Postgraduate medicine最新文献

{"title":"Changes in intravenous pantoprazole utilization following two sequential interventions in a tertiary referral hospital.","authors":"Mona Kargar, Saeideh Mousavi, Kheirollah Gholami, Mohammad Reza Javadi, Samira Chaibaksh, Ramin Ansari, Maryam Taghizadeh-Ghehi","doi":"10.1080/00325481.2026.2748099","DOIUrl":"https://doi.org/10.1080/00325481.2026.2748099","url":null,"abstract":"<p><strong>Objectives: </strong>Intravenous (IV) pantoprazole is an effective proton pump inhibitor (PPI) with certain evidence-based indications for acid-related disorders. However, many studies demonstrated the considerable inappropriate administration of IV pantoprazole, resulting in adverse drug reactions and a financial burden. Irrational pantoprazole use necessitates educational and regulatory interventions. This study aimed to assess the effects of a hospital-wide program to optimize pantoprazole use in a tertiary‑care, referral, university-affiliated hospital.</p><p><strong>Methods: </strong>This study was conducted in three 45-day evaluation phases, before and after two sequential interventions, including the implementation of institutional guidelines with educational sessions and an order entry form (OEF). The use and appropriateness of IV pantoprazole were evaluated in each evaluation phase, and the hospital consumption (DDD/100 Bed-Days) of IV pantoprazole was estimated from 2014 to 2021.</p><p><strong>Results: </strong>The appropriate use of stress ulcer prophylaxis (SUP) in the first-day evaluation of the third phase increased significantly by 7% compared to the first and second evaluation phases (<i>p</i> = 0.03), while other indications remained unchanged. The total number of vials per patient over the 5 days decreased significantly during the three evaluation phases of the study (Coefficient = -0.05, SE = 0.02, <i>p</i> = 0.003).</p><p><strong>Conclusion: </strong>Sequential interventions in our study reduced IV pantoprazole consumption. However, we did not observe a significant improvement in appropriate IV pantoprazole use except for SUP in one of the assessments. Although the reasons behind this should be studied, more comprehensive, continuous, and effective interventions should have been considered to achieve acceptable change.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-10"},"PeriodicalIF":2.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of perioperative risk factors for retrograde type A dissection after thoracic endovascular aortic repair for type B dissection.","authors":"Jiajun Li, Yucong Zhang, Xuegui Chen, Xinyu Tan, Aini Xie, Mingjia Ma, Jing Wang, Xiang Wei, Min Hu","doi":"10.1080/00325481.2026.2748100","DOIUrl":"https://doi.org/10.1080/00325481.2026.2748100","url":null,"abstract":"<p><strong>Objective: </strong>To identify risk factors and develop a predictive model for retrograde type A dissection (RTAD) following thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD).</p><p><strong>Methods: </strong>We analyzed TBAD patients who underwent TEVAR from 2014 to 2024 (IRB:No. TJ-IRB20230805). Patients developing RTAD within 1 year were matched with controls by age, sex, operation date, and location. Logistic regression identified risk factors, and a nomogram was constructed. Model performance was assessed using ROC curves.</p><p><strong>Results: </strong>Of 2383 patients, 76 (3.19%) developed RTAD within one year. 65 RTAD cases and 195 matched controls were analyzed. RTAD patients had a greater horizontal distance of the ascending aorta (HDAA) than controls (53.34 mm vs. 43.05 mm, <i>p</i> < .001). Multivariate analysis identified younger age (OR = 0.95, <i>p</i> = .008), larger HDAA (OR = 1.14, <i>p</i> < .001), aortic root dilatation (OR = 2.85, <i>p</i> = .006), shorter stent length (OR = 0.99, <i>p</i> = .029), and absence of postoperative bradycardic drug use (OR = 0.31, <i>p</i> = .005) as independent RTAD risk factors. The model showed good discrimination (AUC = 0.85).</p><p><strong>Conclusion: </strong>Younger age, larger HDAA, aortic root dilatation, shorter stent length, and no bradycardic drugs postoperatively are independent predictors of RTAD after TEVAR. For TBAD patients with a high risk of RTAD, clinicians should consider the possibility of having connective tissue diseases, select stents appropriately, and optimize postoperative treatment with strict follow-up.