Postgraduate medicine最新文献

{"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}

{"title":"Clinical pharmacokinetics of colistimethate sodium and formed colistin in patients with renal impairment or on dialysis modalities: a systematic review and implications for precision dosing.","authors":"Asha K Rajan, Maria Ioana Onofrei, Ananya Rudra, Soumyajeet Paul, Vishal Shanbhag, Meghana Deepak Madi, Chakrapani Mahabala, Vijayanarayana Kunhikatta, Ravindra Prabhu Attur, Surulivelrajan Mallayasamy, Souvik Chaudhuri, Girish Thunga","doi":"10.1080/00325481.2026.2692127","DOIUrl":"10.1080/00325481.2026.2692127","url":null,"abstract":"<p><strong>Background: </strong>Optimizing colistin dosing in patients with renal impairment, particularly those undergoing renal replacement therapy (RRT), remains a major challenge due to complex and variable pharmacokinetics. This systematic review identifies key covariates affecting pharmacokinetics of colistimethate sodium (CMS) and its active form colistin and evaluates dosing variability in patients with renal impairment, including those receiving RRT.</p><p><strong>Methods: </strong>Systematic searches of PubMed, Embase, Scopus, and Cochrane Library (up to November 2025) identified studies reporting the pharmacokinetics of intravenous CMS, formed colistin or colistin sulfate (nebulized CMS used as adjuvant in some studies) in adults with renal impairment or on RRT. Data on dosing regimens, dialysis characteristics, pharmacokinetic parameters, and covariates were extracted, and methodological quality was appraised using validated pharmacokinetic criteria.</p><p><strong>Results: </strong>Thirteen studies (<i>n</i> = 450) met inclusion. CMS clearance was primarily determined by renal function and dialysis-related parameters were the most consistent determinants of pharmacokinetics, while additional covariates such as cystatin C, ALT, hematocrit, and body weight were identified in individual studies. In patients undergoing SLEDD, extracorporeal clearance was reported to account for up to 67% of total drug clearance in a single study. Standardized CMS dosing regimens often failed to achieve pharmacodynamic targets for formed colistin (fAUC/MIC ≥12).</p><p><strong>Conclusions: </strong>Colistin pharmacokinetics in patients with renal impairment and those receiving renal replacement therapy are highly variable and influenced by both renal and non-renal factors, including dialysis modality. Standard dosing regimens frequently fail to achieve pharmacodynamic targets, highlighting the need for individualized, physiology-based dosing strategies. Integration of renal function, RRT parameters, and emerging biomarkers such as cystatin C, alongside therapeutic drug monitoring, is essential to optimize efficacy while minimizing toxicity in this high-risk population.</p><p><strong>Prospero: </strong>www.crd.york.ac.uk/prospero identifier is CRD42021294141.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"687-704"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148355165","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":"Evidence-informed guidance for the clinical use of oral semaglutide in obesity management.","authors":"Domenica Rubino, Sean Wharton, Michael G Knight, Vanita R Aroda","doi":"10.1080/00325481.2026.2686467","DOIUrl":"10.1080/00325481.2026.2686467","url":null,"abstract":"<p><p>Oral semaglutide, the first oral glucagon-like peptide-1 (GLP-1) receptor agonist therapy approved for the treatment of type 2 diabetes, is now approved for obesity management and cardiovascular risk reduction in adults, demonstrating weight loss comparable to that of subcutaneous GLP-1 therapies, alongside improvements in cardiometabolic risk factors. The availability of oral semaglutide for the treatment of obesity provides healthcare professionals with additional opportunities to individualize therapy based on patient preferences, lifestyle, and clinical circumstances. However, the oral semaglutide formulation requires specific administration conditions to optimize absorption and effectiveness. Notably, oral semaglutide tablets should be taken first thing in the morning on an empty stomach with no more than half a glass of plain water (up to 120 mL or 4 fl oz), followed by 30 min before eating food, drinking additional fluids, or ingesting other oral medications. Person-centered clinical discussions between healthcare professionals (HCPs) and patients prior to treatment initiation are important to ensure patients understand administration requirements and why they are necessary, establish realistic expectations for obesity treatment targets, and cover approaches to maintain adherence. HCP-patient consultations should also include discussion of strategies to help patients minimize, prepare for, and manage adverse events. In this article, we provide practical guidance for incorporating oral semaglutide into obesity management, drawing on evidence from clinical trials, including the OASIS 4 trial, and the authors' clinical insights.