Postgraduate Medical Journal最新文献

{"title":"Dicle University Hospital's hospital disaster plan and emergency service management: Kahramanmaraş earthquake experience.","authors":"Mahmut Yaman, Şilan Göger Ülgüt, Abdullah Şen, Ali Fırat Ülgüt, Sema Belek, Hasan Mansur Durgun","doi":"10.1093/postmj/qgae171","DOIUrl":"10.1093/postmj/qgae171","url":null,"abstract":"<p><strong>Background: </strong>Hospitals, being establishments with varying functions and capacities, must have disaster plans that reduce vulnerability, ensure the continuity, and possibly increase the capacity of healthcare services; these measures are crucial for reducing mortality and facilitating the normalization of life after a disaster. In this study, the aim was to analyze the operational process of the disaster management plan at Dicle University Faculty of Medicine Hospital following the earthquake in Kahramanmaraş on 6 February 2023.</p><p><strong>Methods: </strong>This is a retrospective observational study. The study focused on determining the role of the hospital's disaster plan in crisis situations, specifically examining the emergency service task distribution and management.</p><p><strong>Results: </strong>The study included patients aged 1 to 85 years (median 34, mean 36.9 ± 19.0), with 52.5% being female. The median injury severity score was 17 (mean 20.1 ± 19.2). Hospital admission was 65.7%, with nephrology and orthopedics being the most common departments. Higher injury severity scores were significantly associated with mortality (P < .05), and dialysis and surgery rates were significantly higher in deceased patients (P < .05). No significant differences were found in age, gender, or comorbidities between groups.</p><p><strong>Conclusion: </strong>The earthquake highlighted the importance of disaster preparedness in hospitals for effective patient care, collaboration among disciplines, and resource management. Detailed data on the hospital's disaster plan and its operational process during the earthquake were provided to underscore its critical role in managing the crisis. Lessons learned will shape future disaster response protocols, stressing continual evaluation and improvement in healthcare disaster readiness.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"248-255"},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829652","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":"Timeliness of reperfusion in ST-segment elevation myocardial infarction and outcomes in Kerala, India: results of the TRUST outcomes registry.","authors":"Anoop Mathew, Muhammad Moolla, Panniyammakal Jeemon, Eapen Punnoose, S M Ashraf, Sunil Pisharody, Sunitha Viswanathan, T G Jayakumar, Abdullakutty Jabir, Jubil P Mathew, Thomas John, Vinod Thomas, Kevin Bainey","doi":"10.1093/postmj/qgae129","DOIUrl":"10.1093/postmj/qgae129","url":null,"abstract":"<p><strong>Purpose: </strong>Transatlantic guidelines endorse quality metrics for timely reperfusion in patients with ST-elevation myocardial infarction (STEMI). Compliance in low- and middle-income countries (LMICs) is largely unknown.</p><p><strong>Study design: </strong>We prospectively evaluated 2928 STEMI patients in Kerala, India, across 16 PCI-capable hospitals who received reperfusion with either primary percutaneous coronary intervention (PPCI) or fibrinolysis. Primary endpoint was a major adverse cardiovascular event (MACE) composite of death, non-fatal myocardial infarction, stroke or readmission for heart failure at 1-year.</p><p><strong>Results: </strong>Among reperfused STEMI patients, 320 (10.9%) received timely reperfusion with either PPCI or fibrinolysis, 1985 (67.8%) received delayed PPCI, and 623 (21.3%) received delayed fibrinolysis. Timely reperfusion had lower unadjusted MACE rates than delayed PCI or fibrinolysis (timely reperfusion: 11.9%, delayed PPCI: 13.6%, delayed fibrinolysis: 23.9%, P < 0.001). Mortality was lowest in the timely reperfusion group (timely reperfusion: 6.3%, delayed PPCI: 7.8%, delayed fibrinolysis 18.8%, P < 0.001). After multivariate analysis, delayed fibrinolysis had a higher MACE rate (HR 1.52 95% CI 1.04-2.21) and mortality (HR 1.97, 95% CI 1.18-3.25) compared to timely reperfusion. Total ischemic time > 3 h and delayed first medical contact-to-needle time predicted MACE at 1 year.