Boulmpou A, Ciuca-Pana MA, Ileri C
… +7 more, Ullah I, Cacciatore S, Spadafora L, Bernardi M, Busnatu S, Biondi Zoccai G, Perone F
Postgrad Med J
· 2026 Mar · PMID 41873880
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Patients with chronic coronary syndromes deserve high attention and tailored management for the effective reduction of the residual cardiovascular risk. Long-term secondary prevention strategies are the key to reaching t...Patients with chronic coronary syndromes deserve high attention and tailored management for the effective reduction of the residual cardiovascular risk. Long-term secondary prevention strategies are the key to reaching this goal and mitigating the overall cardiovascular burden. Four pillars should be the cornerstones of the management of patients with chronic coronary syndromes: lifestyle interventions, cardiac rehabilitation, risk factor control and achievement of treatment targets, and guideline-directed medical therapy. These interventions should be personalized to achieve prevention and treatment goals in order to improve prognosis and health-related quality of life. Herein, we present a state-of-the-art review on the comprehensive cardiovascular risk assessment and secondary prevention among patients with chronic coronary syndromes. In addition, we provide practical guidance for the management of this patient population in complex clinical scenarios and specific groups, including those with heart failure, older adults, sex-specific considerations, high bleeding risk, atrial fibrillation, and chronic kidney disease.
Postgrad Med J
· 2026 Mar · PMID 41871207
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Physicians rely on clinical judgment and patients look for it. However, clinical judgment is infrequently discussed in the literature, and is often perceived as an intuitive art, that is likely to be replaced by technolo...Physicians rely on clinical judgment and patients look for it. However, clinical judgment is infrequently discussed in the literature, and is often perceived as an intuitive art, that is likely to be replaced by technology and artificial intelligence. This review offers a reconceptualization of the role of clinical judgment in current medical practice and research, informed by the extensive knowledge that has accumulated in psychosomatic medicine. Clinical judgment consists of three phases: collecting clinical information; interpretation and clinical reasoning; decision making. Interviewing is the primary method for gathering data. Clinical reasoning involves bringing together relevant information and formulating hypotheses, which result in decisions and therapeutic acts. Clinimetrics, the science of clinical measurements, facilitates physician's reasoning and organization of data. Improving the features of clinical judgment is likely to yield a highly effective precision medicine.
Postgrad Med J
· 2026 Mar · PMID 41869966
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BACKGROUND: Parkinson's disease (PD) is regarded as the second most common neurodegenerative disease. Accumulating evidence suggested an emerging effect of the dysregulation of the gut-brain axis in the neurodegenerative...BACKGROUND: Parkinson's disease (PD) is regarded as the second most common neurodegenerative disease. Accumulating evidence suggested an emerging effect of the dysregulation of the gut-brain axis in the neurodegenerative disease pathogenesis, mediated particularly by microbiota-derived metabolites in PD. The aryl hydrocarbon receptor (AHR) is of great importance in regulating central nervous system inflammation by sensing microbiota-derived metabolites. STRATEGY: AHR is a transcription factor activated by ligands, which can be activated locally or remotely by endogenous microbial metabolites. AHR signaling suppressed inflammation by activating anti-inflammatory and immunosuppressive responses, promoting intestinal host-microbiome homeostasis. The pathogenesis of PD is related to the activation of microglia and the occurrence of neuroinflammation. There is increasing attention that alterations in the intestinal flora and decreased AHR activity were closely associated with PD. CONCLUSION: The AHR-gut microbiota axis garnered increasing attention in PD research. In this review, we synthesize current clinical and preclinical evidence linking the AHR-gut microbiota axis to PD pathogenesis, and we highlight that pharmacological targeting of this pathway represents an emerging therapeutic strategy for PD.
