Postgraduate medicine最新文献

{"title":"Ponatinib in CML and Ph+ ALL: balancing high efficacy with vascular safety.","authors":"Arihant Senthil, Aarushi Gupta, Vasu Bansal, Caroline Antony, Yash Vardhan Trivedi, Navjot Kaur, Rohit Jain","doi":"10.1080/00325481.2026.2691687","DOIUrl":"10.1080/00325481.2026.2691687","url":null,"abstract":"<p><p>Chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) are driven by the BCR:ABL1 fusion and remain highly responsive to tyrosine kinase inhibitors (TKIs). Ponatinib, a third-generation TKI, uniquely retains activity against the T315I 'gatekeeper' mutation and most other BCR:ABL1 variants, producing deep cytogenetic and molecular responses in resistant CML and improving survival in Ph+ ALL. Across the PACE and OPTIC programs, frontline Ph+ ALL combinations (hyper-CVAD- and blinatumomab-based), and real-world cohorts, ponatinib demonstrates robust antileukemic efficacy in diverse settings and after multiple prior TKIs. However, its multikinase profile confers a clinically meaningful risk of arterial occlusive events (AOEs)-including coronary, cerebrovascular, and peripheral arterial complications-whose incidence is shaped by baseline cardiovascular risk and overall drug exposure. Mechanistic studies suggest that endothelial dysfunction, pro-inflammatory signaling, impaired nitric oxide bioavailability, and microvascular rarefaction contribute to ponatinib-associated vascular toxicity. Clinically, response-based dosing-such as step-down from 45→30→15 mg in CML or 30→15 mg in Ph+ ALL upon molecular milestones-preserves efficacy while reducing exposure-related AOE risk, though events are not eliminated. Emerging cardio-oncology strategies can further mitigate harm: baseline risk stratification (e.g. SCORE2/SCORE2-OP, HFA-ICOS), aggressive management of blood pressure and lipids, selective antiplatelet prophylaxis in high-risk profiles, and close longitudinal surveillance. Overall, contemporary evidence supports ponatinib as a high-potency option for T315I disease and multi-tyrosine kinase inhibitor (TKI) resistance, and as a practical component of modern Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) therapy, provided that dosing is individualized and cardiovascular risk is proactively managed. Future priorities include refining patient selection, validating preventive cardio-oncology bundles, and defining minimal-effective exposure thresholds that sustain durable disease control with the lowest feasible vascular liability.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"665-675"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427825","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":"Administration of COVID-19 vaccination to adult caregivers in pediatric outpatient clinics: a vaccination cocooning project.","authors":"Lauren Rostkowski Jensen, Molly Posa, Stephanie Filipp, Maria Kelly, Jaclyn Otero","doi":"10.1080/00325481.2025.2482513","DOIUrl":"10.1080/00325481.2025.2482513","url":null,"abstract":"<p><strong>Background: </strong>Vaccination against COVID-19 is safe for patients greater than 6 months of age and reduces virus infectivity and severity. One strategy for protecting children unable to be vaccinated is cocooning, a concept that protects at-risk individuals by vaccinating adult caregivers (ACs). This study evaluates AC characteristics of those receiving COVID-19 vaccination in pediatric healthcare clinics.</p><p><strong>Methods: </strong>This study is a retrospective chart review that identified ACs greater than 21 years of age who received a COVID-19 vaccine at one of six UFHealth pediatric offices between March 2021-April 2022. Investigators collected demographic information of the AC and corresponding child.</p><p><strong>Results: </strong>The AC sample was predominantly female (79.8%), parents (75.3% mothers, 19.3% fathers), White (48.2%) or Black/African American (33.7%). Those who completed both primary doses had higher rates of children less than 5 years compared to those who did not (48.2%, 37.2%; p-value: 0.0225). ACs completing both primary doses were also younger compared to their counterparts (37.0, 39.9 years; p-value: 0.0017), with double the rate of government-funded insurance (42.9%, 20.9%; p-value: <0.0001), and significantly different racial/ethnic distribution (p-value 0.0021).</p><p><strong>Conclusions: </strong>ACs who completed both primary doses were younger females and had higher rates of children under 5 years old. We believe these results reflect the convenience of offering AC vaccines at pediatric healthcare clinics because of the high frequency of well-child checks within the first 5 years of life. This cohort also had double the rate of government-funded insurance, attributable to the free administration of COVID-19 vaccines at UF-affiliated pediatric clinics.