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"654-664"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240938","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 prevalence of functional iron deficiency and its impact on mortality in patients receiving hemodialysis.","authors":"Can Hüzmeli, Ayşe Şeker, Elif Durak Ediboğlu","doi":"10.1080/00325481.2026.2692142","DOIUrl":"10.1080/00325481.2026.2692142","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a major global public health concern and has reached epidemic proportions worldwide, including in our country. Iron deficiency and functional iron deficiency (FID) are common among CKD patients. The objective of this study was to examine the prevalence of FID and its effect on mortality in hemodialysis (HD) patients.</p><p><strong>Methods: </strong>A retrospective observational study was conducted between 2010 and 2024 in patients receiving HD in our hospital. Patients who had been on HD for at least three months were included in the study. Exclusion criteria included peritoneal dialysis, home HD, and age under 18 years.</p><p><strong>Results: </strong>The study included 3184 patients receiving HD (mean age 64.4 ± 13.5 years; 58% male). FID was present in 448 patients (14.1%), while absolute iron deficiency (AID) was identified in 123 (3.9%) of the patients. The overall survival was 97% at 3 months, 85% at 12 months, and 44% at 60 months in patients with FID. Mortality was significantly higher in the FID group compared to other groups (<i>p</i> < 0.05). When we investigated the related factors with mortality in patients with FID, we found that female sex, diabetes mellitus history, and serum albumin levels at diagnosis were the independent factors associated with mortality in patients with FID.</p><p><strong>Conclusions: </strong>The prevalence of FID was determined to be 14.1% in our study. Survival rates in patients with FID declined markedly over time, highlighting the adverse prognostic impact of this condition. Early recognition of FID and careful management of modifiable risk factors, particularly nutritional status, may help improve survival in this high-risk population.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"751-758"},"PeriodicalIF":2.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298130","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":"Divergent prescribing paradigms in cardiovascular care: a comparative analysis of government and private healthcare settings in Goa, India.","authors":"Gianine Megan Lobo, Felicia Mascarenhas, Aditi Vasudev Parab, Tanishq Kurdikar, Liesl Maria Fernandes E Mendonca, Padmanabh V Rataboli","doi":"10.1080/00325481.2026.2707833","DOIUrl":"https://doi.org/10.1080/00325481.2026.2707833","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular diseases (CVDs) are the leading cause of mortality globally and a growing burden in India. This study aimed to assess prescribing patterns for CVDs across government and private healthcare sectors in Goa, India, focusing on rational drug use and safety.</p><p><strong>Research design and methods: </strong>A retrospective, cross-sectional prescription audit of 400 CVD-related prescriptions (200 each from government and private facilities) was conducted between February to April 2025. Data were sourced from digitized prescription records and dispensing databases of government and private healthcare pharmacies. All data were extracted in an anonymized and de-identified format to ensure patient privacy. Primary outcomes measured included polypharmacy, National list of essential medicines (NLEM) compliance, generic and branded drug use, fixed dose combination (FDC) frequency, high-risk drugs used, drug-drug interactions (DDI), and prescribing errors. All records were validated by experienced healthcare professionals. Mann-Whitney U test was employed to evaluate the statistical significance between the prescribing patterns across government and private healthcare sectors.</p><p><strong>Results: </strong>There were significant <i>(U = 8813.5, Z = -9.69, p < 0.001)</i> sectoral disparities observed in prescribing trends. Government prescriptions exhibited use of generic drugs, and fewer FDCs, but had higher incidence of polypharmacy and prescription errors. Private prescriptions exhibited lower NLEM adherence, fewer drugs per prescription, greater use of branded drugs, fixed dose combinations, high-risk medications and potentially greater drug-drug interactions.