Postgraduate Medical Journal最新文献

{"title":"Impact of social deprivation on quality indicators for the acute medical take.","authors":"Christian P Subbe, Matthew S Watson, Noura Al Moubayed, Mark Holland, Catherine Atkin","doi":"10.1093/postmj/qgag094","DOIUrl":"10.1093/postmj/qgag094","url":null,"abstract":"<p><strong>Purpose: </strong>Social deprivation is a predictor of delivered care and clinical outcomes in many areas of medicine. It is not known whether social deprivation affects quality of care received by patients admitted as medical emergencies to hospitals in the United Kingdom (UK).</p><p><strong>Methods: </strong>The Society for Acute Medicine's Benchmarking Audit (SAMBA) measures performance of Acute Medical Units in the UK during a 24-hour period. SAMBA23 took place on Thursday, 22 June 2023. Social deprivation was measured by matching the first half of patient postcodes with publicly available data about the Index of Multiple Deprivation for that geographic area.</p><p><strong>Results: </strong>SAMBA23 included 161 UK hospitals and 9612 patients. Data on social deprivation were available for 7855 patients. Patients from areas with the highest social deprivation were more frail and more likely to be admitted via the emergency department, as opposed to being referred by a General Practitioner. Patients from areas with the highest and lowest levels of deprivation received a similar standard of care as measured by three quality indicators; there were no statistically significant differences in the proportion of patients who received timely measurements of the National Early Warning Score, were seen within 4 hours by a clinician, and were reviewed in a timely manner by a consultant.</p><p><strong>Conclusions: </strong>In this single 24-hour snapshot we were unable to identify differences in the delivery of the Acute Medical take in relation to the residential area index of multiple deprivation. Further research is required using patient level data. Key messages What is already known on this topic: Social deprivation is a co-factor for poor outcomes in most areas of medicine. It is unclear whether social deprivation influences the process of care and outcomes of patients admitted as medical emergencies. What this study adds: We found no evidence for an effect of the residential area index of multiple social deprivation on quality indicators for medical emergencies in data a single 24-hour snapshot as part of a national audit in Acute Medicine. How this study might affect research, practice or policy: This is the first published data from acute medical care in the UK looking at social deprivation, but more data is needed at individual patient level.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"978-983"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621127","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":"If mesh is so good for hernia repair, then why is there a surge in litigation?","authors":"Kaushik Bhattacharya, Dhananjaya Sharma","doi":"10.1093/postmj/qgaf228","DOIUrl":"10.1093/postmj/qgaf228","url":null,"abstract":"<p><p>Despite several studies affirming the safety of mesh hernia repairs, over 26 000 mesh-related lawsuits are pending in the USA as of July 2025. These lawsuits stem from alleged design flaws, lack of proper warnings, and severe postoperative complications. While mesh has revolutionized hernia surgery, the surge in litigation and multi-million-dollar out-of-court settlements by mesh manufacturers raise serious ethical, clinical, and legal concerns. This article examines the root causes behind this paradox, outlines strategies for surgeons and manufacturers to mitigate harm and restore trust, and explores the role of emerging mesh-free techniques and artificial intelligence-driven risk prediction tools in shaping the future of hernia repair.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"962-965"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834415","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 in response to \"How to write a good discharge summary: a primer for junior physicians\".","authors":"Alice Scholfield","doi":"10.1093/postmj/qgaf168","DOIUrl":"10.1093/postmj/qgaf168","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"968-969"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192395","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":"Tracheostomy-associated bleeding: prevention, recognition, and management of a potentially fatal complication.","authors":"Cen-Hung Lin, Hang-Tsung Liu, Ching-Hua Hsieh","doi":"10.1093/postmj/qgaf196","DOIUrl":"10.1093/postmj/qgaf196","url":null,"abstract":"<p><strong>Purpose: </strong>Tracheostomy-associated bleeding is an uncommon but potentially fatal complication. This review outlines its incidence, risk factors, diagnostic approach, management, and prevention, emphasizing early recognition of tracheo-innominate artery fistula (TIF).</p><p><strong>Methods: </strong>Relevant literature from 2000-2025 was reviewed using PubMed and surgical databases, focusing on studies describing tracheostomy-related hemorrhage and TIF.</p><p><strong>Results: </strong>Post-tracheostomy bleeding occurs in 0.6-5% of patients, most often from minor stomal sources. TIF, though rare (<1%), remains the deadliest complication, with mortality over 60%. Major risk factors include low tracheostomy placement, excessive cuff pressure, infection, radiation, and anticoagulant use. Sentinel bleeding precedes 30-50% of TIF events and signals impending catastrophe. Diagnosis relies on prompt bronchoscopy and CT angiography. Management ranges from local control to endovascular or surgical repair. Preventive strategies-meticulous technique, cuff pressure monitoring, and multidisciplinary tracheostomy care-significantly reduce risk.</p><p><strong>Conclusions: </strong>Early identification of sentinel bleeds, rapid airway control, and adherence to standardized protocols are crucial to prevent fatal hemorrhage. Continuous vigilance and team-based care can markedly improve outcomes in tracheostomy management.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"891-898"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148056159","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":"Expression of Concern: Impact of early biliary complications in liver transplantation in the presence or absence of a T-tube: a Chinese transplant centre experience.","authors":"","doi":"10.1093/postmj/qgag041","DOIUrl":"10.1093/postmj/qgag041","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"977"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575224","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 ischemic stroke and herpes zoster in older people: a propensity-matched cohort study.","authors":"Shih-Wei Lai, Kuan-Fu Liao","doi":"10.1093/postmj/qgag112","DOIUrl":"10.1093/postmj/qgag112","url":null,"abstract":"<p><strong>Objective: </strong>Ischemic stroke is known to cause immune dysregulation, yet its potential impact on subsequent herpes zoster risk remains unclear. This study aimed to evaluate whether ischemic stroke was associated with incident herpes zoster among patients aged 65-84 years.