</p><p><strong>Conclusions: </strong>Among STEMI patients in Kerala, India, only one in 10 eligible patients received timely reperfusion. Longer total ischemic times and delayed fibrinolysis were associated with 1-year MACE. Improving timely reperfusion is critical to enhancing STEMI outcomes in LMICs. What is already known on this topic Given the established link between delay to reperfusion and worse major adverse cardiac events (MACE), global efforts have concentrated on minimizing different components of the total ischemic time to improve ST-elevation myocardial infarction (STEMI) outcomes. Compliance in low- and middle-income countries (LMICs) is largely unknown. What this study adds In this cohort of STEMI patients in Kerala, India, total ischemic time and first medical contact-to-needle time correlated with long-term MACE rates, whereas other timeliness indicators did not. How this study might affect research, practice or policy Our study highlights the significant barriers to accessing STEMI care that are prevalent in LMICs despite incremental growth in the number of PCI-capable hospitals. The pre-hospital phase within total ischemic time is the most important quality improvement metric of STEMI care in LMICs, especially for patients chosen for fibrinolysis.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"232-239"},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372671","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 ChatGPT to generate multiple-choice questions in medical education may have potential adverse effects on medical educators and medical students.","authors":"Hongnan Ye","doi":"10.1093/postmj/qgae090","DOIUrl":"10.1093/postmj/qgae090","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"270-271"},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627426","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 to the editor: preventing the exodus of British doctors.","authors":"Vincenza Scannella, Pirapanchen Arulnanthy","doi":"10.1093/postmj/qgae089","DOIUrl":"10.1093/postmj/qgae089","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"268-269"},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620749","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":"Variation of brain natriuretic peptide assists with volume management and predicts prognosis of hemodialysis patients.","authors":"Nan Hu, Jinwei Wang, Yuqing Chen","doi":"10.1093/postmj/qgae128","DOIUrl":"10.1093/postmj/qgae128","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of this study was to elucidate the spectrum of brain natriuretic peptide (BNP) expression in hemodialysis patients with euvolemic status and investigate its prognostic significance.</p><p><strong>Methods: </strong>Patients on chronic hemodialysis were enrolled. The normal range of BNP was measured and analyzed in patients with euvolemic status defined by systolic blood pressure and overhydration. Hemodialysis patients were stratified into groups according to BNP expression at baseline and followed up for 57 months, with all-cause mortality and cardiovascular disease-related death being assessed as primary outcomes.</p><p><strong>Results: </strong>BNP significantly correlated with overhydration in all patients (r = 0.255, P = .004). In patients with euvolemic state, the average BNP level was 701 (±645) pg/ml, with a 95% confidence interval (CI) of 500-902 pg/ml. In patients with BNP < 902 pg/ml, systolic blood pressure significantly correlated with overhydration. Elevated BNP expression correlated with an increased risk of cardiovascular mortality (HR = 1.871, per 782 pg/ml increase, P = .008). The patients with continuously high levels of BNP showed significantly increased risk of cardiovascular disease-related death during follow-up (HR = 12.845, P = .005).</p><p><strong>Conclusion: </strong>Predialysis measured BNP levels correlate with volume status, and the common range is from 500 to 902 pg/ml in dialysis patients with euvolemic status. Patients with upregulated BNP expression showed an increased risk of cardiovascular death. Key messages What is already known on this topic  The volume management of hemodialysis patients should be judged comprehensively by clinical manifestations and objective examinations. The parameters involved in the evaluation need to be further optimized. What this study adds  In hemodialysis patients, BNP serves as an indicator of volume status. Properly hydrated hemodialysis patients typically exhibit BNP levels ranging from 500 to 902 pg/ml, while persistent BNP elevation is associated with increased mortality. How this study might affect research, practice, or policy  In clinical practice, BNP can be routinely monitored in hemodialysis patients to provide information for volume adjustment and to identify patients with high mortality risk. The potential advantages of implementing targeted BNP management warrant further investigation through intervention studies.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"240-247"},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372672","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":"Comparative effect of oral drugs in improving spasticity of different etiology: a network meta-analysis.","authors":"Iris Otero-Luis, Arturo Martínez-Rodrigo, Iván Cavero-Redondo, Nerea Moreno-Herráiz, Samuel López-López, Alicia Saz-Lara","doi":"10.1093/postmj/qgae126","DOIUrl":"10.1093/postmj/qgae126","url":null,"abstract":"<p><strong>Introduction: </strong>Spasticity, a prevalent manifestation of various neurological conditions, significantly impacts the quality of life of patients. Research on the effects of oral drugs on spasticity has produced controversial results. Thus, the aim of this network meta-analysis was to compare the efficacy of oral drugs for improving spasticity in patients with different etiologies.