Zou X, Mo S, Tang S
… +6 more, Shao M, Chen J, Chen F, Zhou L, Huang Z, Dong F
Postgrad Med J
· 2026 Mar · PMID 41834763
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PURPOSE: This study aimed to develop a comprehensive predictive model that integrates clinical factors, conventional ultrasound (US) features, and ultrasound viscosity imaging metrics to improve diagnostic accuracy in th...PURPOSE: This study aimed to develop a comprehensive predictive model that integrates clinical factors, conventional ultrasound (US) features, and ultrasound viscosity imaging metrics to improve diagnostic accuracy in thyroid nodules and to explore the role of viscosity metrics in differentiating benign and malignant thyroid nodules. METHODS: A total of 215 patients with thyroid nodules were included in the study, with 70% in the training set and 30% in the testing set. Univariate and multivariate logistic regression were employed to identify key predictors, resulting in the development of three models. Three models were developed: ModA (clinical factors), ModB (clinical factors and conventional US features), and ModC (clinical factors, conventional US features, and US viscosity imaging). The diagnostic efficacy of the models was evaluated and compared using receiver operating characteristic curves. RESULTS: Multivariate analysis revealed that factors, such as echogenicity, viscosity minimum (Vmin), and viscosity mean (Vmean), were significant risk factors for distinguishing between benign and malignant thyroid nodules. In the testing set, ModA demonstrated an Area Under the Curve (AUC) of 0.777, ModB exhibited an improvement to 0.922, and ModC demonstrated an AUC of 0.945. The findings indicate that ModC exhibits superior predictive accuracy for differentiating between benign and malignant thyroid nodules. CONCLUSION: The integration of US viscosity imaging with clinical factors and conventional US features can enhance the predictive performance of differentiation in thyroid nodules, offering a reliable clinical tool to support early and accurate diagnosis of thyroid nodules.
Ho JK, Chow AK, Wu TC
… +3 more, Leung LY, Tam HL, Tse G
Postgrad Med J
· 2026 Mar · PMID 41831015
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This systematic review and network meta-analysis (NMA) evaluated the efficacy and safety of dual antiplatelet therapy (DAPT) and triple antiplatelet therapy (TAPT) in East Asian patients with acute coronary syndrome. Twe...This systematic review and network meta-analysis (NMA) evaluated the efficacy and safety of dual antiplatelet therapy (DAPT) and triple antiplatelet therapy (TAPT) in East Asian patients with acute coronary syndrome. Twenty-six randomized controlled trials comparing DAPT (P2Y12 inhibitor with aspirin) or TAPT (cilostazol with clopidogrel-based DAPT) were included from four databases. Primary outcomes were major adverse cardiac events (MACEs) and major bleeding events. Frequentist NMA was performed using RRs. The reference comparator was clopidogrel-based DAPT. TAPT significantly reduced MACEs without increasing major bleeding events. Standard-dose potent P2Y12 inhibitor-based DAPT showed no MACE reduction but significantly increased major bleeding events. TAPT had the highest probability of reducing MACEs, while DAPT incorporating potent P2Y12 inhibitors with de-escalation had the highest probability of minimizing major bleeding events. To conclude, TAPT demonstrates promising efficacy without compromising safety, while de-escalation strategies appear effective in balancing the efficacy and safety of DAPT.
Postgrad Med J
· 2026 Mar · PMID 41830998
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PURPOSE OF REVIEW: Expectation effects-particularly the Pygmalion, Galatea and Golem effects-are well recognized in educational psychology but have been insufficiently explored within surgical training. This narrative re...PURPOSE OF REVIEW: Expectation effects-particularly the Pygmalion, Galatea and Golem effects-are well recognized in educational psychology but have been insufficiently explored within surgical training. This narrative review examines how supervisor expectations and reputational labeling influence learning opportunities, entrustment, performance, and well-being among surgical trainees. RECENT FINDINGS: Evidence from education and organizational psychology shows that expectations influence learners through four mechanisms: socio-emotional climate, instructional input, opportunities to demonstrate ability, and the nature of feedback. Emerging research in surgical education demonstrates similar patterns. Qualitative studies describe residents engaging in extensive impression management to meet perceived expectations, often suppressing help-seeking behaviors to avoid negative labels. Experimental work demonstrates that prior learner handover can significantly bias assessments; identical trainee performances are rated more favorably when preceded by a positive reputation. Informal faculty word-of-mouth remains a dominant source of trainee labeling, with implications for entrustment decisions and progression. Negative expectations can erode self-efficacy, heighten anxiety, contribute to burnout, complicate remediation, and may increase attrition. Conversely, high yet supportive expectations, combined with explicit performance goals and formative feedback, are associated with enhanced skill acquisition, motivation, and resilience. SUMMARY: Expectation effects represent a powerful but modifiable influence within surgical education. Training programs should cultivate growth-oriented expectations for all learners, minimize prejudicial labeling in assessment and handover processes, and design remediation pathways that support rather than stigmatize struggling trainees. Creating a culture that emphasizes coaching, transparency, and psychological safety is likely to improve trainee development, well-being, and patient care.