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"729-735"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712636","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":"Managing patients with cardiovascular-kidney-metabolic syndrome: a guideline-driven practical guide for primary care physicians.","authors":"Steve Fordan, Imran Afridi, Andrew Garza, Roberto L Collazo-Maldonado","doi":"10.1080/00325481.2026.2686460","DOIUrl":"10.1080/00325481.2026.2686460","url":null,"abstract":"<p><p>Cardiovascular-kidney-metabolic (CKM) syndrome is a systemic disorder characterized by an overall reduction in cardiovascular health that occurs as a result of the development of ≥2 cardiovascular, kidney, or metabolic risk factors. Prevalence of CKM syndrome and its contributing conditions is rising, carrying an associated increase in excess morbidity, premature mortality, and direct and indirect health-related expenditures for patients, particularly for individuals with adverse social determinants of health. The growing body of evidence supporting CKM syndrome as a single, multifactorial disease underscores the importance of implementing an overarching, interdisciplinary therapeutic approach for the prevention and management of each facet of the disease. The recent development of several therapies with multiple benefits for cardiovascular, kidney, and metabolic health provides an important opportunity to facilitate the development of treatment plans that address the root cause of CKM syndrome for patients in early stages and to alleviate symptoms, delay progression, and improve quality of life in later stages of the syndrome. These developments provide a challenge for primary care physicians (PCPs) to ensure they are managing patients at their current disease stage, with the most appropriate combination of therapies available. This review aims to provide PCPs with a guideline-driven, practical guide to facilitate these decisions on the most appropriate management path for different scenarios for patients with CKM syndrome.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"643-653"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407652","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":"Hyperglycemic chorea: clinical insights and a narrative review of case reports.","authors":"Amteshwar Singh, Ram Agrawal, Waseem Khaliq","doi":"10.1080/00325481.2026.2690294","DOIUrl":"10.1080/00325481.2026.2690294","url":null,"abstract":"<p><p>Hyperglycemic chorea (HC), also known as diabetic striatopathy, is a rare, potentially reversible complication of poorly controlled diabetes mellitus. It manifests as involuntary, often unilateral, choreiform or ballistic movements. Despite its clinical significance, HC remains underrecognized, and its pathophysiology is not fully understood. We present a case of HC and a narrative review of the published case reports to characterize its epidemiology, clinical features, imaging findings, treatment, and outcomes. We conducted a narrative review of case reports and case series on HC using PubMed/MEDLINE from inception to 1 September 2024, following PRISMA guidelines. Inclusion criteria were English-language reports of adult patients (≥18 years) with chorea attributed to hyperglycemia. A total of 80 publications encompassing 100 patients were included. The mean age was 66.6 years, with a female predominance (67%). Hemichorea was more common (71%), with left-sided preponderance. Most patients (75%) had a prior diagnosis of diabetes, and the mean presenting blood glucose and HbA1c were 468 mg/dL and 13.7%, respectively. Imaging revealed basal ganglia hyperintensity on MRI in 80% of cases. Treatment primarily involved insulin therapy, with 69% receiving adjunctive anti-chorea medications. Symptom resolution occurred in 73.9% of patients, with a mean recovery time of 36.7 days. HC is an important differential diagnosis for acute-onset chorea in elderly patients with uncontrolled diabetes. Prompt recognition and glycemic control are key to symptom resolution. Neuroimaging, particularly MRI, plays a crucial role in diagnosis, and adjunctive pharmacotherapy may aid in symptom management.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"676-686"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280569","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":"CV risk: if you aren't testing ACR, you aren't seeing the full picture.","authors":"Ana Cebrián, David C Wheeler, Nikolaus Marx, Adeera Levin","doi":"10.1080/00325481.2026.2692262","DOIUrl":"10.1080/00325481.2026.2692262","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) remains a hidden epidemic, under-recognized and under-diagnosed, despite widespread recognition of the benefits of systematic screening of at-risk individuals and early diagnosis. CKD is an important driver of cardiovascular risk, even in the early stages before a diagnosis has been made. An elevated albumin-to-creatinine ratio is an independent cardiovascular (CV) risk factor, and importantly, it is modifiable. Inclusion of urinary albumin-to-creatine ratio testing enables detection of CV risk and CKD before estimated glomerular filtration rate declines and allows for implementation of guideline‑directed therapy at the earliest point where it is clinically indicated. Inclusion of urinary albumin-to-creatinine ratio as part of routine testing of at-risk individuals in standard practice would enable early intervention with guideline-directed medical therapies to optimize outcomes and alter disease progression. Individuals at risk of CKD include, but are not limited to, those with type 2 diabetes, CV disease, or hypertension, all conditions that can cause early, often silent, kidney damage. In these populations, measuring the urine albumin-to-creatinine ratio enables early detection of CKD and CV risk, allowing timely initiation of guideline-directed therapies to prevent disease progression. Although this podcast presents expert opinion, rather than original research, all recommendations are guideline-driven and evidence-based, rather than opinion-based.