</p><p><strong>Conclusion: </strong>Substantial sectoral differences in prescribing patterns highlight the need for standard guidelines and prescriber education on rational drug use to optimize patient safety in both healthcare settings.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-12"},"PeriodicalIF":2.8,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148611419","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":"Response to: \"finasteride prescribed for hair loss consistently leads to depression\".","authors":"Minh-Ha Nguyen, Tien H Tran, Jeffrey Donovan","doi":"10.1080/00325481.2026.2708413","DOIUrl":"https://doi.org/10.1080/00325481.2026.2708413","url":null,"abstract":"","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-3"},"PeriodicalIF":2.8,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595286","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":"Finasteride prescribed for hair loss consistently leads to depression. Comment on 'Depression risk of 5-alpha reductase inhibitors: impact of active-comparator versus non-drug user control groups on risk measurement'.","authors":"Mayer Brezis","doi":"10.1080/00325481.2026.2708396","DOIUrl":"https://doi.org/10.1080/00325481.2026.2708396","url":null,"abstract":"","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-2"},"PeriodicalIF":2.8,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581658","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":"Relationship of serum nesfatin-1 levels with body mass index and c-reactive protein in patients presenting to the emergency department with epileptic seizures.","authors":"Timur Sarac, Yesim Isler, Halil Kaya, Melih Yüksel, Mehmet Oğuzhan Ay","doi":"10.1080/00325481.2026.2696625","DOIUrl":"https://doi.org/10.1080/00325481.2026.2696625","url":null,"abstract":"<p><strong>Introduction: </strong>Reliable biomarkers reflecting acute seizure activity in patients presenting to the emergency department remain insufficiently defined. This study aimed to compare serum nesfatin-1 levels in patients presenting with epileptic seizures and healthy controls, and to evaluate their associations with clinical, demographic, and inflammatory parameters.</p><p><strong>Methods: </strong>This cross-sectional study included 216 participants, comprising 131 patients admitted to the emergency department due to epileptic seizures and 85 age- and sex-matched healthy controls. Demographic characteristics, comorbidities, antiseizure medication use, seizure features, and laboratory parameters were recorded. Serum nesfatin-1 concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Group comparisons were performed using the Mann-Whitney U test, and correlations were analyzed with Spearman's correlation coefficient.</p><p><strong>Results: </strong>Serum nesfatin-1 levels were significantly higher in patients with epileptic seizures compared with controls (<i>p</i> < 0.001). C-reactive protein (CRP) levels were also elevated in the patient group (<i>p</i> < 0.05). Nesfatin-1 concentrations showed positive correlations with age, CRP levels, and seizure duration, and negative correlations with height and body weight (all <i>p</i> < 0.05). Additionally, sex, diabetes mellitus, congestive heart failure, and type of antiseizure medication were significantly associated with circulating nesfatin-1 levels.</p><p><strong>Conclusion: </strong>Serum nesfatin-1 levels are elevated in patients presenting with epileptic seizures and are associated with inflammatory markers, seizure duration, and metabolic parameters. These findings suggest that nesfatin-1 may reflect integrated neuroinflammatory and metabolic responses occurring during acute seizure episodes. Further prospective studies are required to determine its clinical utility and prognostic value.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-8"},"PeriodicalIF":2.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378882","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":"Operational and demographic predictors of leaving without being seen in a high-volume tertiary emergency department: a five-year case-control study.","authors":"Emine Kadioglu, Abuzer Özkan","doi":"10.1080/00325481.2026.2696684","DOIUrl":"https://doi.org/10.1080/00325481.2026.2696684","url":null,"abstract":"<p><strong>Background: </strong>Patients who leave the emergency department (ED) without being seen (LWBS) represent a critical quality and safety metric. Although most LWBS cases involve low-acuity presentations, some may have time-sensitive conditions, leading to delayed diagnoses, adverse outcomes, and increased healthcare utilization. To determine the prevalence, characteristics, and predictors of LWBS over a multi-year period in a high-volume tertiary ED in Türkiye.