Postgraduate Medical Journal最新文献

{"title":"Is laughter truly the best medicine? Exploring the multifaceted roles of humour in medical practice.","authors":"Isaac K S Ng, An Jian Leung, Wilson G W Goh, Li Feng Tan, Desmond B Teo, Faith H W See","doi":"10.1093/postmj/qgag116","DOIUrl":"https://doi.org/10.1093/postmj/qgag116","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881441","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":"National trainee-led preparation programmes for surgical training transitions: design, delivery and lessons learned.","authors":"Michael El Boghdady","doi":"10.1093/postmj/qgag117","DOIUrl":"https://doi.org/10.1093/postmj/qgag117","url":null,"abstract":"<p><p>Progression through UK surgical training involves highly competitive national selection processes, particularly at entry into Core Surgical Training (CST) and subsequent entry into higher surgical training at ST3 level. Inequities in access to preparation resources and variability in mentorship remain recognized challenges. The Association of Surgeons in Training has developed national, trainee-led initiatives to support trainees at these key transition points. Preparing for a Career in Surgery (P4CS) and Preparing for Core Surgical Training (P4CST), established 10 years ago, supports foundation and early postgraduate doctors preparing for CST, while Preparing for ST3 (P4ST3), supports core trainees transitioning to higher surgical training. Both programmes are delivered nationally and incorporate thematic talks from successful candidates, portfolio clinics with personalized feedback, and mock interviews aligned with current CST and ST3 selection frameworks. Programme delivery has evolved from in-person to predominantly online formats to improve accessibility. Participation has increased steadily over time, with national reach across UK regions. Routine post-course evaluation demonstrated consistently high participant satisfaction across all programmes. Mean ratings for educational sessions ranged from 4.48 to 4.84 out of 5, while over 94% of participants reported adequate opportunities to ask questions and receive personalized feedback from faculty. Preparing for Core Surgical Training and Preparing for ST3 illustrate how trainee-led educational initiatives developed within professional associations can provide scalable, sustainable, and equitable support across the surgical training continuum. This model offers a transferable framework for supporting trainees navigating competitive postgraduate selection processes.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881380","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: Association of gene polymorphisms and the decreased expression of long non-coding RNA LOC553103 with rheumatoid arthritis.","authors":"","doi":"10.1093/postmj/qgag120","DOIUrl":"https://doi.org/10.1093/postmj/qgag120","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866339","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":"Rethinking end of life care in India: it's both withholding and withdrawing.","authors":"Sugata Dasgupta, Atanu Chandra","doi":"10.1093/postmj/qgag115","DOIUrl":"https://doi.org/10.1093/postmj/qgag115","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813847","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":"Motivational interviewing is missing In action.","authors":"Timothy C Frommeyer, TongFan Wu, Mark P Ortenzio, Garrett V Brittain, Katharine Conway, Angie Castle, Paul Hershberger","doi":"10.1093/postmj/qgaf227","DOIUrl":"10.1093/postmj/qgaf227","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"795-797"},"PeriodicalIF":3.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145794557","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":"A comprehensive predictive model study: ultrasound viscosity imaging in thyroid nodules.","authors":"Xiaohan Zou, Sijie Mo, Shuzhen Tang, Mengna Shao, Jing Chen, Fengling Chen, Lin Zhou, Zhibin Huang, Fajin Dong","doi":"10.1093/postmj/qgaf224","DOIUrl":"10.1093/postmj/qgaf224","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to develop a comprehensive predictive model that integrates clinical factors, conventional ultrasound (US) features, and ultrasound viscosity imaging metrics to improve diagnostic accuracy in thyroid nodules and to explore the role of viscosity metrics in differentiating benign and malignant thyroid nodules.</p><p><strong>Methods: </strong>A total of 215 patients with thyroid nodules were included in the study, with 70% in the training set and 30% in the testing set. Univariate and multivariate logistic regression were employed to identify key predictors, resulting in the development of three models. Three models were developed: ModA (clinical factors), ModB (clinical factors and conventional US features), and ModC (clinical factors, conventional US features, and US viscosity imaging). The diagnostic efficacy of the models was evaluated and compared using receiver operating characteristic curves.</p><p><strong>Results: </strong>Multivariate analysis revealed that factors, such as echogenicity, viscosity minimum (Vmin), and viscosity mean (Vmean), were significant risk factors for distinguishing between benign and malignant thyroid nodules. In the testing set, ModA demonstrated an Area Under the Curve (AUC) of 0.777, ModB exhibited an improvement to 0.922, and ModC demonstrated an AUC of 0.945. The findings indicate that ModC exhibits superior predictive accuracy for differentiating between benign and malignant thyroid nodules.