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"623-627"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392885","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":"The role of type D personality in pregnancy symptom severity, functional limitations, and maternal ambivalence.","authors":"Alihan Tigli, Yakup Baykus, Burcu Cilingir, Guzide Ece Akinci, Nazli Sener, Yasemin Ercan Degirmenci, Erdem Gurkan, Oguzhan Karakoc, Guler Tekcan, Rulin Deniz","doi":"10.1080/00325481.2026.2696099","DOIUrl":"10.1080/00325481.2026.2696099","url":null,"abstract":"<p><strong>Back and objectives: </strong>Pregnancy is a biopsychosocial process in which personality traits may influence the perception of physical symptoms and emotional adaptation to motherhood. Type D personality, defined by negative affectivity (NA) and social inhibition (SI), has been associated with adverse mental health outcomes, yet its relationship with pregnancy symptom burden and maternal ambivalence remains unclear. This study aimed to investigate the associations between Type D personality characteristics, pregnancy symptom frequency, symptom-related functional limitations, and maternal ambivalence.</p><p><strong>Methods: </strong>This cross-sectional study included 336 pregnant women attending a tertiary care hospital. Participants completed the Type D Personality Scale (DS-14), the Pregnancy Symptom Inventory (PSI), and the Maternal Ambivalence Scale (MAS). Crude and adjusted linear regression models were used to examine the associations of negative affectivity, social inhibition, and their interaction with pregnancy symptom frequency, symptom-related functional limitations, and maternal ambivalence.</p><p><strong>Results: </strong>Type D personality was identified in 12.2% of participants. In adjusted models, NA was significantly associated with increased pregnancy symptom frequency (β = 0.412, <i>p</i> < 0.001) and greater symptom-related functional limitations (β = 0.343, <i>p</i> < 0.001), whereas SI and the NA × SI interaction were not significantly associated with these physical symptom outcomes. For maternal ambivalence, nominal associations were observed for NA and SI across several domains. After false discovery rate correction, the most robust adjusted associations were observed between SI and total maternal ambivalence and between NA and the doubt dimension. The NA × SI interaction for suppression was nominally significant but did not remain significant after false discovery rate correction.</p><p><strong>Conclusions: </strong>Negative affectivity appears to be the main Type D personality component associated with pregnancy-related symptom burden and functional limitations. Social inhibition may be relevant to maternal ambivalence, particularly the total score, while the possible role of the combined NA × SI profile in suppression of ambivalent maternal emotions requires cautious interpretation. These findings highlight the importance of considering personality-related psychosocial characteristics in antenatal assessment.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"759-769"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148348091","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":"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":"10.1080/00325481.2026.2696097","DOIUrl":"10.1080/00325481.2026.2696097","url":null,"abstract":"<p><strong>Objectives: </strong>The increasing use of tumor necrosis factor (TNF) inhibitors poses new challenges in terms of drug iatrogenicity and diagnosis. In this study, we focus on the description of the TNF-inhibitors-induced vasculitis.</p><p><strong>Methods: </strong>We conducted a retrospective descriptive study using the French national pharmacovigilance database to study cases of vasculitis attributable to TNF-inhibitor treatment.</p><p><strong>Results: </strong>A total of 164 cases were analyzed, patients' mean age was 49.1 years, and 61.4% were women. The indications for TNF-inhibitor therapy were Crohn's disease (27%), rheumatoid arthritis (27%) and ankylosing spondylitis (21%). The median time to onset of vasculitis was 390 days [120-1095]. Clinical manifestations included cutaneous manifestations (88%), mainly purpura, rheumatic manifestations (27%), general symptoms (15%), renal manifestations (14%) and gastrointestinal and neurological manifestations (8% each). Skin biopsy was the most important diagnostic test, with 67.7% of cases showing vasculitis. Our study found mainly nonspecific vasculitis (54.9%), IgA vasculitis (28%) and ANCA vasculitis (7.9%). A possible association was observed between IgA vasculitis and TNF-inhibitors treatment for Crohn's disease, compared with other indications.</p><p><strong>Conclusion: </strong>Our study, based on national pharmacovigilance data, provides a better characterization of TNF-inhibitor-induced vasculitis. Resolution of vasculitis upon TNF inhibitor discontinuation, followed by recurrence upon reintroduction, confirms the drug's causative role and suggests that treatment should be stopped if possible. Clinicians should exercise heightened vigilance for symptom onset within the first 500 days of therapy. The atypical features of certain vasculitis, particularly from an epidemiological perspective given the unusual age at presentation, should prompt consideration of an iatrogenic etiology, including potential anti-TNF involvement.