3.59; and p-OR = 2.27; 95% CI: 1.66-3.11, respectively). Similarly, peripheral PWV was associated with ECC in both unadjusted and adjusted models (p-OR = 3.73; 95% CI: 2.76-5.05; and p-OR = 1.49, 95% CI: 1.26-1.75, respectively), though with considerable heterogeneity. Age, diabetes, low-density lipoprotein cholesterol, total cholesterol, pulse pressure, and body mass index were related to p-OR. Publication bias was identified in all models except the adjusted peripheral model. This meta-analysis highlights a significant association between central arterial stiffness and ECC, supporting PWV as a promising noninvasive biomarker. Given the cross-sectional nature of the available evidence and the observed heterogeneity, further prospective studies are needed to confirm these findings, clarify their clinical relevance, standardize measurement methods, and to strengthen the overall evidence base.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685590","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

Learner handover in surgical and procedural training: continuity of coaching or reputational contamination? A narrative review. 外科和程序培训中的学习者交接：指导的连续性还是声誉的污染？叙述性评论

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-08-05 DOI: 10.1093/postmj/qgag103

Amna Qamar, Robert M Maweni

{"title":"Learner handover in surgical and procedural training: continuity of coaching or reputational contamination? A narrative review.","authors":"Amna Qamar, Robert M Maweni","doi":"10.1093/postmj/qgag103","DOIUrl":"https://doi.org/10.1093/postmj/qgag103","url":null,"abstract":"Purpose: Learner handover is the transfer of learner-related information between supervisors, rotations or educational phases. This narrative review examines learner handover in surgical and procedural training, including surgery, interventional cardiology, interventional radiology and gastrointestinal endoscopy, where information about prior performance may influence entrustment, supervision, case allocation and technical opportunity.Results: Learner handover has been proposed as a way to mitigate the discontinuity inherent in rotational training and to enable earlier, more targeted coaching. However, empirical work on prior performance information shows that assessors can be influenced by what they are told before observing a learner, with both assimilation and contrast effects described. Learners report that handover can feel opaque, anxiety-provoking and reputationally risky when they do not know what is shared, by whom or for what purpose. In procedural specialties these concerns are amplified because reputational information may alter access to scarce cases, thresholds for hands-on participation and the level of supervision granted during invasive tasks.Conclusion: Learner handover should neither be adopted uncritically nor rejected outright. Surgical and procedural programmes should replace informal reputational exchange with structured developmental handover that is behaviourally specific, recent, proportionate, learner-centred, time-limited and linked to explicit coaching actions. The central task is to preserve continuity of coaching while preventing reputational contamination.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679883","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

Future medical libraries. 未来的医学图书馆。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-07-31 DOI: 10.1093/postmj/qgag110

Apichai Wattanapisit, Chirk Jenn Ng, Sanhapan Wattanapisit

引用次数: 0

Training medical students as peer simulated patients in undergraduate medical education: a narrative review and implementation framework. 本科医学教育中医学生作为同伴模拟病人的训练：叙述回顾与实施框架。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-07-31 DOI: 10.1093/postmj/qgag100

Uri Pollak, Yael Feinstein

{"title":"Training medical students as peer simulated patients in undergraduate medical education: a narrative review and implementation framework.","authors":"Uri Pollak, Yael Feinstein","doi":"10.1093/postmj/qgag100","DOIUrl":"https://doi.org/10.1093/postmj/qgag100","url":null,"abstract":"Standardized patients (SPs) are a core modality in undergraduate medical education for teaching and assessing communication, history-taking, and clinical reasoning through simulated encounters and objective structured clinical examinations. Yet, scaling SP provision can be limited by financial cost, the availability of trained actors, and the faculty workload required for recruitment, training, and quality assurance (QA). A peer simulated patient (PSP) model, also described as \"students as patients\" or student standardized-patients model, trains senior medical students to portray SPs roles for junior learners and, in many designs, to provide structured feedback. This manuscript synthesizes evidence from systematic reviews and comparative studies of peer role-play, student SP, and occupational SP models and integrates peer-assisted learning theory, deliberate practice, and SP standards of best practice to propose an implementation framework suitable for medical schools. Available evidence suggests that peer simulation can be acceptable and sufficiently realistic for many educational goals, can yield learner outcomes comparable to occupational SPs in selected settings, may offer benefits for the senior students and may offer favorable cost profiles when programs are scaled. However, PSP programs may introduce risks, including variability in standardization, role confusion, confidentiality breaches, and psychological safety concerns for both junior learners and student-actors. We provide a stepwise framework covering recruitment, training (portrayal and feedback), QA, safeguarding psychological safety, and evaluation of outcomes for both learner and PSP cohorts. When carefully designed and governed, PSP programs can expand access to repeated, deliberate practice with feedback, strengthen senior students' teaching and professional identity formation, and reduce resource barriers to high-frequency simulation.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631412","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

