Postgraduate Medical Journal最新文献

{"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}

{"title":"Kounis syndrome: not as rare as presumed? Two cases of type II within a single month.","authors":"Yasemin Akgul Balaban, Ozan Koksal","doi":"10.1093/postmj/qgag138","DOIUrl":"https://doi.org/10.1093/postmj/qgag138","url":null,"abstract":"","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":"149064148","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":"Rage against the machine? Artificial intelligence in medicine: recognising risks and reasonable responses-a personal view.","authors":"Michael Trimble","doi":"10.1093/postmj/qgag125","DOIUrl":"https://doi.org/10.1093/postmj/qgag125","url":null,"abstract":"<p><p>This review aims to consider the practical, ethical, and social implications of the widespread application of artificial intelligence systems in healthcare and wider society and to highlight some of the risks inherent with the technology. A cautious and informed approach is advocated, and users are encouraged to avoid the dangers of cognitive offloading and skills erosion.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040346","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":"Vulnerability assessment at Emergency Department triage: between feasibility, reproducibility, and prognostic value.","authors":"Tanguy Espejo, Christian H Nickel, Fabienne Hilpert","doi":"10.1093/postmj/qgag136","DOIUrl":"https://doi.org/10.1093/postmj/qgag136","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040353","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 between controlling nutritional status (CONUT) scores, osteopenia, and osteoporosis during menopausal transition: a NHANES study.","authors":"Po-Yao Chuang, Tien-Yu Yang, Kuo-Chin Huang, Yao-Hung Tsai, Ling-Yun Cheng, Ying-Chen Lu","doi":"10.1093/postmj/qgag056","DOIUrl":"10.1093/postmj/qgag056","url":null,"abstract":"<p><strong>Background: </strong>Osteopenia and osteoporosis commonly affect women during the menopausal transition. The controlling nutritional status (CONUT) score, a marker of nutritional health, has been linked to various clinical outcomes, but its relationship with bone health in menopause remains unclear. This study examined associations between CONUT scores and osteopenia and osteoporosis in menopausal women.</p><p><strong>Methods: </strong>Data from 1188 women aged 45-55 years in the 2005-2010 National Health and Nutrition Examination Survey (NHANES) were analyzed, representing 19.5 million U.S. women. Bone mineral density (BMD) at the femur sites was assessed using dual-energy X-ray absorptiometry (DEXA), and T-scores defined osteopenia and osteoporosis. CONUT scores were derived from serum albumin, total cholesterol, and lymphocyte count. Logistic regression evaluated associations between CONUT scores and bone health outcomes, adjusting for confounders. Analyses were stratified by body mass index (BMI > 25 vs. ≤ 25 kg/m2).</p><p><strong>Results: </strong>Women with higher CONUT scores (≥2) had significantly greater odds of osteopenia (adjusted odds ratio [aOR] = 1.82; 95% CI: 1.06-3.13; P = .031). No significant association was observed between CONUT scores and osteoporosis (P = .091). In BMI-stratified analysis, the association between high CONUT scores and osteopenia was stronger among women with BMI > 25 kg/m2 (aOR = 2.66; 95% CI: 1.41-5.01; P = .003).</p><p><strong>Conclusions: </strong>Poor nutritional status, as reflected by higher CONUT scores, is associated with higher likelihood of osteopenia in women undergoing menopausal transition, especially those with higher BMI. Key messages What is already known on this topic: Osteopenia and osteoporosis occur commonly in women undergoing menopausal transition. Use of controlling nutritional status (CONUT) scores to assess nutritional health, has been associated with various health outcomes, but the CONUT role in bone health during menopause has not been explored. What this study adds: This study examined the association between nutritional status, as assessed by the CONUT score, and bone health in women during the menopausal transition. The results demonstrated that poorer nutritional status was significantly associated with a higher likelihood of osteopenia, particularly among individuals with higher BMI. How this study might affect research, practice, or policy: These findings suggest that attention to nutritional status may contribute to strategies aimed at preventing early bone deterioration.