Postgraduate Medical Journal最新文献

{"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":"https://doi.org/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":""},"PeriodicalIF":3.6,"publicationDate":"2024-10-23","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":"Assessment of imposter syndrome among postgraduate residents using Clance imposter phenomenon scale: a multicentric, cross-sectional study.","authors":"Nehal Amir, Nabiha Eeman, Muhammad Nouman Ahmed, Ayesha Nazakat, Irteeqa Azhar, Maimoona Azhar, Hassan Mumtaz","doi":"10.1093/postmj/qgae145","DOIUrl":"https://doi.org/10.1093/postmj/qgae145","url":null,"abstract":"<p><strong>Background: </strong>Imposter syndrome develops when high-achieving individuals, despite external measurements of achievement, have a chronic sense of self-doubt paired with a fear of being exposed as a hoax. This endangers one's mental health and well-being. The objective of the study was to determine the prevalence and severity of imposter syndrome among postgraduate residents and to identify the risk factors associated with imposter syndrome.</p><p><strong>Methods: </strong>This is a cross-sectional study conducted among the postgraduate trainees working in four different training hospitals in Pakistan. Imposter syndrome was assessed using the Clance Imposter Phenomenon Scale.</p><p><strong>Results: </strong>A total of 146 postgraduate residents participated in this study. The majority had significant imposter syndrome, with females more suffered than males. Trainees of the pediatrics department were affected the most while of the dentistry were least to be affected. Multiple factors including marital status, number of children, working hours, extracurricular activities, and private practice have been shown to affect the prevalence of imposter syndrome.</p><p><strong>Conclusion: </strong>Imposter syndrome is a prevalent phenomenon among the residents of Pakistan. Efforts to identify and establish a proper relationship between general demographics and imposter syndrome are required for the healthy work experience of the trainees.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472936","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":"Reflections on a 19th century Qing dynasty portrait with neurofibromatosis type 1.","authors":"Bingwen Eugene Fan","doi":"10.1093/postmj/qgae070","DOIUrl":"10.1093/postmj/qgae070","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"872-874"},"PeriodicalIF":3.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318125","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":"Influence of familial forms of inflammatory bowel disease on the use of immunosuppressants, biological agents, and surgery in the era of biological therapies. Results from the ENEIDA project.","authors":"Carlos González-Muñoza, Margalida Calafat, Javier P Gisbert, Eva Iglesias, Miguel Mínguez, Beatriz Sicilia, Montserrat Aceituno, Fernando Gomollón, Xavier Calvet, Elena Ricart, Luisa De Castro, Montserrat Rivero, Francisco Mesonero, Lucía Márquez, Pilar Nos, Ainhoa Rodríguez-Pescador, Jordi Guardiola, MarianaFe García-Sepulcre, Santiago García-López, Rufo H Lorente-Poyatos, Cristina Alba, Ramon Sánchez-Ocaña, Isabel Vera, Lucía Madero, Sabino Riestra, Mercedes Navarro-Llavat, Jose L Pérez-Calle, Blau Camps, Manuel Van Domselaar, Alfredo J Lucendo, Maria Dolores Martín-Arranz, Miguel A Montoro-Huguet, Mónica Sierra-Ausín, Jordina Llaó, Daniel Carpio, Pilar Varela, Olga Merino, Luis I Fernández-Salazar, Marta Piqueras, Eva Sesé, David Busquets, Carlos Tardillo, Nuria Maroto, Joan Riera, Carlos Martínez-Flores, Fernando Muñoz, Jordi Gordillo-Ábalos, Federico Bertoletti, Esther Garcia-Planella, Eugeni Domènech","doi":"10.1093/postmj/qgae076","DOIUrl":"10.1093/postmj/qgae076","url":null,"abstract":"<p><strong>Background and aims: </strong>Familial inflammatory bowel disease (IBD) history is a controversial prognostic factor in IBD. We aimed to evaluate the impact of a familial history of IBD on the use of medical and surgical treatments in the biological era.</p><p><strong>Methods: </strong>Patients included in the prospectively maintained ENEIDA database and diagnosed with IBD after 2005 were included. Familial forms were defined as those cases with at least one first-degree relative diagnosed with IBD. Disease phenotype, the use of biological agents, or surgical treatments were the main outcomes.</p><p><strong>Results: </strong>A total of 5263 patients [2627 Crohn's disease (CD); 2636 ulcerative colitis (UC)] were included, with a median follow-up of 31 months. Of these, 507 (10%) corresponded to familial forms. No clinical differences were observed between familial and sporadic IBD forms except a lower age at IBD diagnosis and a higher rate of males in familial forms of UC. In CD, the proportions of patients treated with thiopurines (54.4% vs 46.7%; P = .015) and survival time free of thiopurines (P = .009) were lower in familial forms. No differences were found regarding the use of biological agents. Concerning surgery, a higher rate of intestinal resections was observed in sporadic CD (14.8% vs 9.9%, P = .027). No differences were observed in UC.