Postgraduate Medical Journal最新文献

{"title":"NRMP couples match outcomes for internal medicine residents.","authors":"Ashley Diaz, Armaan Singh, Daniel Bujnowski, Jeanne Farnan","doi":"10.1093/postmj/qgaf198","DOIUrl":"10.1093/postmj/qgaf198","url":null,"abstract":"<p><strong>Background: </strong>The National Residency Match Program considers a successful Couples Match when both parties match, regardless of location. However, there is a dearth of data on Couples Match outcomes compared to normal Match Outcomes.</p><p><strong>Objective: </strong>To compare the success rates, geographic preferences, and application preparation between Couples Match and traditional Match applicants within the specialty of internal medicine.</p><p><strong>Methods: </strong>An anonymous, cross-sectional, two-part REDCap survey was designed for standard and Couples Match residents. This survey was distributed via email to 437 academic United States internal medicine program directors from 1 October 2022 to 31 December 2023. Questions focused on post-match satisfaction, pre-application priorities, and number of interviews conducted. Around 248 residents completed the survey across the 437 internal medicine residency programs initially contacted.</p><p><strong>Results: </strong>64% (52/82) of Couples Match participants felt the need to make compromises to ensure dual matching. Compared to standard applicants, Couples Match applicants were significantly less likely to match in their top three ranked programs (89% vs. 67%, P < 0.01). When asked how to rate their perceived stress during the match process on a scale of 1-10, Couples Match respondents reported significantly higher perceived stress than their standard match counterparts (7.85 ± 1.30 vs. 7.13 ± 1.74) (P < 0.001).</p><p><strong>Conclusions: </strong>We found that Couples Match applicants had differing pre-match priorities, significantly less likelihood of matching in their top three programs, and significantly higher perceived levels of stress. Our study highlights the unique needs and stressors of medical students who are applying to internal medicine through the Couples Match. Key messages What is already known on this topic: While the NRMP Couples Match boasts a high overall success rate, little is known about specialty-specific outcomes, applicant satisfaction, or the personal and professional compromises made by couples, particularly within internal medicine. What this study adds: This is the first national study to quantify internal medicine Couples Match outcomes, revealing that these applicants face significantly higher stress, are less likely to match at top-choice programs, and frequently compromise on prestige, geography, and personal priorities to match with their partner. How this study might affect research, practice, or policy: These insights underscore the need for tailored advising, informed program recruitment strategies, and potential policy considerations to better support the unique constraints faced by Couples Match applicants-enhancing both resident well-being and match satisfaction.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"428-433"},"PeriodicalIF":2.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565164","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":"Graves' disease in India: epidemiological, clinical, and genetic differences from Caucasians.","authors":"Shailendra Kumar Singh, Rina Singh, Arun Kumar Pandey, Vanshika Singh, Alankar Tiwari, Pradeep Kumar Rai","doi":"10.1093/postmj/qgaf204","DOIUrl":"10.1093/postmj/qgaf204","url":null,"abstract":"<p><p>The prevalence of thyroid dysfunction is rising in India and thus so is Graves' disease (GD). The phenotype of Indian GD is different than in Caucasians and is characterized by lower age at onset, lower female to male ratio, delayed diagnosis, more signs and symptoms, lower body mass index (BMI) and weight, lower prevalence of Graves' orbitopathy (GO), more inactive GO, lower doses of carbimazole being more effective, different markers of remission, and other things. Mechanistic studies are urgently needed to characterize the pathophysiology of Indian GD. Prevention, early diagnosis, and adequate treatment of GD should become urgently a public health priority in India.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"392-399"},"PeriodicalIF":2.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850698","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 \"Effects of mindfulness and sleep quality on self-efficacy of clinical decision making among resident physicians: an observational study\".","authors":"Rupak Chatterjee, Atanu Chandra","doi":"10.1093/postmj/qgaf075","DOIUrl":"10.1093/postmj/qgaf075","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"470-471"},"PeriodicalIF":2.