Postgraduate Medical Journal最新文献

{"title":"Medical Students' Insight into Foundation Training (MEDSIFT): a National Cross-Sectional Online Survey reveals close to 50% are considering a career outside the NHS.","authors":"Benjamin Cook, Edelyne Tandanu, Umar Rehman, Elena Whiteman, Temidayo Osunronbi, Ghazel Mukhtar, Garikai Kungwengwe, Mohammad Sohaib Sarwar, Sammy Arab, Karanjot Chhatwal, Ricky Ellis, Karl Romain, Akib Khan, Ahmed Ezzat, Justin Wormald, George Adigbli, Manaf Khatib, Simon Filson, Naveen Cavale, Peter A Brennan","doi":"10.1093/postmj/qgaf071","DOIUrl":"https://doi.org/10.1093/postmj/qgaf071","url":null,"abstract":"<p><strong>Introduction: </strong>The new preference-informed allocation (PIA) system introduced for the 2024 UK cohort Foundation Programme (UKFPO) marks a shift away from the traditional meritocratic 'ranking' used in previous years. Instead of appointment to Foundation Programme places, PIA is a computer-generated allocation and deanery preferencing system. This change has raised numerous concerns among both students and clinicians.</p><p><strong>Aims: </strong>To investigate the opinions of medical students on the new UKFPO PIA system.</p><p><strong>Methodology: </strong>An online questionnaire was distributed to medical students graduating in 2024, 2025, or 2026 across the UK.</p><p><strong>Results: </strong>In total, 2297 responses were collected and 2288 were included in the study. Overall, 51.6% (n = 1183) of respondents felt the PIA system was unfair, 76.3% (n = 1746) felt they had lost control of their application, and 46.3% (n = 1049) had noticed a negative effect on their physical or mental health. Notably, 48.2% (n = 1094) of students who responded are now considering a career outside the National Health Service (NHS).</p><p><strong>Conclusions: </strong>Overall, the PIA system falls short of students' expectations and has led to record numbers of students considering careers outside the NHS. Further changes to this system are needed and should aim to address fairness and equity while rewarding students for their hard work. According to these data, the PIA system risks further deteriorating workforce morale and attrition rates.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094653","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":"Association between diabetes mellitus and fetal and maternal outcomes during and after pregnancy-a nationwide study.","authors":"Binita Neupane, Sunita Karki, Monica Sharma, Umer Farooq","doi":"10.1093/postmj/qgae191","DOIUrl":"10.1093/postmj/qgae191","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes Mellitus (DM) affects both the mother and fetus during and after pregnancy. Multiple studies have shown the prognostic impact of DM on maternal and fetal outcomes, but studies at the national level are limited. Therefore, we aimed to conduct this nationwide study.</p><p><strong>Materials and methods: </strong>This retrospective study used a Nationwide Inpatient Sample 2020 (NIS) using International Classification of Diseases (ICD-10) codes for adult pregnant patients. STATA version MP14.2 was used mainly for analysis. We used Fischer's exact test to compare proportions, the student's t-test to compare continuous variables, and multivariate regression analysis to calculate the adjusted odds ratio.</p><p><strong>Results: </strong>The total number of pregnant patients included in the study was 3 436 671; 36 350 (1.05%) had DM. Patients with DM had longer hospital lengths of stay than non-diabetic patients (3.93 days vs. 2.5 days, P < .01). Other significant outcomes were higher cost of hospital stay ($37 079 vs. $23 371, P < .01), preeclampsia (7.17% vs. 2.02%, P < .01), intrauterine fetal death (0.63% vs. 0.13%, P < .01), stillbirth (2.89% vs. 0.75%, P < .01), gestational hypertension (7.07% vs. 3.07%, P < .01) and preterm labor (5.8% vs. 1.94%, P < .01). There were no differences in the two groups regarding pre-existing hypertension, abortion, large for gestational age, eclampsia, placenta previa, abruptio placenta, postpartum anemia, prolonged labor, intrapartum, and postpartum hemorrhage. We conducted a trend analysis from 2016 to 2020 for mortality, length of stay, total charges, and significant maternal and fetal outcomes.</p><p><strong>Conclusion: </strong>DM is associated with greater maternal and fetal adverse outcomes, resource utilization, and length of stay.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"563-569"},"PeriodicalIF":3.6,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953781","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":"Venous thromboembolism in professional drivers of automatic transmission vehicles: an underestimated occupational risk?","authors":"Dimitrios Ragias, Maria Tzikopoulou, Matthew E Falagas","doi":"10.1093/postmj/qgaf074","DOIUrl":"https://doi.org/10.1093/postmj/qgaf074","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094658","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 screening and management of skin diseases in remote African regions: a narrative review.","authors":"Nadine Mugisha, Laura Ghanem, Omar A I Komi, Agnes Zanotto Manoel, Sanobar Shariff, Magda Wojtara, Olivier Uwishema","doi":"10.1093/postmj/qgae133","DOIUrl":"10.1093/postmj/qgae133","url":null,"abstract":"<p><strong>Introduction: </strong>Skin diseases in remote African regions are often exacerbated due to a lack of resources and expertise with little current research addressing the challenges that patients and healthcare systems experience. Although skin diseases in remote African regions are prevalent and pose a substantial health burden, they remain neglected and understudied. This review aims to explore current challenges in the diagnosis and management of skin diseases in African regions and focus on the need for enhanced understanding and improved healthcare strategies.