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-7"},"PeriodicalIF":2.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central sensitization in rheumatoid arthritis: a cross-sectional analysis of functional disability, disease activity, and glucocorticoid use.","authors":"Vedat Gerdan, Yesim Erez","doi":"10.1080/00325481.2026.2749905","DOIUrl":"https://doi.org/10.1080/00325481.2026.2749905","url":null,"abstract":"<p><strong>Objective: </strong>To examine the clinical correlates of central sensitization (CS) in patients with rheumatoid arthritis (RA) and to perform an exploratory analysis of its association with glucocorticoid use.</p><p><strong>Methods: </strong>This single-center, cross-sectional study included 286 patients with RA (≥18 years) fulfilling the 2010 EULAR/ACR classification criteria and receiving stable treatment for at least 3 months. Demographic data, clinical characteristics, and treatment history were recorded. Participants completed the Central Sensitization Inventory (CSI) and the Fibromyalgia Impact Questionnaire (FIQ). Multivariable logistic regression was performed to identify factors independently associated with CS.</p><p><strong>Results: </strong>CS was present in 31.5% (<i>n</i> = 90) of patients. Patients with CS exhibited significantly higher tender joint counts and DAS28-CRP scores, while CRP levels and swollen joint counts were comparable between groups. In univariable analyses, CS was associated with younger age, female sex, longer disease duration, greater biologic exposure, and more frequent current steroid use (54.4% vs. 34.7%, <i>p</i> = 0.002). Multivariable logistic regression revealed that higher HAQ scores remained the sole independent factor associated with CS (OR: 5.32, <i>p</i> < 0.001), whereas the initial association with corticosteroid use lost significance after adjustment.</p><p><strong>Conclusion: </strong>CS in RA is independently linked to functional disability rather than objective inflammation, highlighting a potential discordance between clinical findings and symptom burden. Recognition of these non-inflammatory mechanisms may help prevent unnecessary treatment escalation, particularly glucocorticoid overuse, and support more appropriate pain management strategies.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-7"},"PeriodicalIF":2.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteocalcin and impaired cerebral resting-state functional connectivity in postmenopausal osteoporosis: a pilot case-control study.","authors":"Marie-Eva Pickering, Véronique Morel, Bruno Pereira, Gisèle Pickering, Roland Chapurlat, Anne Tournadre, Carine Chassain, Anna Sontheimer","doi":"10.1080/00325481.2026.2739000","DOIUrl":"https://doi.org/10.1080/00325481.2026.2739000","url":null,"abstract":"<p><strong>Purpose: </strong>Postmenopausal osteoporosis and circulating osteocalcin have been suggested to influence brain function. Objectives aim to explore associations between brain network resting-state functional magnetic resonance imaging (fMRI) connectivity, bone status, and circulating osteocalcin with the hypothesis of an impairment of the bone-brain axis in osteoporosis.</p><p><strong>Methods: </strong>This pilot fMRI case-control study included postmenopausal osteoporosis women and matched healthy volunteers, and took place in University Hospital, Clermont-Fd, France. Endpoints were the comparisons between cases and controls of intra- and internetworks connectivity and correlations with bone mineral density (BMD) and osteocalcin.</p><p><strong>Results: </strong>Twenty women with osteoporosis and ten matched healthy volunteers were included. Salience, visual and language intranetwork connectivity were all decreased compared to controls (False Discovery Rate (FDR)-corrected <i>p</i> = 0.006, 0.0132 and 0.0199, respectively). Internetwork connectivity was also impaired. For visual network, with three regions of the default mode (p-FDR = 0.0265, 0.0296 and 0.0265) and one with dorsal attention network (p-FDR = 0.0296), and for salience, with dorsal attention networks (p-FDR = 0.0494). Circulating osteocalcin correlated with connectivity between right anterior insula (salience network) and bilateral intraparietal sulci (dorsal attention network) (p-FDR = 0.0145 right side, p-FDR = 0.0421 left side). BMD correlated with connectivity between left regions of the dorsal attention and language networks (p-FDR = 0.0164).