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"736-750"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392374","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":"A plain language summary: an overview of objective (scientific) data and patient experiences showing how effective lemborexant is for treating insomnia.","authors":"Charles M Morin, Alex Desautels, Dinesh Kumar, Kate Pinner, Barbara Ramos, Margaret Moline","doi":"10.1080/00325481.2026.2696101","DOIUrl":"10.1080/00325481.2026.2696101","url":null,"abstract":"","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"628-642"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521805","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":"Risk of adverse effects of the concomitant use of statins with calcium channel blockers: a systematic review and meta-analysis.","authors":"Ilil Maidatuz Zulfa, Hindun Wilda Risni, Ruth Brauer, Cate Whittlesea, Li Wei","doi":"10.1080/00325481.2026.2693370","DOIUrl":"10.1080/00325481.2026.2693370","url":null,"abstract":"<p><p>Calcium channel blockers (CCBs) and statins are commonly combined to prevent cardiovascular diseases (CVDs). However, their concomitant use may lead to drug-drug interactions (DDIs) and increased adverse effects (AEs). This systematic review and meta-analysis aimed to evaluate the evidence of adverse effects (AEs) associated with the calcium channel blockers (CCBs) and statins concomitant use. We searched MEDLINE, Embase, Web of Science, and CENTRAL from database inception to 4 April 2025. Eligible studies included randomized controlled trials (RCTs) and observational studies reporting AEs of CCB-statin combinations compared with CCB or statin treatment in adults. Outcomes assessed included CCBs- and statins-associated AEs, treatment discontinuation, hospitalization, and all-cause mortality. Meta-analyses of similar outcomes were performed to estimate pooled Odds Ratios (OR) with 95% confidence intervals (CI). Of 9,737 articles screened, 20 studies (<i>n</i> = 1,053,198) were included. Peripheral edema, myalgia, and discontinuation were most reported in 11, 7, and 9 studies, respectively. Meta-analyses demonstrated no significant differences in the risk of peripheral edema (OR 1.03, 95% CI 0.14-1.48), myalgia (OR 1.33, 95% CI 0.63-2.79), or discontinuation (OR 0.78, 95% CI 0.50-1.23 for CCB-statin vs. CCB; OR 0.97, 95% CI 0.68-1.38 for CCB-statin vs. statin). However, evidence of other AEs was inconsistent and limited. CCB-statin combination appears generally safe in a short-term use (3 to 6 months). Further research is warranted to clarify the long-term risk of AEs.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"705-720"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148335294","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":"Perceptions of secure text messaging systems: a cross-sectional survey of hospitalist physicians and advanced practice providers.","authors":"Mukul Sharda, Madison J McGuire, Arjan Bindra, Abrahim N Razzak, Talha Ahmad, Sanjay Bhandari, Alisha Sharma, Pinky Jha","doi":"10.1080/00325481.2026.2691355","DOIUrl":"10.1080/00325481.2026.2691355","url":null,"abstract":"<p><strong>Introduction: </strong>Secure text messaging systems (STMS) have largely replaced pagers in inpatient care, yet their operational, workflow, and safety implications in hospital medicine remain poorly understood. We evaluated perceived benefits, challenges, and improvement opportunities related to STMS use among hospitalist physicians and advanced practice providers (APPs) at a large academic medical center.</p><p><strong>Methods: </strong>We conducted a cross-sectional, anonymous survey of 133 hospitalist physicians and APPs using Likert-scale items addressing message volume, urgency, platform preference, teamwork, workflow, safety, and well-being, along with open-ended questions. Quantitative data were summarized descriptively, and qualitative responses were analyzed using inductive thematic analysis.</p><p><strong>Results: </strong>Sixty-four clinicians responded (48.1% response rate), with 59 complete surveys analyzed. Over half (57.6%) reported using STMS more than pagers, and more than 80% received ≤50 messages daily. Nearly all respondents rated message urgency as low to moderate. While most reported improved multidisciplinary coordination (93.2%) and teamwork (79.7%), 50.9% experienced alarm fatigue or cognitive overload, and 49.2% reported negative effects on well-being. Physicians were more likely than APPs to perceive adverse effects on teamwork (mean 2.71 vs. 3.50, <i>p</i> = 0.006). Qualitative themes included message overload, workflow disruption, and safety risks related to missed or delayed responses. Suggested improvements included urgency labeling, role-based routing, and clearer communication protocols.</p><p><strong>Conclusion: </strong>STMS are valued for care coordination but may simultaneously contribute to communication burden, workflow fragmentation, and safety concerns. Hospital systems should adopt governance strategies, including triage tools, training, and role-specific expectations, to optimize digital communication while protecting clinician well-being and patient safety.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"721-728"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280582","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}