Postgraduate Medical Journal最新文献_第7页

A viewpoint on virtual teaching in medical education: walking into the digital era with our eyes open. 医学教育中的虚拟教学：睁大眼睛走进数字时代

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-09-22 DOI: 10.1093/postmj/qgag121

Bernard Theodore Davis, Mydhili Chellappah, Elena Nikiphorou, Sarah Helen Oram, Hadi Rabee, James Galloway

{"title":"A viewpoint on virtual teaching in medical education: walking into the digital era with our eyes open.","authors":"Bernard Theodore Davis, Mydhili Chellappah, Elena Nikiphorou, Sarah Helen Oram, Hadi Rabee, James Galloway","doi":"10.1093/postmj/qgag121","DOIUrl":"https://doi.org/10.1093/postmj/qgag121","url":null,"abstract":"The COVID-19 pandemic triggered an explosion of interest in virtual teaching, fundamentally altering the delivery of education worldwide. Students and teachers alike embraced the convenience of learning from home, while platforms offered impressive functionality ranging from live interactive features to offline pre-recorded resources allowing for more flexible self-directed study. However, as the initial enthusiasm waned, significant challenges emerged. Cognitive overload from excessive synchronous virtual content led to disengagement and burnout, with students consuming finite cognitive resources across competing browser tabs rather than encoding new knowledge. Nevertheless, virtual teaching does still have a legitimate role within education, but realizing its potential requires substantial investment in pedagogical design, engagement mechanisms, and staff training. Within medical education, Hafferty's concept of the hidden curriculum-the informal, unscripted learning occurring in clinical environments-highlights what risks being lost. Some knowledge is 'caught' through direct observation rather than formally 'taught', and such learning does not transmit through a video feed. Lave and Wenger's situated learning theory reinforces this: students are apprenticed into clinical communities through physical participation, not passive observation via a screen. Miller's pyramid of clinical competence offers a useful framework-virtual teaching may service the lower levels of knowledge acquisition, but 'shows how' and 'does' require embodied presence, real patients, and authentic clinical environments. The digital transformation of medical education will not reverse. Our responsibility is to embrace its potential while protecting what cannot be digitized: the formation of doctors through presence, participation, and clinical experience.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017760","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}

引用次数: 0

GLP-1 medications and health equity: when insurance access determines who benefits. GLP-1药物和健康公平：当保险获得决定谁受益。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-09-22 DOI: 10.1093/postmj/qgag128

Samia Arif, Amina Chaudhary, Syed Mohib Ullah, Muhammad Shahzaib

引用次数: 0

Is predictive validity enough? The multi-specialty recruitment assessment (MSRA) in postgraduate medical specialty selection. 预测有效性就足够了吗？医学研究生专业选择中的多专业招生评估。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-09-22 DOI: 10.1093/postmj/qgag130

Jun Jie Lim, Tom Scurr

引用次数: 0

Beyond efficacy: health inequities limiting access to semaglutide for obesity management. 功效之外：卫生不公平限制了西马鲁肽用于肥胖管理的可及性。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-09-22 DOI: 10.1093/postmj/qgag129

Kanwal Islam, Mahmood Hassan

引用次数: 0

Longitudinal HbA1c trajectories and clinical prognosis in type 2 diabetes: a population-based cohort study. 2型糖尿病患者HbA1c的纵向轨迹和临床预后：一项基于人群的队列研究

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-09-18 DOI: 10.1093/postmj/qgag124

Jose A Quesada, Francisco Jose Pomares-Gomez, Amanda Esquerdo-Arroyo, Concepcion Carratala-Munuera, Vicente F Gil-Guillen, Domingo Orozco-Beltran, Adriana Lopez-Pineda

{"title":"Longitudinal HbA1c trajectories and clinical prognosis in type 2 diabetes: a population-based cohort study.","authors":"Jose A Quesada, Francisco Jose Pomares-Gomez, Amanda Esquerdo-Arroyo, Concepcion Carratala-Munuera, Vicente F Gil-Guillen, Domingo Orozco-Beltran, Adriana Lopez-Pineda","doi":"10.1093/postmj/qgag124","DOIUrl":"https://doi.org/10.1093/postmj/qgag124","url":null,"abstract":"Objective: To characterize longitudinal glycated haemoglobin (HbA1c) trajectories before and after the diagnosis of type 2 diabetes and to evaluate their association with major cardiovascular events and all-cause mortality.Design: Retrospective population-based cohort study using Spanish electronic health records. Adults with incident type 2 diabetes diagnosed between 2005 and 2019 were included. Longitudinal HbA1c trajectories were modelled using functional principal component analysis and classified using Gaussian mixture modelling. The primary outcome was a composite of hospital admission for ischaemic heart disease, cerebrovascular disease, and all-cause mortality. Associations were assessed using adjusted Cox proportional hazards models.Results: A total of 264 634 individuals with incident type 2 diabetes and 1 719 720 HbA1c measurements were included. Three distinct HbA1c trajectory classes were identified. Mean HbA1c values remained within the prediabetes range until ~10 years before diabetes diagnosis. The highest risk of the composite outcome was observed in the trajectory class with intermediate, rather than the highest, HbA1c levels. Compared with trajectory class 2, trajectory class 1 was associated with a substantially increased risk of the composite outcome in women (HR: 3.34, 95% CI: 3.18-3.50) and men (HR: 2.93, 95% CI: 2.81-3.05).Conclusions: The trajectory associated with the greatest risk was not the one with the highest HbA1c levels, but the one characterized by greater baseline clinical vulnerability. The greatest impact of the associations falls on total mortality. These findings highlight the importance of considering long-term glycaemic patterns alongside clinical context when stratifying cardiovascular risk in people with type 2 diabetes.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002650","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}