</p><p><strong>Conclusion: </strong>The integration of US viscosity imaging with clinical factors and conventional US features can enhance the predictive performance of differentiation in thyroid nodules, offering a reliable clinical tool to support early and accurate diagnosis of thyroid nodules.</p><p><strong>Research questions: </strong></p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"817-825"},"PeriodicalIF":3.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463640","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":"Effect of remote ischemic conditioning on albuminuria in adults with diabetes mellitus (ricadime): a parallel group, double blind, sham controlled, randomized clinical trial.","authors":"Nishanth Dev, Garima Kumar, Gaurav Singh, Jhuma Sankar","doi":"10.1093/postmj/qgag040","DOIUrl":"10.1093/postmj/qgag040","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic kidney disease (DKD), a chronic microvascular complication is leading cause of End Stage Kidney disease (ESKD). Reduction of ≥30% urinary albumin is recommended to slow ESKD progression. Remote Ischemic conditioning (RIC) induces brief episodes of ischemia and reperfusion and has protective effect on various organs. The current study aims to explore the effects of RIC on albuminuria reduction in adults with type-2 Diabetes Mellitus.</p><p><strong>Materials and methods: </strong>In this double blind, sham controlled, Randomized Clinical Trial, we assigned 40 normotensive Diabetic adults with moderate and severely increased albuminuria to RIC group (n = 20) or Sham group (n = 20) weekly for 8 weeks. Primary outcome was reduction in albuminuria at the end of 8 weeks. Secondary outcomes were changes in serum creatinine, e-Glomerular Filtration Rate (eGFR), and HbA1c levels.</p><p><strong>Results: </strong>The reduction in albuminuria at the end of 8 weeks was 37.9% [Median (IQR): -7.5, 43.9] in the RIC group while it increased by 1.10% (-5.6, 15.2) in the Sham group (P = 0.015). Significant reduction was noted in serum creatinine in RIC group from 1 to 0.83 mg/dl as compared to increase in Sham group from 0.97 to 1.1 mg/dl (P = 0.0004). The mean eGFR in the RIC group improved from 85 to 99 (ml/min/1.73m2) P = 0.0001). No significant change was detected in HbA1C levels. Mild pain was the only adverse effect noted in 10% in the RIC group and none in the Sham group.</p><p><strong>Conclusion: </strong>Among adults with DKD, treatment with RIC significantly reduced albuminuria and serum creatinine while improving the eGFR (CTRI/2024/09/074453).</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"840-846"},"PeriodicalIF":3.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841993","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 homocysteine levels and arterial stiffness in the adult population: a systematic review and meta-analysis.","authors":"Alicia Saz-Lara, Andrea Del Saz-Lara, Carla Geovanna Lever-Megina, Sara Valladolid-Ayllón, David Tébar-García, Eva María Galán-Moya, Iván Cavero-Redondo","doi":"10.1093/postmj/qgaf137","DOIUrl":"10.1093/postmj/qgaf137","url":null,"abstract":"<p><strong>Purpose: </strong>The aim was to evaluate the association between homocysteine levels and arterial stiffness in the adult population.</p><p><strong>Methods: </strong>Scopus, Web of Science, and PubMed databases were searched from their inception to November 30, 2024. The DerSimonian and Laird method was used to calculate pooled odds ratio (OR) estimates and 95% confidence intervals (95% CIs) of the associations between homocysteine levels (plasma and serum homocysteine) and arterial stiffness in the adult population.</p><p><strong>Results: </strong>Finally, 17 studies were included in the systematic review, and 16 studies were included in the meta-analysis, and included a total of 31 049 subjects. Our findings provide evidence supporting the associations between plasma homocysteine levels and arterial stiffness (OR: 2.06; 95% CI: 1.50, 2.82) and between serum homocysteine levels and arterial stiffness (OR: 1.76; 95% CI: 1.17, 2.65) in the adult population.</p><p><strong>Conclusion: </strong>For each μmol/L unit increase in homocysteine levels, the risk of arterial stiffness increased by 106% for plasma homocysteine and by 76% for serum homocysteine. These findings are of clinical importance for understanding the underlying mechanisms involved in vascular dysfunction to establish preventive strategies in the cardiovascular setting.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"798-805"},"PeriodicalIF":3.