</p><p><strong>Methods: </strong>This retrospective case-control study included all adult ED visits between 1 January 2020, and 30 June 2025, at Taksim Training and Research Hospital. LWBS cases were identified from electronic medical records and compared with controls presenting during the same timeframes. Demographic, triage, temporal, and operational factors were analyzed, and binary logistic regression identified independent predictors.</p><p><strong>Results: </strong>From a total of 1,058,817 adult emergency department (ED) visits during the study period, 9,737 LWBS cases were identified, corresponding to an overall LWBS incidence of 1.0%. Annual LWBS counts ranged from 1,447 (14.9%) in 2020 to a peak of 2,995 (30.8%) in 2022, before declining to 450 (4.6%) in 2024. Patients who left without being seen were younger (mean 36.1 ± 15.0 years) and predominantly male (61.6%).The highest frequency of LWBS occurred during the evening shift (16:00-00:00) and among green-triage patients, with multivariable analysis confirming increased odds in these groups (evening shift OR = 4.99; 95% CI, 3.18-8.09). Night-shift presentations were associated with reduced LWBS risk (OR = 0.54; <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Younger age, evening presentation, and triage category were associated with LWBS in this high-volume tertiary emergency department. However, the predictive performance of the regression model was modest (AUC = 0.584), suggesting that additional patient-related, behavioral, and system-level factors may contribute to LWBS. Further studies are needed to better understand the determinants of this phenomenon.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"1-7"},"PeriodicalIF":2.8,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341689","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":"Polypharmacy and associated factors in patients with type 2 diabetes: a nationwide cross-sectional study (TEMD-2 polypharmacy study).","authors":"Fatma Tuğçe Şah Ünal, Asena Gökçay Canpolat, Rıfat Emral, Cem Haymana, İbrahim Demirci, Serpil Salman, Canan Ersoy, Fahri Bayram, İlhan Satman, Alper Sönmez, Demet Çorapçıoğlu, Temd-Study Group","doi":"10.1080/00325481.2026.2673267","DOIUrl":"10.1080/00325481.2026.2673267","url":null,"abstract":"<p><strong>Background: </strong>Polypharmacy is a growing concern in the management of patients with Type 2 diabetes mellitus (T2DM), as multiple comorbidities necessitate complex pharmacological regimens. However, excessive medication use has been associated with adverse drug reactions, medication non-adherence, and poor clinical outcomes. Understanding the impact of polypharmacy in patients with T2DM is essential for optimizing treatment strategies.</p><p><strong>Methods: </strong>This nationwide, cross-sectional study analyzed data from a 2023 survey involving 4,956 patients with T2DM across Türkiye. Polypharmacy was defined as the use of five or more medications. Demographic characteristics, comorbidities, diabetes-related complications, and laboratory parameters were compared between patients using 1-4 medications and those with polypharmacy. Logistic regression analysis identified independent predictors of polypharmacy.</p><p><strong>Results: </strong>Polypharmacy was observed in 46.7% (<i>n</i> = 2,312) of the patients. Those with polypharmacy were significantly older, had a longer diabetes duration, higher body mass index, and elevated systolic blood pressure (<i>p</i> < 0.001). The prevalence of macrovascular and microvascular complications was higher in this group (<i>p</i> < 0.001), and severe hypoglycemia was more frequent (<i>p</i> = 0.034). Regression analysis identified older age, longer diabetes duration, dyslipidemia, hypertension, nonalcoholic fatty liver disease, hypothyroidism, osteoporosis, coronary artery disease, cerebrovascular disease, neuropathy, and nephropathy as factors independently associated with polypharmacy (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Polypharmacy is highly prevalent in older adults with T2DM and is associated with an increased burden of complications. These findings highlight the importance of careful medication assessment in patients with T2DM with complex comorbidity profiles.</p><p><strong>Clinical trial registration: </strong>www.clinicaltrials.gov identifier is NCT06347445.</p>","PeriodicalId":94176,"journal":{"name":"Postgraduate medicine","volume":" ","pages":"557-566"},"PeriodicalIF":2.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936724","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}