</p><p><strong>Conclusions: </strong>In the era of biological therapies, familial and sporadic forms of IBD show similar phenotypes and are managed medically in a similar way; whether these is due to lack of phenotypical differences or an effect of biological therapies is uncertain. What is already known on this topic: IBD's etiopathogenesis points to an interaction between environmental and genetic factors, being familial history a controversial prognostic factor. Biological agents use and need for surgery regarding familial or sporadic forms of IBDs present conflicting results. What this study adds: Familial and sporadic forms of IBD have similar phenotypes and are managed medically and surgically in a similar way. How this study might affect research, practice or policy: Familial aggregation should not be considered a factor associated with more aggressive disease.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"836-844"},"PeriodicalIF":3.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443268","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":"Relationship between human serum metabolites and angina pectoris: a Mendelian randomization study.","authors":"Jian Xiong, Ying Liao, Liyuan Yang, Ying Wei, Dehua Li, Yi Zhao, Qianhua Zheng, Wenchuan Qi, Fanrong Liang","doi":"10.1093/postmj/qgae067","DOIUrl":"10.1093/postmj/qgae067","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to explore the causal relationship between human serum metabolites and angina pectoris.</p><p><strong>Methods: </strong>This study used two-sample Mendelian randomization (MR) analysis to assess the association between 486 serum metabolites and angina pectoris. The analytical methods employed to reduce study bias included inverse variance weighted, MR-Egger, and weighted median method. A comprehensive sensitivity analysis was performed using the leave-one-out method, while instrumental variable pleiotropy was tested with MR-Pleiotropy RESidual Sum and Outlier. Metabolic pathways of angina-associated metabolites were analysed on the MetaboAnalyst metabolomics analysis tool platform.</p><p><strong>Results: </strong>In this study, 42 serum metabolites were found to be strongly associated with angina pectoris. They mainly belonged to seven groups: amino acids, carbohydrates, cofactors and vitamins, lipids, nucleotides, unknown metabolites, and exogenous substances. Pipecolate posed the highest risk for the development of angina pectoris among the 42 serum metabolites. The main metabolic pathways associated with angina pectoris were glycine, serine, threonine metabolism, primary bile acid biosynthesis, and caffeine metabolism.</p><p><strong>Conclusion: </strong>We identified 25 high-risk and 17 protective human serum metabolites associated with angina pectoris. Their associated major metabolic pathways were also determined. The serum metabolite pipecolate was significantly and positively correlated with the risk of angina pectoris. This finding may serve as a valuable reference for testing serum markers associated with angina pectoris.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"811-819"},"PeriodicalIF":3.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238161","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":"Revisiting the diagnostic and prognostic significance of high-frequency QRS analysis in cardiovascular diseases: a comprehensive review.","authors":"Shifeng Qiu, Tinghui Liu, Zijin Zhan, Xue Li, Xuewei Liu, Xiaoyu Xin, Junyan Lu, Lipei Wu, Li Wang, Kai Cui, Jiancheng Xiu","doi":"10.1093/postmj/qgae064","DOIUrl":"10.1093/postmj/qgae064","url":null,"abstract":"<p><p>Cardiovascular diseases (CVDs) present a significant global public health threat, contributing to a substantial number of cases involving morbidity and mortality. Therefore, the early and accurate detection of CVDs plays an indispensable role in enhancing patient outcomes. Decades of extensive research on electrocardiography at high frequencies have yielded a wealth of knowledge regarding alterations in the QRS complex during myocardial ischemia, as well as the methodologies to assess and quantify these changes. In recent years, the analysis of high-frequency QRS (HF-QRS) components has emerged as a promising non-invasive approach for diagnosing various cardiovascular conditions. Alterations in HF-QRS amplitude and morphology have demonstrated remarkable sensitivity as diagnostic indicators for myocardial ischemia, often surpassing measures of ST-T segment changes. This comprehensive review aims to provide an intricate overview of the current advancements, challenges, and prospects associated with HF-QRS analysis in the field of CVDs.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"785-795"},"PeriodicalIF":3.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155710","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":"Prevalence of tight glycemic control based on frailty status and associated factors in community-dwelling older adults.","authors":"Li Feng Tan, Reshma Aziz Merchant","doi":"10.1093/postmj/qgae077","DOIUrl":"10.1093/postmj/qgae077","url":null,"abstract":"<p><strong>Background: </strong>Tight control of type 2 diabetes (T2DM) in frail older adults has shown to be associated with adverse outcomes. The objective of this study is to determine the prevalence of tight glycemic control based on underlying frailty status and its association with functional and cognitive measures in community-dwelling older adults.</p><p><strong>Methodology: </strong>Ancillary study of the Singapore Population Health Studies on older adults aged ≥65 years with T2DM. Tight glycemic control cut-offs were based on the 2019 Endocrine Society guideline using HbA1c target range based on a patient's overall health status measured by the FRAIL scale. Data on basic demographics, frailty, cognitive, and functional statuses were collected. Multivariable regression was used to assess potential factors associated with tight glycemic control.