</p><p><strong>Methods: </strong>We reviewed papers that were retrieved from PubMed, Google Scholar, and other relevant academic search sites to analyze the prevalence, screening techniques, as well as management strategies and obstacles associated with dermatological diseases in remote African regions.</p><p><strong>Results: </strong>Current literature suggests there is indeed a high prevalence of skin diseases where other infections are predominant. Further, different factors, such as socioeconomic status and environmental conditions, make it challenging for optimal screening and treatment of skin diseases in remote African regions. Common screening methods for skin diseases involve clinical examination and laboratory tests, while management includes pharmacotherapy, surgery, and counseling approaches. Overall, access to medications and adequate healthcare services remains limited.</p><p><strong>Conclusion: </strong>Early diagnosis and management of skin diseases in remote African regions have significant challenges, including a lack of funding for dermatology, education, and research. Future promising strategies such as teledermatology, point-of-care diagnostic technologies, and task shifting show promise in improving access to care. However, there is a need for sustained efforts to address the underlying socioeconomic factors and improve healthcare delivery in remote African regions.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"504-510"},"PeriodicalIF":3.6,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626418","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":"Causal relationship between gut microbiota and lung squamous cell carcinoma: a bidirectional two-sample Mendelian randomization study.","authors":"Weijian Song, Jianwei Shi, Minjun Du, Mei Liang, Boxuan Zhou, Linchuan Liang, Yushun Gao","doi":"10.1093/postmj/qgae184","DOIUrl":"10.1093/postmj/qgae184","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aims to explore the potential causal relationship between gut microbiota and lung squamous cell carcinoma (LUSC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A bidirectional two-sample Mendelian randomization analysis was conducted using genome-wide association study (GWAS) data from gut microbiota and LUSC. Gut microbiota served as the exposure factor, with instrumental variables selected from a GWAS involving 18 340 participants. LUSC data were drawn from a European cohort including 29 266 LUSC cases and 56 450 controls. Inverse-variance weighted (IVW) method was used as the primary method, with the Benjamini-Hochberg method applied to adjust for multiple comparisons. An independent dataset (ieu-a-967, containing 3275 LUSC cases and 15 038 controls) was used for replication analysis to ensure robustness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;IVW analysis found that Butyricicoccus (OR = 0.79, 95% CI: 0.63-0.99, P = .042) and Coprobacter (OR = 0.85, 95% CI: 0.74-0.97, P = .018) were significantly protective against LUSC. In contrast, Victivallis (OR = 1.11, 95% CI: 1.00-1.23, P = .045) and Ruminococcus (OR = 1.28, 95% CI: 1.03-1.60, P = .028) increased LUSC risk. Replication analysis in the independent dataset confirmed significant associations for Ruminococcus and Coprobacter. No reverse causality or pleiotropy was detected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study provides evidence of a causal relationship between specific gut microbiota and LUSC risk, highlighting new microbial targets for potential prevention and treatment strategies in lung cancer. Key messages What is already known on this topic?  Previous studies have suggested potential links between gut microbiota composition and the development of various cancers, including lung cancer. However, the exact causal relationship between specific gut microbiota and lung squamous cell carcinoma (LUSC) has remained unclear. Traditional observational studies have struggled to determine the direction of causality due to confounding factors, making further investigation necessary through more robust methods such as Mendelian randomization (MR). What this study adds?  This bidirectional MR study provides novel genetic evidence indicating that certain gut microbiotas are causally associated with LUSC risk. Specifically, Butyricicoccus appears to reduce the risk of LUSC, while Victivallis increases the risk. These findings highlight the role of the gut-lung axis in LUSC and open up new avenues for exploring gut microbiota as potential modulators of lung cancer risk. How this study might affect research, practice, or policy?  