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128274","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":"Traumatic injuries in polo players.","authors":"Gie Ken-Dror, Victor Chua, Pankaj Sharma","doi":"10.1093/postmj/qgaf200","DOIUrl":"10.1093/postmj/qgaf200","url":null,"abstract":"<p><strong>Objective: </strong>To determine the frequency of traumatic injuries in polo players in England.</p><p><strong>Methods: </strong>The survey included data on body location and reason for injury derived from accident reports using a retrospective cohort design from 26 participating English polo clubs between the years 2018 and 2024.</p><p><strong>Results: </strong>The study population included injuries in 236 polo players. The most common injury site was the limb (arm, hand, leg, wrist, shoulder) 47.9% (95% CI: 41.4-54.5), and face or head 38.6% (95% CI: 32.3-45.1), of which 12.1% (95% CI: 6.2-20.6) affected the eyes. The most common reason to require hospital treatment was injury sustained to the eyes, 45.5% (95% CI: 16.7-76.6), followed by limb 36.9% (95% CI: 27.6-47.0), and face or head 35.4% (95% CI: 23.9-48.2) (proportional difference P = .006). The most common sites to suffer an injury by the ball or stick and require hospital treatment were the head or face, 38.1% (95% CI: 23.6-54.4), eyes, 37.5% (95% CI: 8.5-75.5), and limb, 19.2% (95% CI: 9.6-32.5) (proportional difference P ≤ .001). The most common injury requiring hospital treatment that involved the horse was to the eyes, 66.7% (95% CI: 1.0-91.0). There was a significant proportional difference for eye injuries caused by the horse requiring hospital treatment compared to face/head (57.7%, 95% CI: 28.8-86.6, P < .001) or limb injuries (58.9%, 95% CI: 30.3-87.7, P < .001).</p><p><strong>Conclusion: </strong>Traumatic injury to the eyes while playing polo is the most common reason for requiring hospital treatment. As the head is already protected by mandating helmet use, we now advise similar regulation for eye protection by directing the wearing of sports glasses, goggles, or face guards. Key messages What is already known on this topic: Polo is regarded as a high-risk sport, which may result in traumatic injuries, the most serious affecting the head. Wearing of helmets is required during play to reduce this risk. What this study adds: Traumatic eye injuries during play are common and sustained from either the stick, ball, or fall from the horse. While the head is reasonably protected with helmets, injuries to the eyes while playing polo are the most common reason for requiring hospital treatment. How this study might affect research, practice or policy: As helmets are already mandated while playing polo, we now advocate the compulsory use of eye protection (sports glasses, goggles or face guards) for all polo players.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"434-438"},"PeriodicalIF":2.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565178","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":"Equality of opportunity-absolutely, it is right and just. Virtue signalling without focus on the individual-no thank you! Let's place individualism over collectivism.","authors":"John Bunni","doi":"10.1093/postmj/qgaf087","DOIUrl":"10.1093/postmj/qgaf087","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"472-473"},"PeriodicalIF":2.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192070","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":"Parental socioeconomic status and medical specialty choice: a nationwide analysis of Japanese physicians.","authors":"Kota Sakaguchi, Hinami Yamamoto, Yukiko Ohira, Tomoe Otsuka, Daisaku Yamasaki, Yasuharu Tokuda, Yoshihiko Shiraishi, Takashi Watari","doi":"10.1093/postmj/qgaf188","DOIUrl":"10.1093/postmj/qgaf188","url":null,"abstract":"<p><strong>Purpose of the study: </strong>Previous studies have suggested a potential link between parental socioeconomic status and medical specialty choice; however, empirical evidence from Japan remains scarce. Therefore, we aimed to investigate the association between parental socioeconomic status and medical specialty choice in Japan.</p><p><strong>Study design: </strong>This nationwide cross-sectional online survey was conducted in June 2022 using \"Nikkei Medical Online\", a professional platform for physicians. Data on medical specialty choice and parental socioeconomic status indicators (household income, occupation, and birthplace) were collected. Parental socioeconomic status was dichotomized based on an annual household income threshold of US$60 000 (approximately Japanese Yen 10 million). Association was evaluated by multivariable logistic regression analysis.