Postgraduate Medical Journal最新文献

{"title":"Impacts of viral respiratory infections on segments of fatal out-of-hospital cardiac arrests.","authors":"Jo-Jo Hai, Di Liu, Kathy Leung, Eric Lau, Sai-Chak Lai, Chin-Pang Chan, Chiu-Sun Yue, Lok-Yan Tam, Yuet-Wong Cheng, Wai-Ling Poon, Ngai-Yin Chan, Chu-Pak Lau, Joseph-Tszkei Wu, Hung-Fat Tse","doi":"10.1093/postmj/qgaf057","DOIUrl":"https://doi.org/10.1093/postmj/qgaf057","url":null,"abstract":"<p><strong>Purpose of the study: </strong>Viral respiratory infections have been linked to fatal out-of-hospital cardiac arrest (OHCA), yet the specific causes remain unclear, and the impact of individual viral infections is often confounded by local meteorological and environmental factors. This study aimed to investigate the independent effects of prevalent viral respiratory infections on the risk and causes of fatal OHCA in different age groups.</p><p><strong>Study design: </strong>We conducted negative binomial regression analyses to investigate the association between influenza, respiratory syncytial virus (RSV), and coronavirus disease 2019 (COVID-19) infections, along with temperature, extreme weather alerts, and the air quality health index, with age- and cause-specific fatal out-of-hospital cardiac arrest (OHCA) from the 2nd week of 2014 to the 17th week of 2020. The analysis covered three etiological categories (cardiovascular, respiratory, and non-cardiovascular non-respiratory) across three age groups (≤ 64 years, 65-84 years, ≥ 85 years) in Hong Kong.</p><p><strong>Results: </strong>During this period, there were 41 548 fatal OHCA cases in Hong Kong. Influenza was consistently associated with fatal OHCA across all etiologies and age groups, significantly impacting cardiovascular and non-cardiovascular non-respiratory causes more than respiratory causes (110.9, 66.8, and 17.4 per 1 million persons, respectively). Reduced healthcare-seeking behaviors during the COVID-19 pandemic was linked to increased fatal OHCA across all ages and etiologies, except for respiratory causes. RSV showed no association with fatal OHCA in our population.</p><p><strong>Conclusions: </strong>Influenza is a significant independent risk factor for fatal OHCA across variouscauses and age groups, particularly affecting cardiovascular and non-cardiovascular non-respiratory outcomes.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013149","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":"Recruiting and retaining doctors-a wicked problem needing complex solutions.","authors":"Jo-Anne Johnson, Sanjiv Ahluwalia","doi":"10.1093/postmj/qgaf058","DOIUrl":"https://doi.org/10.1093/postmj/qgaf058","url":null,"abstract":"<p><p>Recruiting and retaining healthcare professionals, particularly doctors, remains a critical challenge for the National Health Service (NHS), exacerbated by an ageing population, geographical disparities, and persistent workforce shortages. Traditional linear solutions fail to address the complexity of these interconnected issues, necessitating a multidimensional approach rooted in complexity science. This article frames the recruitment and retention of doctors as a wicked problem, characterized by interdependencies, dynamic interactions, and context-specific nuances. Using the Anglia Ruskin University School of Medicine in Essex as a case study, we explore a locally contextualized strategy within the national 'train, retain, reform' framework. Initiatives include the innovative Medical Degree Doctor Apprenticeship, targeted outreach programmes, and collaboration with NHS England to prioritize local foundation training posts for graduates. These strategies are designed to address workforce disparities in socioeconomically disadvantaged regions whilst fostering local retention. Our findings highlight the need for adaptive, non-linear solutions that integrate national policies with local innovations to address workforce inequalities effectively. We argue that sustainable improvements require distributed control, interdependent systemic interventions, and stakeholder collaboration. This approach not only addresses local recruitment challenges but also contributes to reducing health inequalities, emphasizing the importance of local agency within a national framework.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041597","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":"Creativity in medicine during times of uncertainty.","authors":"Caitlin Linscheid, Gillian Luevano, Lindsay Nordwald","doi":"10.1093/postmj/qgaf060","DOIUrl":"https://doi.org/10.1093/postmj/qgaf060","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041780","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":"Resilience or endurance? When training culture rewards survival over learning.","authors":"Waseem Jerjes","doi":"10.1093/postmj/qgaf061","DOIUrl":"https://doi.org/10.1093/postmj/qgaf061","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053325","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":"Using freedom of information requests to access novel data sources in health professions education research.","authors":"Sophie E Yale, Megan E L Brown, Matthew H V Byrne","doi":"10.1093/postmj/qgae166","DOIUrl":"10.1093/postmj/qgae166","url":null,"abstract":"<p><p>Educators and researchers are reliant upon access to data to drive teaching methods, curricular improvements, and progress in medical education research. However, data are not always accessible, due to resource constraints, institutional policies, and privacy concerns. Researchers have attempted to access novel data sources through surveys, semistructured interviews, and databases; however, these methodologies are limited. To improve access to data, Freedom of Information (FOI) Acts grant researchers the ability to formally request data that any public institute holds. Researchers have been reluctant to use this tool due to negative perceptions, despite its unique benefits. To increase awareness of this underutilized methodology, we summarize the process of FOI Act requests, its strengths and weaknesses, and the ways in which health professions education can leverage FOI requests within research. We provide examples of the use of FOI requests as a research method within adjacent fields and nascent use within the field of health professions research. In doing so, we hope to highlight how FOI requests can be a useful tool in health professions education researchers and its potential to increase access to unique data sources.