</p><p><strong>Conclusion: </strong>This pilot study suggests possible impairment of brain connectivity and compensatory protective mechanisms/maladaptive mechanisms in postmenopausal osteoporosis. It also unveils that lower osteocalcin concentrations and BMD may be associated with altered cerebral connectivity, confirming animal studies, and providing preliminary findings for further research.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-9"},"PeriodicalIF":2.8,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of chronic kidney disease with major cardiovascular outcomes following lower extremity endovascular revascularization.","authors":"Namra Khan, Hana Shah, Pura Rodriguez de la Vega, Rupa Seetharamaiah, Georgeta Vaidean","doi":"10.1080/00325481.2026.2748095","DOIUrl":"https://doi.org/10.1080/00325481.2026.2748095","url":null,"abstract":"<p><strong>Objective: </strong>Chronic kidney disease (CKD) amplifies cardiovascular risk, yet its stage-specific influence on perioperative outcomes following endovascular lower extremity revascularization (LER) for peripheral artery disease (PAD) remains poorly characterized.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the ACS NSQIP registry (2013-2022). Adults undergoing endovascular LER for PAD were stratified by preoperative estimated glomerular filtration rate (eGFR) via the CKD-EPI 2021 equation: G1 (≥90), G2 (60-89), G3 (30-59), G4 (15-29), and G5 (<15 mL/min/1.73 m2 or dialysis dependent). The primary outcome was 30-day major adverse cardiovascular events (MACE: myocardial infarction, stroke, or death). Multivariable logistic regression estimated adjusted odds ratios (OR) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Among 22,424 patients (64.6% aged ≥65 years; 36.1% women), comorbidity burden increased progressively with CKD stage. Within 30 days, 556 patients (2.5%) experienced MACE. Event rates rose stepwise: 1.5% (G1), 1.6% (G2), 2.7% (G3), 4.9% (G4), and 6.0% (G5). After adjustment for age, sex, race/ethnicity, ASA class, admission status, presenting symptoms, and preoperative hematocrit, advanced CKD remained independently associated with MACE: OR 2.30 (95% CI 1.50-3.52) for G4 and OR 3.15 (95% CI 2.28-4.35) for G5 versus G1.</p><p><strong>Conclusion: </strong>CKD stage provides independent prognostic information in patients undergoing endovascular LER. Advanced CKD independently predicts 30-day MACE with a dose-response relationship across stages. Preoperative eGFR should be incorporated into perioperative risk stratification protocols to guide cardiovascular optimization and surveillance planning.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-8"},"PeriodicalIF":2.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward consensus on complementary feeding recommendations: findings from a national evidence-informed modified Delphi study in Türkiye.","authors":"Sıddika Songül Yalçın, Öykü Özbörü Aşkan, Adnan Barutçu, Habip Almiş, Emel Örün, Aysu Duyan Çamurdan","doi":"10.1080/00325481.2026.2745217","DOIUrl":"https://doi.org/10.1080/00325481.2026.2745217","url":null,"abstract":"<p><strong>Background: </strong>Complementary feeding (CF) recommendations are generally based on international guidelines; however, several clinical issues remain controversial, resulting in variability in professional practice. This study aimed to develop evidence-informed expert consensus on complementary feeding recommendations and to explore the reasons underlying persistent disagreement.</p><p><strong>Methods: </strong>In this national evidence-informed modified Delphi study in Türkiye, 58 pediatricians working in Social Pediatrics participated in the first round and evaluated 53 statements using a five-point Likert scale. Statements not reaching consensus were revised based on participants' comments and reevaluated in a second round. Thirteen unresolved statements underwent a third round involving evidence presentation and structured online discussion with 23 participants; 22 subsequently completed the final re-rating. Audio-recorded discussions and written comments were analyzed using reflexive thematic analysis in MAXQDA Analytics Pro 24.