</p><p><strong>Results: </strong>Of 3580 physicians included, 48.6% were from families with a parental household income of US$60000 or more. The proportion of physicians from high-income families was the highest in neurosurgery (65.8%) and dermatology (57.0%) and the lowest in radiology (30.8%), pathology (36.2%), and psychiatry (35.7%). Using multivariable analysis, choosing certain specialties was significantly associated with having a physician father (adjusted odds ratio, 14.46; 95% confidence interval, 12.10-17.29) and being born in an urban area (adjusted odds ratio, 1.65; 95% confidence interval, 1.41-1.92).</p><p><strong>Conclusions: </strong>This is the first study to quantitatively assess the significant association between parental socioeconomic status and medical specialty choice among physicians in Japan. Parental socioeconomic status appears to be a key factor in physicians' career choices. Future research should be more comprehensive and include multifaceted components of socioeconomic status and psychosocial factors. Key messages What is already known on this topic: Previous studies, primarily from Western countries, have suggested a potential link between socioeconomic status and physicians' specialty choice; however, empirical data from Japan are largely absent. What this study adds: This nationwide study in Japan revealed a significant association between specialty choice and parental factors, including high income and having a physician parent and urban birthplace. This highlights the fact that physicians from high-socioeconomic status backgrounds are disproportionately represented in certain specialties, such as neurosurgery and dermatology. How this study might affect research, practice or policy: Understanding the association between parental socioeconomic status and specialty choice could inform policy designs aimed to promote equitable career counseling and ensure a balanced distribution of the physician workforce across specialties.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"420-427"},"PeriodicalIF":2.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565169","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":"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":"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":"461-465"},"PeriodicalIF":2.7,"publicationDate":"2026-04-23","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":"Associations of the neutrophil-to-lymphocyte ratio with all-cause and cardiovascular mortality in patients with chest pain.","authors":"Zhiqiang Li, Shuhui Wu, Chao Wu, Yue Yin, Yuanbo Fu, Yingying Li, Zhangyong Xia","doi":"10.1093/postmj/qgaf186","DOIUrl":"10.1093/postmj/qgaf186","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Inflammation is crucial in cardiovascular disease (CVD). While the neutrophil-to-lymphocyte ratio (NLR), a simple inflammatory marker, has been linked to adverse outcomes in various CVD populations, its prognostic significance in patients with chest pain remains unclear. This study aimed to investigate the associations of the NLR with all-cause and CVD mortality in a large cohort of chest pain patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study included 3048 chest pain patients. The NLR was calculated from complete blood counts, and patients were divided into three tertiles. Cox proportional hazards regression models, adjusting for confounders, were used to estimate all-cause and CVD mortality hazard ratios (HRs). Kaplan-Meier survival curves were also created, and sensitivity analyses were performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A significant positive association was found between the NLR and the risk of both all-cause and CVD mortality. According to the fully adjusted model, a one-unit increase in log10 NLR correlated with a 4.68-fold increase in CVD mortality risk and a 2.37-fold increase in all-cause mortality risk. Compared with the lowest NLR tertile (T1), the highest (T3) was associated with significantly greater all-cause mortality [HR 1.43, 95% confidence interval (CI) 1.14-1.80] and CVD mortality (HR 2.03, 95% CI 1.28-3.22). An NLR ≥ 0.43 (log10) also significantly increased mortality risk. Survival decreased as NLR increased, with these relationships remaining robust in sensitivity analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Chest pain patients with increased NLRs are at greater risk of all-cause and CVD mortality. NLR can serve as a practical, cost-effective prognostic indicator in this group. Key messages What is already known on this topic: The neutrophil-to-lymphocyte ratio (NLR) is an established marker of systemic inflammation, and its prognostic value has been demonstrated in specific populations with diagnosed cardiovascular disease. However, its utility for risk stratification in the broader, undifferentiated population of patients initially presenting with chest pain remained unclear, warranting further investigation in a large-scale cohort. What this study adds: In this large cohort of over 3000 patients, this study provides robust evidence that an elevated NLR is a significant and independent predictor of both all-cause and cardiovascular mortality. Specifically, after full adjustment, patients in the highest NLR tertile had a 43% higher risk of all-cause mortality (HR 1.43) and a more than 2-fold greater risk of cardiovascular mortality (HR 2.03) compared to those in the lowest tertile. How this study might affect research, practice or policy: These findings support the integration of NLR-a readily available and cost-effective marker from a standard blood count-into the early risk assessment pathways for patients with chest pain. Clinicians can use the NLR to help i","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"474-482"},"PeriodicalIF":2.