Postgrad Med J
· 2026 Mar · PMID 41785049
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PURPOSE OF THE STUDY: Access to postgraduate medical specialty training differs markedly across European Union (EU) and European Economic Area (EEA) countries. This review mapped and compared national pathways into medic...PURPOSE OF THE STUDY: Access to postgraduate medical specialty training differs markedly across European Union (EU) and European Economic Area (EEA) countries. This review mapped and compared national pathways into medical residency training across all EU/EEA states. STUDY DESIGN: Data were collected using a standardized template based on official governmental, university, and hospital sources, verified as current in October 2025. RESULTS: Five main access models were identified: immediate access through a national examination; immediate access without a national exam; delayed access following general medical training; delayed access with an additional examination; and mixed systems depending on the specialty. CONCLUSIONS: Each model presents distinct strengths and limitations. National Examinations promote transparency and merit-based selection but may limit individual choice, whereas direct access models enhance flexibility while risking inequality. Delayed access systems support professional development but may prolong training and delay workforce availability. This overview provides a concise reference to support informed decision-making on postgraduate training and mobility within Europe.
Kim HJ, Yoon J, Goh TS
… +3 more, Moon JK, Kim H, Lee SH
Postgrad Med J
· 2026 Feb · PMID 41744196
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BACKGROUND: Despite growing interest in using Chat-based Generative Pre-trained Transformer (ChatGPT) for academic writing, limited evidence exists regarding its ability to generate abstracts that are structurally compli...BACKGROUND: Despite growing interest in using Chat-based Generative Pre-trained Transformer (ChatGPT) for academic writing, limited evidence exists regarding its ability to generate abstracts that are structurally compliant and ethically acceptable in orthopedic surgery. OBJECTIVE: To assess the performance of ChatGPT-generated abstracts using only article titles from recent publications in major orthopedic journals. METHODS: We extracted 90 human-written abstracts from three leading orthopedic journals and used each title to generate abstracts with ChatGPT-3.5 and ChatGPT-4.0. A total of 180 AI-generated abstracts were created using a standardized prompt. Each abstract was evaluated for format compliance, adherence to word limit, word count, consistency in study design, sample size correlation, and conclusion relevance. Plagiarism and AI detectability were assessed. Four orthopedic surgeons independently reviewed a subset of abstracts to identify their source. RESULTS: GPT-4.0 achieved perfect compliance with journal format and word count, while GPT-3.5 met these criteria in 34.4% (31 of 90) and 86.7% (78 of 90) of cases, respectively (P < .001). However, only half of abstracts presented fully relevant conclusions. Plagiarism was flagged in 45% to 70% of cases across both detection programs. AI detection scores were significantly higher in GPT-generated abstracts than for human-written ones (P < .001). Human reviewers showed limited ability to distinguish between human and AI-generated abstracts, with minimal inter-rater agreement (Cohen's kappa = 0.25). CONCLUSION: Although ChatGPT, particularly GPT 4.0, can generate abstracts that meet structural requirements and reproduce surface-level elements of academic style, significant limitations remain in content accuracy, originality, and ethical considerations. Key messages What is already known on this topic: With the expanding application of artificial intelligence (AI) techniques, the development of large language models (LLMs) has enabled the generation of natural language with enhanced performance, driven by improved context handling, broader multimodal capabilities, and optimized architectures. However, their specific capacity to generate structurally compliant and ethically acceptable abstracts in the field of orthopedic surgery remains unclear. What this study adds: This study demonstrates that while GPT-4.0 achieves superior adherence to formatting and word counts compared to GPT-3.5, both models frequently generate inaccurate conclusions and exhibit high plagiarism rates, despite being difficult for human reviewers to distinguish from human-written text. How this study might affect research, practice, or policy: Although ChatGPT shows potential as a supportive tool for generating orthopedic research abstracts, our overall findings emphasize that its unregulated or exclusive use introduces significant ethical and practical concerns. To ensure the integrity of academic publishing, it is imperative to establish clear, field-specific guidelines that govern the responsible application of LLMs in scientific writing.