</p><p><strong>Results: </strong>Consensus was achieved for most recommendations regarding the timing of CF, developmental readiness, responsive feeding, and several feeding practices. Persistent disagreement remained for recommendations concerning formula-fed infants, infants with poor weight gain, preterm infants, baby-led weaning (BLW), vegan CF, bottle use, and selected allergy-related practices. Qualitative analysis generated five overarching themes: (1) individualization beyond fixed age thresholds; (2) balancing nutritional priorities with developmental safety and feasibility; (3) risk-stratified introduction of allergenic foods; (4) conditional rather than universal acceptance of BLW; and (5) ethical and clinical tensions surrounding vegan CF. Experts generally agreed on the underlying scientific principles but emphasized that recommendations should incorporate developmental readiness, clinical judgment, family circumstances, cultural context, and implementation feasibility rather than relying on rigid or universal recommendations.</p><p><strong>Conclusions: </strong>Integration of quantitative Delphi findings with qualitative thematic analysis revealed that non-consensus primarily stemmed from the practical nuances of clinical execution and contextual adaptation, rather than a fundamental skepticism toward the underlying scientific data. These findings provide an evidence-informed foundation for developing context-sensitive CF recommendations for clinical practice.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-12"},"PeriodicalIF":2.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic pathways are associated with increased estimated cardiovascular risk in major depressive disorder: a QRISK3-based analysis.","authors":"Serpil Ceylan Hoca, Ubeyd Turgut Demirel, Emre Hoca","doi":"10.1080/00325481.2026.2746141","DOIUrl":"https://doi.org/10.1080/00325481.2026.2746141","url":null,"abstract":"<p><strong>Background: </strong>Depression and anxiety are among the most commonly encountered disorders in psychiatric practice. Previous studies have shown that both cardiovascular disease and cardiovascular risk are increased in these disorders. This study aimed to investigate the potential relationship between depression, anxiety, and cardiovascular risk by utilizing the QRISK3 cardiovascular risk algorithm. It also aimed to explore the potential explanatory roles of metabolic and inflammatory processes on cardiovascular risk.</p><p><strong>Methods: </strong>After obtaining ethical approval, patients who met the inclusion criteria (<i>n</i> = 229) were divided into three groups: patients with depression (<i>n</i> = 78), patients with anxiety (<i>n</i> = 91), and a control group (<i>n</i> = 60) with no significant psychiatric disorder according to the Structured Clinical Interview for DSM-5. The laboratory parameters of the patients were evaluated, and their cardiovascular risks were determined according to the QRISK3 score.</p><p><strong>Results: </strong>When the data were compared between the patient groups in pairs and trios, it was observed that the relative risk of QRISK3 was higher in the patient group with depression than in the other two groups. Exploratory mediation analyses suggested that metabolic markers, rather than inflammatory markers, were associated with higher estimated cardiovascular risk in the depression group.</p><p><strong>Conclusion: </strong>The increased cardiovascular risk in depressed patients appears to be largely explained by metabolic factors such as the triglyceride/glucose index. Therefore, cardiovascular risk assessment is essential in patients with depression, a highly prevalent condition in psychiatric practice, and biochemical markers may be useful in this context.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-10"},"PeriodicalIF":2.