Methods used and lessons learnt: a post-graduate general practice curriculum redesign initiative from Ireland. 使用的方法和吸取的教训：来自爱尔兰的研究生全科实践课程重新设计倡议。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-07-29 DOI: 10.1093/postmj/qgag102

Robert Scully, Padraic McCarthy

{"title":"Methods used and lessons learnt: a post-graduate general practice curriculum redesign initiative from Ireland.","authors":"Robert Scully, Padraic McCarthy","doi":"10.1093/postmj/qgag102","DOIUrl":"https://doi.org/10.1093/postmj/qgag102","url":null,"abstract":"Background: Curriculum review is a core component of postgraduate medical education, with implications for trainees, educators, and healthcare systems. In 2021, the Irish College of General Practitioners assumed full responsibility for national GP training in Ireland, creating an opportunity for comprehensive curriculum redesign. The redesign reduced curricular complexity, enhanced usability, and strengthened constructive alignment. Digitizing the curriculum improved accessibility, enables real-time updates, and supports learner engagement through multimedia. A structured governance framework, including ongoing review and audit cycles, has been established.Methods: A redesign was undertaken, guided by constructive alignment and established curriculum theory. One thousand seven hundred intended learning outcomes from the 2020 curriculum were critically reviewed, consolidated, and reformulated into 500 higher-level Professional Standards Statements. A multi-stage process included expert review, iterative committee evaluation, consensus meetings, equity diversity and inclusion review, and national stakeholder consultation. Curriculum content was mapped to national and international frameworks. Migration to a digital platform was completed. New content areas, informed by needs assessment include Artificial Intelligence & Medical Technology, Leadership, Traveller Health, and Haematology.Conclusions: This national curriculum redesign demonstrates how outcome consolidation, stakeholder engagement, and digital innovation can enhance curriculum coherence and sustainability in postgraduate training. Key lessons include the importance of usability, constructive alignment, flexible incorporation of emerging topics, and rigorous governance. These insights may inform similar initiatives internationally.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621153","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

Gut microbiota metabolites and microbiota-targeted interventions in bone metabolism: from SCFAs and TMAO to probiotics and FMT. 肠道菌群代谢物和针对骨代谢的微生物干预：从SCFAs和TMAO到益生菌和FMT。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-07-28 DOI: 10.1093/postmj/qgag099

Zhihui Huang, Zhigang Li, Fan Wu, Dabiao Zhou

{"title":"Gut microbiota metabolites and microbiota-targeted interventions in bone metabolism: from SCFAs and TMAO to probiotics and FMT.","authors":"Zhihui Huang, Zhigang Li, Fan Wu, Dabiao Zhou","doi":"10.1093/postmj/qgag099","DOIUrl":"https://doi.org/10.1093/postmj/qgag099","url":null,"abstract":"Background: Accumulating evidence supports a microbiota-gut-bone axis in which intestinal microbes influence skeletal remodeling through barrier integrity, immune signaling, and metabolite production.Methods: This review emphasizes specific metabolites, strain-level intervention data, and translational limitations.Results: Preclinical studies consistently show that dysbiosis, barrier disruption, and altered microbial metabolites promote osteoclastogenesis and suppress osteoblast function. Among short-chain fatty acids, propionate and butyrate have the strongest direct anti-osteoclast evidence, whereas acetate a bone-relevant systemic substrate/signaling molecule with context-dependent skeletal effects. Trimethylamine N-oxide has been linked mechanistically to impaired osteogenic commitment of bone marrow stromal cells and inflammatory signaling, although human epidemiologic findings are not uniform. These mechanisms appear particularly relevant in postmenopausal osteoporosis and glucocorticoid-induced osteoporosis, where estrogen deficiency or glucocorticoid exposure amplifies intestinal permeability, inflammatory tone, and microbial dysbiosis. In humans, the clinical signal is promising but heterogeneous. Fecal microbiota transplantation remains largely preclinical in bone disease and faces major challenges in donor selection, protocol standardization, timing, and long-term safety.Conclusions: Overall, the field is moving from associative observations toward causal and precision-oriented models, but large, well-phenotyped human studies integrating metagenomics, metabolomics, proteomics, and host clinical data are still needed before microbiota-targeted therapies can be routinely incorporated into osteoporosis care.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148606562","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