</p><p><strong>Results: </strong>Of 172 community-dwelling older adults with diabetes mellitus and HbA1c done, frail (65%) and pre-frail (64.4%) participants were more likely to have tight glycemic control than robust participants (31.6%, P < 0.001). In multi-variate analysis, frailty (OR 6.43, 95% CI 1.08-38.1, P = 0.041), better cognition (OR 1.15, 95% CI 1.02-1.32, P = 0.028), and multi-morbidity (OR 7.36, 95% CI 1.07-50.4, P = 0.042) were found to be significantly associated with increased odds of tight glycemic control.</p><p><strong>Conclusion: </strong>Tight glycemic control was highly prevalent in frail and pre-frail older adults, especially in those with multi-morbidity and better cognition. Future prospective longitudinal studies are required to evaluate effectiveness of frailty screening in making treatment decisions and long-term outcomes. Key messages What is already known on this topic:  There is growing recognition that glycemic targets should be adjusted based on health or frailty status. However, there is no consensus on how health status or frailty should be defined when determining glycemic control targets. What this study adds:  Our study found that tight glycemic control was highly prevalent in frail and pre-frail older adults. Our findings highlight the importance of assessing for tight glycemic control based on frailty status and further work is needed to aid implementation of screening and intervention policies to avoid the attendant harms of tight glycemic control.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"845-850"},"PeriodicalIF":3.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141458859","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":"Facial recognition for disease diagnosis using a deep learning convolutional neural network: a systematic review and meta-analysis.","authors":"Xinru Kong, Ziyue Wang, Jie Sun, Xianghua Qi, Qianhui Qiu, Xiao Ding","doi":"10.1093/postmj/qgae061","DOIUrl":"10.1093/postmj/qgae061","url":null,"abstract":"<p><strong>Background: </strong>With the rapid advancement of deep learning network technology, the application of facial recognition technology in the medical field has received increasing attention.</p><p><strong>Objective: </strong>This study aims to systematically review the literature of the past decade on facial recognition technology based on deep learning networks in the diagnosis of rare dysmorphic diseases and facial paralysis, among other conditions, to determine the effectiveness and applicability of this technology in disease identification.</p><p><strong>Methods: </strong>This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for literature search and retrieved relevant literature from multiple databases, including PubMed, on 31 December 2023. The search keywords included deep learning convolutional neural networks, facial recognition, and disease recognition. A total of 208 articles on facial recognition technology based on deep learning networks in disease diagnosis over the past 10 years were screened, and 22 articles were selected for analysis. The meta-analysis was conducted using Stata 14.0 software.</p><p><strong>Results: </strong>The study collected 22 articles with a total sample size of 57 539 cases, of which 43 301 were samples with various diseases. The meta-analysis results indicated that the accuracy of deep learning in facial recognition for disease diagnosis was 91.0% [95% CI (87.0%, 95.0%)].</p><p><strong>Conclusion: </strong>The study results suggested that facial recognition technology based on deep learning networks has high accuracy in disease diagnosis, providing a reference for further development and application of this technology.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"796-810"},"PeriodicalIF":3.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894110","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":"Ceftriaxone near-fatal anaphylaxis.","authors":"Ami Schattner, Ina Dubin","doi":"10.1093/postmj/qgae066","DOIUrl":"10.1093/postmj/qgae066","url":null,"abstract":"","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"856-857"},"PeriodicalIF":3.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180565","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":"Left ventricular ejection fraction: time to revise the metric?","authors":"Avik Ray, Dan Zlotoff, Ichiro Kawachi","doi":"10.1093/postmj/qgae074","DOIUrl":"10.1093/postmj/qgae074","url":null,"abstract":"<p><p>In this paper, we highlight the prevalent misconception among patients regarding the normal value of left ventricular ejection fraction in cardiac function assessment. This misconception arises from the proportion dominance effect, wherein individuals tend to judge based on proportions rather than absolute values. We explain how this misunderstanding impacts patient demoralization and medical adherence, leading to worse clinical outcomes. To address this, the concept of \"Left Ventricular Ejection Fraction - Proportion of Normal\" is introduced, which adjusts left ventricular ejection fraction to a patient-specific normal range. This patient-centric approach aims to enhance comprehension, engagement, and adherence by conveying accurate information through the lens of proportions, thereby potentially improving clinical outcomes.</p>","PeriodicalId":20374,"journal":{"name":"Postgraduate Medical Journal","volume":" ","pages":"875-876"},"PeriodicalIF":3.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427429","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}