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565094","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 physical activity volume on all-cause mortality in patients with cardiovascular-kidney-metabolic syndrome: evidence from the China health and retirement longitudinal study.","authors":"Xiaohong Fu, Weiwei Sun, Zengfu Zhang, Jia Gao, Min Guo, Rui Wang","doi":"10.1093/postmj/qgaf205","DOIUrl":"10.1093/postmj/qgaf205","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cardiovascular-Kidney-Metabolic (CKM) syndrome is characterized by the interrelatedness of chronic kidney disease, cardiovascular disease, and metabolic disorders. Although physical activity is widely acknowledged as an effective intervention for improving the prognosis of chronic diseases, its impact on all-cause mortality among patients with CKM syndrome remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the impact of physical activity on all-cause mortality among patients with CKM syndrome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;Data from the 2011 wave of the China Health and Retirement Longitudinal Study were used as the baseline, with follow-up conducted until 2013. According to the International Physical Activity Questionnaire criteria, weekly physical activity levels were divided into three categories: light-volume physical activity (LPA), moderate-volume physical activity (MPA), and vigorous-volume physical activity (VPA). Cox proportional hazards regression models were employed to assess the impact of varying levels of physical activity on all-cause mortality. Restricted cubic spline analysis was used to explore possible nonlinear relationships.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 3343 patients with CKM syndrome were enrolled in this study. During the 2-year follow-up period, 44 deaths were recorded. After adjusting for potential confounders, VPA was associated with a 54% lower risk of all-cause mortality (adjusted hazard ratios, 0.46; 95% confidence interval: 0.24-0.89). Dose-response relationships demonstrated that all-cause mortality decreased as physical activity increased, with a 5.8% reduction in all-cause mortality risk for every 1000 MET-min/week increment in physical activity levels.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;VPA was significantly associated with reduced all-cause mortality in patients with CKM syndrome. Encouraging patients with CKM syndrome to engage in increased physical activity may improve clinical outcomes. Key messages What is already known on this topic: Cardiovascular-Kidney-Metabolic (CKM) syndrome involves a complex interplay between cardiovascular disease, metabolic disorders, and chronic kidney disease. While prior studies have established that physical activity can decrease mortality risk in the general population as well as in patients with cardiovascular and metabolic syndromes, the evidence regarding its impact on individuals with CKM syndrome remains limited. Additionally, there is a lack of detailed dose-response analyses of physical activity specifically targeting this high-risk population. What this study adds: This study provides novel evidence indicating that vigorous-volume physical activity (&gt;3000 MET-minutes/week) significantly decreases all-cause mortality by 54% among patients with CKM syndrome, whereas moderate-volume, and light-volume physical activities show no significant effects. Notably, a linear dose-response relationship was established, ","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"454-460"},"PeriodicalIF":2.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145637913","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":"Women in surgery: addressing inequality in the surgical workforce and improving training for all.","authors":"Caitlin Brennan, Vishwani Chauhan, Rahee Mapara, Philippa Rust","doi":"10.1093/postmj/qgaf120","DOIUrl":"10.1093/postmj/qgaf120","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"466-469"},"PeriodicalIF":2.7,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837435","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}