</p><p><strong>Methods: </strong>We searched four different databases from their inception to 30 November 2023. A network meta-analysis using a frequentist perspective was conducted to assess the effects of different oral drugs on spasticity, evaluated by the modified Ashworth scale.</p><p><strong>Results: </strong>Our findings showed that, in a frequentist network meta-analysis, eperisone, diazepam, and baclofen had significantly greater spasticity, as measured by the modified Ashworth scale, than did the placebo (MD: -0.80; 95% CIs: -1.42, -0.18; MD: -0.68; 95% CIs: -1.28, -0.09; MD: -0.58; 95% CIs: -1.11, -0.06, respectively).</p><p><strong>Conclusion: </strong>In summary, our study confirmed that eperisone, diazepam, and baclofen could be effective approaches for reducing spasticity of different etiologies and could be useful approaches for improving patient quality of life. Key messages What is already known on this topic: The impact of oral drugs, such as baclofen, gabapentin, tizanidine, and dantrolene, in the treatment of spasticity has been documented. What this study adds: This study determines which of the oral drugs aimed at treating spasticity is the most effective across different etiologies. How this study might affect research, practice, or policy: This study suggests tailored treatment strategies for spasticity based on its etiology.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"212-218"},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352496","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":"What must a medical student learn?","authors":"Gustavo L Franklin","doi":"10.1093/postmj/qgae158","DOIUrl":"10.1093/postmj/qgae158","url":null,"abstract":"<p><p>Studying medicine is not a passive activity; it demands dedication, curiosity, and continuous learning through observation, reading, and repetition. The Latin root of \"student\" reflects eagerness, and similarly, \"aluno\" derives from \"alere,\" meaning \"to nourish,\" symbolizing the nourishment of knowledge. As students, it is crucial to understand not just the scientific knowledge but also the human side of medicine. Learning goes beyond textbooks. Patients themselves are the greatest source of wisdom. Medicine is the art of care, offering comfort and understanding of what is hidden beneath the surface. Growth in this field requires seeing beyond the obvious and developing strategies to understand patients' stories. The medical student may develop strategies to know how to listen, build trust, and empathize with patients, guiding them through their fears. Carrying their burdens and interpreting their unspoken words is essential for providing both medical care and comfort.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"272-273"},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676636","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 basic statistical concepts and their interrelationships in diagnostic research.","authors":"Yitao Mao, Juxiong Xiao, Liping Zhu, Yu Zhang, Yueshuang Leng, Qingling Li, Ying Li, Chuyi Liu, Luqing Zhao","doi":"10.1093/postmj/qgae139","DOIUrl":"10.1093/postmj/qgae139","url":null,"abstract":"<p><strong>Background: </strong>Many medical postgraduate students exhibit a lack of clarity in their understanding of relevant statistical concepts during the conduct of diagnostic studies.</p><p><strong>Methods: </strong>This article, grounded in research practice, delves into the role of understanding statistical concepts in diagnostic research. It includes an exploration of sensitivity, specificity, types of statistical errors, and their interrelationships, as well as a discussion on statistical power-an often-overlooked but crucial concept in research.</p><p><strong>Results: </strong>The article elucidates these important concepts with specific examples and illustrations, and addresses an issue of inconsistency related to the receiver operating characteristic curve in research practice.</p><p><strong>Conclusion: </strong>By drawing analogies between basic concepts in diagnostic tests and concepts in statistics, this article helps to enhance researchers' abilities in designing and interpreting clinical diagnostic studies, thereby improving the quality of clinical diagnostic research.