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019461","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":"Syndecan-1 as a biomarker of endothelial glycocalyx injury in sepsis: a meta-analysis of associations with shock, organ complications and mortality.","authors":"Dongling Xu, Chengshu Dong, Zifang Zhao, Siyuan Hou","doi":"10.1093/postmj/qgag053","DOIUrl":"10.1093/postmj/qgag053","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;This meta-analysis aimed to assess syndecan-1 as a biomarker reflecting endothelial glycocalyx injury in sepsis, investigate its correlation with disease severity, organ complications and clinical prognosis, and clarifies its complementary value relative to conventional sepsis biomarkers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A systematic review and meta-analysis conducted in accordance with PRISMA guidelines. Data analysis was performed using Review Manager 5.3, with standardized mean differences (SMD) and 95% confidence intervals (CI) calculated. Subgroup analyses were stratified by sepsis definitions (Sepsis 1.0/2.0 vs. 3.0), and sensitivity analyses were performed by excluding studies with serious or critical ROBINS-I bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;A total of 29 studies involving 4985 participants (3902 with sepsis) were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;Circulating syndecan-1 levels in sepsis patients versus non-sepsis controls, survivors versus non-survivors, and patients with septic shock, acute kidney injury (AKI) and disseminated intravascular coagulation (DIC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Syndecan-1 levels were significantly higher in sepsis patients than non-sepsis [SMD = 1.16, 95% CI (0.86, 1.47), p &lt; 0.00001]. Non-survivors had significantly elevated levels compared with survivors, and higher levels were also observed in patients with septic shock, AKI and DIC (all p &lt; 0.00001). Subgroup analyses yielded consistent findings across different sepsis definitions, and sensitivity analyses excluding 9 high-bias studies confirmed the robustness of the results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Elevated syndecan-1 indicates endothelial glycocalyx disruption in sepsis, and is closely linked to worse prognosis, septic shock and organ dysfunction. As a complementary biomarker to lactate, procalcitonin and C-reactive protein, it improves multi-domain sepsis risk stratification and supports individualized resuscitation and endothelial-protective intervention research. Key messages What is already known on this topic? Syndecan-1 is a marker of endothelial glycocalyx degradation and has been linked to sepsis severity. However, its precise association with prognosis and complications remains unclear, and its clinical value relative to traditional sepsis biomarkers (lactate/PCT/CRP) has not been systematically clarified, necessitating a meta-analysis to quantify its clinical relevance and complementary role. What this study adds This study confirms that syndecan-1 levels are significantly elevated in sepsis, especially in severe cases, non-survivors, and patients with AKI or DIC, validating its role as a specific biomarker of sepsis-associated endothelial glycocalyx injury. Importantly, it clarifies that syndecan-1 is not a replacement for traditional biomarkers but a complementary indicator that captures the endotheliopathy domain unmeasured by lactate/PCT/CRP. Its lack of specificity for sepsis ","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"867-875"},"PeriodicalIF":3.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147779286","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":"Artificial intelligence for assessment in competency-based medical education: current practices and future directions.","authors":"Lucy Muying Hui, Enoch Yu, Andrew Chung, Benjamin Y M Kwan","doi":"10.1093/postmj/qgaf195","DOIUrl":"10.1093/postmj/qgaf195","url":null,"abstract":"<p><strong>Background: </strong>Competency-Based Medical Education (CBME) relies on frequent, competency-focused assessments, which can be challenging to implement consistently. Artificial Intelligence (AI) holds promise to improve assessment efficiency, objectivity, and feedback in CBME, but its use remains in early stages with limited understanding of current practices and evaluation methods. This study aims to map existing AI applications in CBME assessments to guide future work.</p><p><strong>Methods: </strong>A comprehensive search was performed in MEDLINE (Ovid), EMBASE (Ovid), PsycINFO, and Scopus using tailored keywords and MeSH terms. Included studies focused on the deployment of AI for assessment within CBME, covering applications in generating, analyzing, or interpreting evaluation data across undergraduate, graduate, and continuing professional education. The PRISMA-ScR guidelines were used to ensure transparent reporting, and findings were synthesized following Levac et al.'s approach.</p><p><strong>Results: </strong>Of the 1002 search results, 32 studies met the inclusion criteria. Key findings indicate a wide application of AI from surgical or procedural skill assessment, to clinical note assessment, communication assessment, feedback generation, projected trainee performance, and analysis of narrative feedback from supervisors.</p><p><strong>Conclusion: </strong>This review highlights potential advantages, such as timely evaluations, and challenges, such as lack of granularity, of AI integration. In conclusion, thoughtful integration of AI into competency-based medical education can complement traditional assessment methods and enhance learner outcomes, provided it is supported by robust infrastructure, ethical oversight, and collaborative policy development.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"806-816"},"PeriodicalIF":3.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964438","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}