引用次数: 0

"Good manners" in clinical medicine: what modern training no longer teaches. 临床医学中的“礼貌”：现代培训不再教的东西。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-09-18 DOI: 10.1093/postmj/qgag135

Shigeki Matsubara

引用次数: 0

A clinician's guide to infectious diseases diagnostics: principles, pitfalls, and stewardship. 临床医生传染病诊断指南：原则、陷阱和管理。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-09-18 DOI: 10.1093/postmj/qgag134

Bo Yan Khoo, Mucheli Sharavan Sadasiv

{"title":"A clinician's guide to infectious diseases diagnostics: principles, pitfalls, and stewardship.","authors":"Bo Yan Khoo, Mucheli Sharavan Sadasiv","doi":"10.1093/postmj/qgag134","DOIUrl":"https://doi.org/10.1093/postmj/qgag134","url":null,"abstract":"Accurate interpretation of infectious diseases diagnostic tests requires a comprehensive understanding of test principles, performance characteristics, and the cognitive discipline of diagnostic stewardship. While contemporary modalities range from traditional culture to high-throughput metagenomics, postgraduate trainees may struggle to reconcile complex laboratory data with the clinical context. This educational primer aims to bridge the gap between laboratory science and bedside decision-making. We first distinguish between analytical (limit of detection) and clinical sensitivity, emphasizing how disease prevalence dictates predictive values. We then move beyond theoretical limitations to identify clinician-modifiable pre-analytical variables, such as specimen collection techniques, that directly affect diagnostic test performance. A core framework for Diagnostic Stewardship is introduced, focusing on the test-treatment threshold and the critical distinction between organism detection and active infection. Through illustrative case studies, we apply clinical reasoning strategies to resolve common pitfalls, including serological cross-reactivity, polymerase chain reaction inhibition in critical samples, and prozone phenomena. Enhanced diagnostic competence requires more than memorizing test characteristics; it demands the integration of stewardship principles, awareness of cognitive biases, and active collaboration with other healthcare professionals. This review provides a structured approach for trainees to navigate the complexities of modern infectious disease diagnostics. Key messages Infectious disease tests should be interpreted in light of the syndrome, pre-test probability and the timing, and type of specimen tested. NAAT positivity detects nucleic acid, not necessarily viable organisms or active disease. Most avoidable microbiological diagnostic errors begin before the sample reaches the laboratory. Discordant test results should trigger a deliberate diagnostic pause and, when needed, discussion with the laboratory.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002598","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}

引用次数: 0

The answer is not the reasoning: protecting clinical judgement in medical education. 答案不是推理：在医学教育中保护临床判断。

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-09-18 DOI: 10.1093/postmj/qgag126

Waseem Jerjes, Austen El-Osta, Azeem Majeed

引用次数: 0

Beyond the bottleneck: could portfolio-based progression create an evidence race? 超越瓶颈：基于组合的进程是否能够创造一种证据竞赛？

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-09-18 DOI: 10.1093/postmj/qgag127

Theodora Okechukwu

引用次数: 0

Potential clinical utility of a KDIGO 2021-based clinical decision support system for glomerular diseases: a retrospective two-center pilot study. 基于KDIGO 2021的肾小球疾病临床决策支持系统的潜在临床应用：一项回顾性双中心试点研究

IF 3.6 4区医学

Postgraduate Medical Journal Pub Date : 2026-09-18 DOI: 10.1093/postmj/qgag133

Krzysztof Michalak, Oliwia Sędziak, Dawid Pawuś, Krzysztof Benc, Alicja Bujara, Łukasz Mazur, Tomasz Porażko

{"title":"Potential clinical utility of a KDIGO 2021-based clinical decision support system for glomerular diseases: a retrospective two-center pilot study.","authors":"Krzysztof Michalak, Oliwia Sędziak, Dawid Pawuś, Krzysztof Benc, Alicja Bujara, Łukasz Mazur, Tomasz Porażko","doi":"10.1093/postmj/qgag133","DOIUrl":"https://doi.org/10.1093/postmj/qgag133","url":null,"abstract":"Purpose: Glomerulopathies are a heterogeneous group of diseases characterized by complex immunopathogenesis and wide clinical variability. A wide range of laboratory and histopathological tests is used to assess glomerular diseases. However, the volume of data is often too great to analyze and to provide a clear diagnosis. The rapid development of artificial intelligence (AI) methodologies, including machine learning (ML) and deep learning, facilitates the integration of histopathological, clinical, and molecular data. This foundation enables the creation of more precise and objective diagnostic models.Method: Modular expert systems based on ML algorithms (XGBoost, Random Forest, and natural language processing were implemented. A retrospective comparative analysis was performed comparing physician decisions with algorithmic recommendations in a patient cohort from the Opole University Clinical Hospital and the Wroclaw Medical University Hospital (2018-2025), comprising idiopathic membranous glomerulonephritis (iMN, n = 56), focal segmental glomerulosclerosis (FSGS, n = 127), lupus nephritis (LN, n = 31), and minimal change disease (MCD, n = 187).Results: The iMN module achieved 100% accuracy in risk categorization. Retrospective analysis revealed significant gaps in clinical practice: 13.4% of decisions were suboptimal in the FSGS group, 25.8% of diagnoses were irregular in the LN cohort, and 10.8% of diagnoses were irregular in the MCD group.Conclusion: The integration of AI into clinical practice is a key element in the evolution of \"precision nephrology,\" supporting the detection of subtle disease patterns and the standardization of management.","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002690","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}

引用次数: 0