The implications of this study may significantly influence future research into cancer prevention strategies by targeting gut microbiota. Additionally, it could inform clinical practices aimed at modulating gut microbiota to lower the risk of LUSC, potentially influencing dietary or probiotic interventions to reduce cancer susceptibility. Furthermore, ","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"526-534"},"PeriodicalIF":3.6,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847258","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":"Navigating UK internal medicine training applications: 10 essential tips.","authors":"Sara Khalid, Thomas Heather, Victoria Palin, Oliver I Brown, Michael Drozd","doi":"10.1093/postmj/qgae190","DOIUrl":"10.1093/postmj/qgae190","url":null,"abstract":"<p><p>Internal medicine training applications in the UK have become increasingly competitive. This article provides ten tips for optimizing internal medicine training applications covering portfolio development, teaching experience, project selection, and interview preparation. We outline strategies for maximizing application scores through efficient resource allocation, effective project selection, and structured interview preparation. These tips are designed to help candidates navigate the competitive selection process while developing skills valuable for their future medical careers.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"570-573"},"PeriodicalIF":3.6,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896869","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 advancements of organoids push the boundaries of glioblastoma research.","authors":"Gang Cui, Song Xue, Xiaoshan Wang, Wei Song","doi":"10.1093/postmj/qgae149","DOIUrl":"10.1093/postmj/qgae149","url":null,"abstract":"<p><p>Glioblastoma (GBM) is a malignant tumor of the nervous system, which is difficult to treat due to its strong invasiveness, rapid progression, and poor prognosis. To understand the complex biological behavior of glioblasts and the interaction between tumors and hosts, a new in vitro platform based on human cells is required, which can summarize the complex cellular structure and cell diversity of the human brain, as well as the biological behavior of GBM. Organoids are 3D self-organizing tissues, partially similar to source tissues, which can simulate the structure and physiological functions of organs or tissues in vitro. In this review, we underline the widespread application of different types of GBOs models in GBM pathogenesis, including cells derived, tumor tissues derived, and other co-culture models, as well as their application and shortcomings in the treatment of GBM.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"497-503"},"PeriodicalIF":3.6,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583992","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":"Beyond medicine: how Dr. Smarajit Jana transformed public health for India's most vulnerable.","authors":"Atanu Chandra, Rupak Chatterjee, Sugata Dasgupta, Shatavisa Mukherjee","doi":"10.1093/postmj/qgae177","DOIUrl":"10.1093/postmj/qgae177","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"588-590"},"PeriodicalIF":3.6,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807756","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":"Serum uric acid and prediabetes progression and regression: a retrospective cohort study.","authors":"Yijia He, Miaomin Ye, Yin Xia, Ziyi Zhong, Qian Li","doi":"10.1093/postmj/qgae183","DOIUrl":"10.1093/postmj/qgae183","url":null,"abstract":"<p><strong>Background: </strong>The impact of serum uric acid (SUA) levels on metabolic disorders, particularly concerning the development or reversal of prediabetes, is not well understood. While high uric acid is recognized for its association with metabolic disturbances, its specific influence on prediabetes progression and regression has been insufficiently explored. This study investigates how SUA levels correlate with the natural course of prediabetes, shedding light on its management.</p><p><strong>Methods: </strong>A cohort of 3659 individuals diagnosed with prediabetes at Nanjing First Hospital was tracked over three years. Follow-up assessments included fasting plasma glucose and hemoglobin A1c (HbA1c) measurements. Serum uric acid was measured initially and categorized into quartiles (Q1 through Q4). To assess the impact of uric acid levels on shifting prediabetes status, methods such as restricted cubic spline, segmented regression, stratified analysis, and receiver operating characteristic curves were utilized in a multinomial logistic regression framework.</p><p><strong>Results: </strong>At baseline, all 3659 participants had prediabetes; by the three-year mark, 2626 remained in this category, 523 reverted to normal fasting glucose (NFG), and 510 advanced to diabetes. After adjustment for potential confounders, a positive correlation was found between higher SUA levels and progression to diabetes (Odds ratio [OR] 1.182, 95% confidence interval [CI]: 1.095-1.276), with no significant link to reversion to NFG (OR: 0.987, 95% CI: 0.909-1.073).</p><p><strong>Conclusion: </strong>Elevated SUA levels are linked with a higher likelihood of progressing from prediabetes to diabetes but do not significantly forecast a regression to NFG.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"553-562"},"PeriodicalIF":3.6,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896872","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":"Oseltamivir-induced hemorrhagic colitis.","authors":"Koji Tajima, Takeru Azuma, Ayako Kita, Yumi Shimoyama, Haruyo Tada, Yasushi Nishimura, Chidu Mukobayashi, Hisanobu Deguchi, Ryuta Yanagimoto, Kimihiko Yanaoka","doi":"10.1093/postmj/qgaf006","DOIUrl":"10.1093/postmj/qgaf006","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"583-584"},"PeriodicalIF":3.6,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143010293","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}