</p><p><strong>Methods: </strong>This retrospective cohort study utilized electronic medical records from 2006 to 2024, obtained through the TriNetX Collaborative Network. Two study groups were identified: patients aged 65-84 years with a diagnosis of ischemic stroke, and controls without any cerebrovascular disease diagnosis. We conducted 1:1 propensity score matching, with demographic characteristics, comorbidities, and medication use included as covariates in the propensity score model. The primary outcome was a new diagnosis of herpes zoster. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using the \"Compare Outcomes\" module within the TriNetX platform.</p><p><strong>Results: </strong>After 1:1 propensity score matching and applying a post-matching 3-month lag exclusion, 25 011 patients in the ischemic stroke group and 25 029 patients in the control group were included. Over a 5-year follow-up period, the cumulative incidences of herpes zoster were 0.492% in the ischemic stroke group and 0.156% in the control group. In the Cox proportional hazards model, ischemic stroke was significantly associated with an increased risk of incident herpes zoster (HR, 3.607; 95% CI, 2.515-5.173), although the absolute incidence was low.</p><p><strong>Conclusion: </strong>Ischemic stroke is associated with a higher risk of herpes zoster in patients aged 65-84 years. Further studies are warranted to clarify the underlying mechanisms and potential clinical implications. Key messages What is already known on this topic  The risk of herpes zoster increases with aging and immune senescence.Ischemic stroke can induce central nervous system injury-related immune suppression, thereby increasing susceptibility to infections. What this study adds  The Cox model demonstrated an association between ischemic stroke and incident herpes zoster, although the absolute incidence was low during follow-up. How this study might affect research, practice, or policy  Among patients aged 65-84 years, ischemic stroke is associated with a higher cumulative incidence of herpes zoster.Clinicians should remain attentive to the possibility of herpes zoster in post-stroke care, particularly in older people.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"942-947"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797250","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":"Correction to: The impact of community-based Tai Chi exercise on intrinsic capacity improvement in the elderly: a meta-analysis of randomized controlled trials.","authors":"","doi":"10.1093/postmj/qgag061","DOIUrl":"10.1093/postmj/qgag061","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"976"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147819803","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 validity of selection assessments for medical specialty selection: examining prediction across different training outcomes.","authors":"Emma Morley, Stephen A Woods, Helen Baron, Fiona Patterson","doi":"10.1093/postmj/qgag054","DOIUrl":"10.1093/postmj/qgag054","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose of the study: &lt;/strong&gt;The Multi-Specialty Recruitment Assessment (MSRA) is a proctored assessment, comprising a clinical problem-solving (CPS) test and a situational judgement test (SJT), often combined with selection interviews, for admission to multiple postgraduate medical specialty training programmes in the UK. The study examined the predictive validity of these selection assessments (i.e. the extent to which they effectively predicted later performance outcomes).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Data were obtained from the UKMED dataset and analyzed for ten UK medical specialties (~13 000 unique applications) to explore relationships between selection data (CPS, SJT, and selection interview) and subsequent performance outcomes; Annual Review of Competence Progression (ARCP) and national professional examination scores, comprising Applied Knowledge Tests (AKTs) and Objective Structured Clinical Examinations (OSCEs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Results supported the predictive validity of the MSRA and interview scores with some evident trends across different criteria. For example, the CPS tended to be most predictive of the AKT performance, and the SJT (which assesses non-academic skills) tended to be more strongly predictive of OSCE than AKT performance. The predictive validity of the selection interviews beyond the MSRA varied by specialty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Results provide evidence of the predictive validity for both the MSRA and interviews across a range of specialties, providing insights into how best to design and combine different selection methods to balance key considerations such as reliability, validity, efficiency, and positive candidate feedback. The findings of this research also have implications for other healthcare selection settings. Key messages • What is already known on this topic - Previous research has already demonstrated that the MSRA shows predictive validity in the context of General Practice and Psychiatry selection, and has begun to explore the validity of the MSRA and interviews in further specialties. However, there is a lack of recent research exploring the predictive validity of MSRA in selection processes across other specialties, using a range of criterion measures and longitudinal performance outcomes, such as exam data. • What this study adds - The MSRA demonstrates validity with Annual Review of Competence Progression (ARCP) and national professional examination scores in postgraduate medical specialty training, across a range of different medical specialties. • How this study might affect research, practice, or policy - The results of this study can be used to inform future policy and decision making regarding the use of the MSRA alongside selection interviews and to enhance the reliability, validity, efficiency, and candidate experience for selection in future. Further, results provide valuable insights about the validity of such methods which may be informa","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"899-908"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147932603","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":"Self-discharge: intervention needed now?","authors":"Vicky Price, Louis Rischer, Michael Trimble","doi":"10.1093/postmj/qgag037","DOIUrl":"10.1093/postmj/qgag037","url":null,"abstract":"<p><p>Although they comprise only a small proportion of the medical take, patients who decide to self-discharge against medical advice pose a significant management challenge. They are often from a vulnerable patient population, and the challenges of providing adequate care are not insignificant. This short paper highlights the difficulties and explores possible responses.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"984-985"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618790","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":"From integration to belonging: rethinking the experience of international medical graduates.","authors":"Florence Morriello, Donald Livingstone, Peter Amgolu, Parisa Mirzajani, Joseph Barbosa","doi":"10.1093/postmj/qgaf207","DOIUrl":"10.1093/postmj/qgaf207","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"889-890"},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865011","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}