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"909-915"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148055832","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":"Think like a surgeon: the T-DODAR tool for problem solving in oral examinations and clinical practice.","authors":"Petrut Gogalniceanu, Stefano Artusa, Cameron Ruckley","doi":"10.1093/postmj/qgaf146","DOIUrl":"10.1093/postmj/qgaf146","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"970-974"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103007","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":"Increased food prices and changes in food consumption behavior: an early precursor to malnutrition, and widespread food insecurity among the Egyptian population.","authors":"Nadira Mansour Hassan, Shimaa Mohamed Koabar","doi":"10.1093/postmj/qgag078","DOIUrl":"10.1093/postmj/qgag078","url":null,"abstract":"<p><strong>Background: </strong>Recent increases in food prices in Egypt have raised concerns about their impact on dietary patterns and household food security (FS), particularly among economically vulnerable groups, forcing families to reduce dietary diversity and nutrient intake. This may indirectly contribute to an increased risk of malnutrition and chronic diseases.</p><p><strong>Aim: </strong>To identify changes in food consumption behavior (food choices and dietary patterns) among Egyptian households following food inflation and determine the levels and predictors of food insecurity (FI).</p><p><strong>Methods: </strong>An online cross-sectional survey of 723 Egyptian households from June to December 2024. Data was collected using a pretested structured questionnaire targeting household heads. The tool assessed sociodemographic characteristics, food consumption changes, and FS status.</p><p><strong>Results: </strong>Most participants reported increased food expenditure (58.2%) with dietary shift toward cheaper carbohydrate-rich staple foods (55.2%). Reduced consumption of animal protein and dairy products was also observed. Overall, 64.6% of households experienced FI: 15.8% mild, 27.5% moderate, and 20.3% severe levels. Significant predictors of FI included female respondents (OR = 2.425, P < .001), maternal unemployment [odds ratio (OR) = 1.597, P = .018], low household income (OR = 1.774, P = .001), maternal financial responsibility (OR = 3.432, P < .001), the presence of a family member with chronic disease (OR = 1.748, P = .002), and a current smoking father (OR = 1.711, P = .004).</p><p><strong>Conclusion: </strong>Increased food prices lead to changes in food consumption patterns with shifts toward less nutritionally valuable foods and deprive most households of FS. Therefore, there is an urgent need for national nutrition health education programs to help households optimize the use of limited household budgets to achieve a balanced diet.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"925-934"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278516","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":"Building global learning networks: a practical guide for medical educators.","authors":"Jun Jie Lim, Amani Mansour Mohmad Alnimr, Iveren Winifred Nyinoh, Elsa Sanatombi Devi, Joanna Matthan, Paul Stephen Hubbard, Thomas Quinn, Dara Stanescu, Vrinda Nayak","doi":"10.1093/postmj/qgaf213","DOIUrl":"10.1093/postmj/qgaf213","url":null,"abstract":"<p><p>As healthcare becomes increasingly globalized, postgraduate medical education must evolve to prepare clinicians for an increasingly interconnected, diverse, and intercultural healthcare landscape. This article offers nine practical tips for designing and sustaining global learning networks-virtual, collaborative frameworks that connect trainees, educators, and institutions across borders. The recommendations are organized under four themes: (1) designing equitable curricula, (2) facilitating global collaboration, (3) developing culturally competent educators and learners, and (4) sustaining and evaluating learning networks. These recommendations are grounded in the theoretical frameworks of systems thinking and communities of practice. We emphasize co-created curricula, digital platforms for international engagement, culturally responsive pedagogy, inclusive assessment strategies, and decentralized leadership models. Each tip is grounded in peer-reviewed literature, international case studies, and lessons from our collaborative experiences. We address barriers such as time zones, resource inequities, and quality assurance. By embedding global perspectives into postgraduate programmes, global learning networks strengthen intercultural competence, enhance professional identity formation, expand access to medical education in low-resource settings, and foster mutual learning across diverse health systems. This guide supports postgraduate medical educators in cultivating culturally competent clinicians and advancing a more equitable, collaborative, and resilient global healthcare workforce.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"953-959"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918053","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}