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sweet syndrome and thyroid diseases: a case-based review of a possible association.","authors":"Simatul Rashid, Nicholas Gulati, Maaike van Gerwen","doi":"10.1080/00325481.2026.2743392","DOIUrl":"https://doi.org/10.1080/00325481.2026.2743392","url":null,"abstract":"<p><p>Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is a rare dermatological condition characterized by the abrupt onset of tender, erythematous skin lesions, often presenting with fever and systemic inflammation. It is commonly associated with infection, malignancy, and medication exposure. Isolated case reports have described the co-occurrence of Sweet syndrome and thyroid disease, but these reports have not previously been collected or appraised together. A case-based narrative review was conducted using published case reports and case series describing patients with both conditions. Eight cases were identified, involving Hashimoto thyroiditis, subacute thyroiditis, transient autoimmune thyroiditis, Graves' disease, and papillary follicular thyroid carcinoma. These reports suggest a possible association rather than a causal relationship; neither the direction nor the mechanism of any such relationship can be determined from the available evidence, and confounding, diagnostic lag, and chance co-occurrence remain plausible explanations. The temporal relationship between the two varies, with Sweet syndrome occurring before, concurrently with, or after the thyroid disease diagnosis. Most cases of Sweet syndrome improved with corticosteroids, and outcomes for both diseases were generally favorable with appropriate management. Given that the existing literature is limited to case reports, the true prevalence of this co-occurrence remains unknown. Larger comparative studies are needed to determine whether a meaningful association exists.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-6"},"PeriodicalIF":2.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors' reply regarding: 'Anti-TNF-induced vasculitis: analysis of data from the French national pharmacovigilance database'.","authors":"Facundo Izquierdo, Greta Gourier, Caroline Clabecq, Elliot Ewig, Florelle Bellet, Romain Barus, Pauline-Eva Pecquet, Bénédicte Rouvière","doi":"10.1080/00325481.2026.2740277","DOIUrl":"https://doi.org/10.1080/00325481.2026.2740277","url":null,"abstract":"","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-2"},"PeriodicalIF":2.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory depression with concomitant use of opioids and cannabinoids: a case report.","authors":"Cody L Messick, Molly Svendsen, Joshua Codding, Marla Rejbi","doi":"10.1080/00325481.2026.2739680","DOIUrl":"https://doi.org/10.1080/00325481.2026.2739680","url":null,"abstract":"<p><strong>Background: </strong>The United States has had a 15-fold increase in daily cannabis use in the last 30 years. There is a growing importance for palliative care physicians to understand the pharmacological interactions between high-dose opioids and cannabinoids when treating patients with cancer-related pain who are increasingly concomitantly using cannabinoids. We present a case of respiratory depression following high‑dose THC and opioids. We discuss proposed mechanistic interactions, the importance of cannabinoid use in social history, and the role of proactive counseling of patients with concomitant use.</p><p><strong>Case report: </strong>A middle-aged patient with metastatic stage IV rhabdomyosarcoma presented to the hospital for management of abdominal distension and severe pain. Palliative care was consulted for cancer-related pain management and goals-of-care conversation. Hydromorphone patient-controlled analgesia (PCA) was started along with methadone on the second day. Following a goals-of-care discussion regarding the terminal prognosis, the patient independently took 100 mg THC/CBD tincture to manage anxious emotions. Later that evening, the patient developed bradypnea and unresponsiveness, recovering fully after two administrations of naloxone. After a brief intermission, PCA was increased without further respiratory depression despite overall higher morphine equivalent daily dose.</p><p><strong>Conclusions: </strong>In our case, we describe how 100 mg cannabinoid product was a contributing factor in acute opioid toxicity possibly due to active inhibition of UGT2B7 (UDP-glucuronosyltransferase 2B7), a liver enzyme crucial in the metabolism of morphine. For patients who use cannabis, explicit counseling regarding the risks of combining high-dose opioids with high-dose cannabinoids is needed. Proactive counseling with patients in this changing landscape of cannabinoid use will become essential for their safety in the treatment of cancer-related pain.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-4"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}