Falagas ME, Kontogiannis DS, Chatzimichalis M
… +1 more, Raffay V
Postgrad Med J
· 2026 Feb · PMID 41697770
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BACKGROUND: PubMed Central (PMC) is a freely accessible digital repository offering full-text biomedical literature with structured metadata. Despite its scale, its suitability as a resource for systematic reviews, parti...BACKGROUND: PubMed Central (PMC) is a freely accessible digital repository offering full-text biomedical literature with structured metadata. Despite its scale, its suitability as a resource for systematic reviews, particularly in medical research and education, remains underexplored. METHODS: We studied the proportion of systematic reviews using PMC compared to other resources. Additionally, we examined the number of results retrieved by search strategies in PMC compared to PubMed in three random samples of subject topics (10 of 28 of the general and 25 of 413 of the extensive contents of the "Goldman's Cecil Medicine, 26th Edition" textbook, and 25 of 502 of the essential medicines listed in the "World Health Organization Model List of Essential Medicines"). RESULTS: About 0.5% of 407 242 systematic reviews archived in PubMed included PMC in the title and/or abstract, a considerably lower proportion compared to other resources (36%, 33.9%, 30.4%, 18%, 14.1%, and 5.8% for PubMed, Embase, Cochrane Library, Web of Science, Scopus, and Google Scholar, respectively). Even though PMC includes a considerably smaller number of articles than PubMed (11 vs. 39 million), the yield from PMC was higher compared to PubMed in the studied random samples [in 9/10 (90%), 21/25 (84%), and 25/25 (100%) of subject topics]. DISCUSSION: PMC is rarely utilized for systematic reviews. Although the number of articles retrieved from PMC is higher than PubMed, further studies should evaluate the comparative relevance of their yield, as PMC may return fewer specific articles on the studied research topic due to its inclusion of full-text articles. Key messages What is already known on this topic PubMed Central (PMC) is a free resource of full-text articles in biomedical fields. What this study adds Our study shows that PMC is rarely used as a resource for full-text articles for systematic reviews in biomedical research and education. In all three random samples of clinical medicine subjects that we studied, the yield of articles was higher in PMC than in PubMed. How this study might affect research, practice, or policy Future studies should focus on the relevance (specificity) of the yield of articles from PMC searches in specific research topics in systematic reviews.
Nasher M, Beveridge N, Burrows S
… +7 more, Jones N, Gurumurthi S, Sajjad A, Gurung S, Griffiths B, Wong W, Varia R
Postgrad Med J
· 2026 May · PMID 41671110
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BACKGROUND: Inappropriate coagulation testing contributes to inefficiency, cost, and environmental harm. Baseline audits on our acute medical unit (AMU) showed that one-third of coagulation screen requests lacked a clear...BACKGROUND: Inappropriate coagulation testing contributes to inefficiency, cost, and environmental harm. Baseline audits on our acute medical unit (AMU) showed that one-third of coagulation screen requests lacked a clear clinical indication. AIM: To reduce unnecessary coagulation screens on acute medical services [AMU and Medical Same Day Emergency Care (mSDEC)] by 90% within 12 months, aligned with National Health Service (NHS) Net Zero ambitions and our Trust's Green Plan. METHODS: Using the Model for Improvement, we conducted three Plan-Do-Study-Act cycles. Our analogue and digital interventions included revised triage order sets, condition-specific electronic order sets, and a digital decision prompt requiring clinicians to confirm test indication. Data were collected at baseline (January-February 2024) and re-audited after interventions (December 2024). Outcome measures were the proportion of inappropriate tests, cost savings, staff time, and carbon reduction. RESULTS: At baseline, 34%-39% of coagulation screens were inappropriate across AMU areas. Postintervention, inappropriate testing reduced to 20% in mSDEC, 10% in AMU 1B, and 15% in AMU 1C. This equates to a projected annual reduction of 44 000 tests, saving £130 000, 367 staff hours, and 3.6 tonnes CO₂e (equivalent to a 9000-mile car journey). Laboratory workload and plastic waste also fell substantially. CONCLUSION: Embedding decision prompts within electronic order systems achieved rapid, sustained reductions in unnecessary testing. This scalable, low-cost intervention aligns clinical practice with sustainability goals and offers a model for reducing unwarranted diagnostics across the NHS. In the face of the climate crisis, aligning practice with environmental goals is both a professional responsibility and an opportunity to improve care, efficiency, and outcomes. Key messages What is already known on this topic Inappropriate coagulation testing is common across NHS acute care, with studies showing over one-third of tests lack a clinical indication.Excess diagnostic testing contributes to financial costs, staff workload, plastic waste, and carbon emissions.Previous quality improvement initiatives have focused mainly on education or guideline dissemination, with variable success. What this study adds Embedding a simple digital decision prompt into electronic order sets significantly reduced inappropriate coagulation screens across an Acute Medical Unit.The intervention was low-cost, rapidly implemented, and co-designed with frontline clinicians to improve uptake and sustainability.Projected impact includes avoidance of 44 000 tests annually, saving ~£130 000, 367 staff hours, and 3.6 tonnes CO₂e, supporting NHS Net Zero targets.This scalable model demonstrates how small digital changes can drive large improvements in clinical quality, efficiency, and sustainability.