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"481-486"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732103","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 key to addressing the issue of academic misconduct in the medical field is to reform the evaluation system.","authors":"Hongnan Ye","doi":"10.1093/postmj/qgae134","DOIUrl":"10.1093/postmj/qgae134","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"492-493"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372670","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 role of NGOs and humanitarian organizations in enhancing surgical capacity in Africa: lessons learned and future directions-a narrative review.","authors":"Hajar Nasir Tukur, Olivier Uwishema, Fatima Soufan, Ruth Girum Tamir, Jack Wellington","doi":"10.1093/postmj/qgae137","DOIUrl":"10.1093/postmj/qgae137","url":null,"abstract":"<p><strong>Introduction: </strong>Significant inequities exist in surgical care accessibility across marginalized African communities. Non-governmental organizations (NGOs) and humanitarian groups are vital in supporting Africa's surgical infrastructure. This narrative review explores the current status of surgical care in Africa, highlighting NGO initiatives, past challenges, and future opportunities.</p><p><strong>Methods: </strong>A narrative review was conducted using PubMed/Medline, ScienceDirect, and other relevant organizational websites.</p><p><strong>Results: </strong>Over 90% of patients in Africa lack access to proper surgical care due to funding shortages, inadequate resources, and a lack of skilled personnel. NGOs have addressed these gaps through successful initiatives, including fundraising and training, although past failures emphasize the need for clearer objectives and sustainable strategies.</p><p><strong>Discussion: </strong>Future efforts should prioritize addressing cultural sensitivities, setting realistic goals, and leveraging telemedicine. NGOs and humanitarian organizations will remain critical to improving surgical care for underserved populations in Africa.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"389-395"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564729","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":"We are all flawed. Fewer are less flawed than others.","authors":"Philip D Welsby","doi":"10.1093/postmj/qgaf002","DOIUrl":"10.1093/postmj/qgaf002","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"494-495"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010310","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":"When trimethoprim-sulfamethoxazole goes rogue.","authors":"Tina H Dao, Christopher D Jackson","doi":"10.1093/postmj/qgae192","DOIUrl":"10.1093/postmj/qgae192","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"487-488"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953786","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":"Evaluating safety and efficacy of plastic versus metal stenting in malignant hilar biliary obstruction: a systematic review and meta-analysis of randomized controlled trials.","authors":"Xinjie Luo, Zhicheng Huang, Kamran Ali, Khizar Hayat","doi":"10.1093/postmj/qgae165","DOIUrl":"10.1093/postmj/qgae165","url":null,"abstract":"<p><strong>Background: </strong>Stenting malignant hilar biliary obstruction (MHBO) is challenging due to its complex structure, and it is less effective than blockages in the distal bile duct area. Plastic stents (PSs) and metal stents (MSs) are commonly used for stenting MHBO. This study aims to compare the outcomes of PSs and MSs in MHBO patients.</p><p><strong>Methods: </strong>We conducted a search of medical databases up to March 2024. Using a fixed-effect model, we analyzed the risk ratios (RRs) of the outcomes between the PS and MS groups. We calculated the RR for clinical and technical success, reinterventions, and adverse events, as well as the hazard ratio (HR) for survival and stent patency.</p><p><strong>Results: </strong>This analysis includes five randomized controlled trials (RCTs) that met the inclusion criteria, comprising a total of 322 patients (156 in the PS group and 166 in the MS group). Significant differences (P < .05) in favor of the MS group were found in the reinterventions (RR 1.80, 95% CI 1.07-3.04), and stent patency (HR 0.54, 95% CI 0.32-0.90). There were no significant differences (P > 0.05) between the PS and MS groups regarding technical success (RR 1.01, 95% CI 0.94-1.09), clinical success (RR 0.86, 95% CI 0.69-1.07), overall survival (HR 0.71, 95% CI 0.47-1.05), stent migration (RR 0.69, 95% CI 0.08-6.02), stent occlusion (RR1.32, 95% CI 0.97-1.81), and adverse events (RR 0.80, 95% CI 0.53-1.20).</p><p><strong>Conclusion: </strong>Both PS and MS are effective for managing MHBO, while MS offers greater efficacy in increased stent patency and lower reintervention rates. Key message What is already known on this topic Metal stents (MSs) and plastic stents (PSs) are used for palliative treatment of malignant hilar biliary obstruction (MHBO). MSs significantly reduced the need for reinterventions compared to PSs in patients with MHBO. What this study adds There were no significant differences between MSs and PSs in terms of technical success, clinical success, overall survival, stent migration, stent occlusion, or adverse events. How this study might affect research, practice, or policy The study's findings may prompt researchers to design more targeted studies to further investigate these specific outcomes in MHBO patients. The results encourage endoscopists to consider patient-specific factors, such as life expectancy and preference for minimizing recurrent procedures, when choosing between MSs and PSs for MHBO.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"447-457"},"PeriodicalIF":3.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687680","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}