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"263-267"},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506491","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 association between telomere length and female cancers: a two-sample Mendelian randomization study.","authors":"Yangyang Shi, He Huang, Rui Zhang, Ling Yin","doi":"10.1093/postmj/qgaf028","DOIUrl":"https://doi.org/10.1093/postmj/qgaf028","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To explore the causal associations between genetically predicted telomere length and gynecologic and breast cancers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This Mendelian randomization study used data from genome-wide association studies on telomere length and breast (BC), cervical cancer, endometrial (EC), and ovarian (OC) cancers. The primary analysis was performed using the inverse variance weighted (IVW) method, with confirmation using the weighted median, weighted mode, and MR-Egger methods. Heterogeneity was detected using Cochran's Q-test, horizontal pleiotropy using MR-Egger regression, outliers using MR-PRESSO, and discordant single-nucleotide polymorphisms using the leave-one-out method.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The genetic prediction results indicated causal associations between the risk of telomere length and EC [IVW; OR = 1.29, 95% confidence interval (95%CI): 1.05-1.59, P = .02], leukocyte telomere length and EC (IVW; OR = 1.23, 95%CI: 1.01-1.51, P = .04), telomere length and OC (IVW; OR = 1.27, 95%CI: 1.01-1.60, P = .04), telomere length and BC (IVW; OR = 1.12, 95%CI: 1.01-1.23, P = .03), and leukocyte telomere length and BC (IVW; OR = 1.12, 95%CI: 1.02-1.24, P = .02). Cochran's Q-test revealed heterogeneity for telomere length and BC (P &lt; .001), leukocyte telomere length and BC (P &lt; .001), and B-cell telomere length and BC (P = .012). The MR-Egger regression results suggest that the analyses of telomere length and BC (P = .014) and leukocyte telomere length and BC (P = .044) were influenced by horizontal pleiotropy. The MR-PRESSO analysis indicated the presence of outliers in the analyses of telomere length and BC and leukocyte telomere length and breast cancer. After removing the outliers, the statistical significance remained.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This MR study suggests a causal association between telomere length and BC, EC, and OC, warranting additional study. Key message What is already known on this topic?  Previous research has indicated an association between telomere length and the risk of various cancers, including breast and gynecologic cancers. However, the causal relationship remained unclear, necessitating further exploration to establish whether telomere length could be a modifiable risk factor for these cancers. What this study adds?  This study provides robust evidence of a causal relationship between genetically predicted telomere length and an increased risk of breast cancer, endometrial cancer, and ovarian cancer, with specific odds ratios indicating a significant association. It highlights that both leukocyte and overall telomere length are important factors in cancer risk. How this study might affect research, practice, or policy?  The findings could inform future research into telomere length as a biomarker for cancer risk, promote investigations into telomere-targeting interventions, and influence guidelines on screening and preventive strategies for at-risk popula","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441770","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":"How to write a good discharge summary: a primer for junior physicians.","authors":"Isaac K S Ng, Daniel Tung, Trisha Seet, Ka Shing Yow, Karis L E Chan, Desmond B Teo, Chun En Chua","doi":"10.1093/postmj/qgaf020","DOIUrl":"https://doi.org/10.1093/postmj/qgaf020","url":null,"abstract":"<p><p>A discharge summary is an important clinical document that summarizes a patient's clinical information and relevant events that occurred during hospitalization. It serves as a detailed handover of the patient's most recent and updated medical case records to general practitioners, who continue longitudinal follow-up with patients in the community and future medical care providers. A copy of the redacted/abbreviated form of the discharge summary is also usually given to patients and their caregivers so that important information, such as diagnoses, medication changes, return advice, and follow-up plans, is clearly documented. However, in reality, as discharge summaries are often written by junior physicians who may be inexperienced or have lacked medical training in this area, clinical audits often reveal poorly written discharge summaries that are unclear, inaccurate, or lack important details. Therefore, in this article, we sought to develop a simple \"DISCHARGED\" framework that outlines the important components of the discharge summary that we derived from a systematic search of relevant literature and further discuss several pedagogical strategies for training and assessing discharge summary writing.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433639","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}