Lippi D, Varotto E, Galassi FM
… +1 more, Baldanzi F
Postgrad Med J
· 2026 Jan · PMID 41518138
·
Publisher ↗
The concept of rare disease, formalized in the United States in the 1980s with the Orphan Drug Act, has historical and cultural roots dating back to the Renaissance. The definition of "rarity" has changed over time accor...The concept of rare disease, formalized in the United States in the 1980s with the Orphan Drug Act, has historical and cultural roots dating back to the Renaissance. The definition of "rarity" has changed over time according to diagnostic tools, social contexts, and economic factors. With the advent of genetics, many new low-prevalence diseases have emerged, raising clinical and ethical challenges. Today, rare diseases require a multidisciplinary approach that also includes narrative medicine, in order to value the patient's experience and better understand the relationship between disease, illness, and society.
Postgrad Med J
· 2026 Feb · PMID 41511186
·
Publisher ↗
Adrenaline (epinephrine) is an endogenous catecholamine with potent β₁-adrenergic, moderate β₂-, and α₁-adrenergic activity, widely used in resuscitation and critical care. At lower infusion rates, it increases cardiac o...Adrenaline (epinephrine) is an endogenous catecholamine with potent β₁-adrenergic, moderate β₂-, and α₁-adrenergic activity, widely used in resuscitation and critical care. At lower infusion rates, it increases cardiac output and decreases systemic vascular resistance. While at higher doses it will result in greater inotropy and peripheral vasoconstriction, with potential adverse effects such as arrhythmias, lactic acidosis, and ischemia. This review synthesises contemporary evidence surrounding adrenaline's physiological and pharmacological profile, highlighting its role in cardiac arrest, perioperative medicine, sepsis, toxidromes, and specific contraindicated states. Clinical trials, including PARAMEDIC-2 and various observational registries, support adrenaline's effectiveness in achieving return of spontaneous circulation but raise concerns regarding neurological outcomes. The timing and dosing of adrenaline administration, particularly in non-shockable rhythms and in-hospital cardiac arrests, appear critical to optimising survival. Specific scenarios, such as post-cardiac surgery, neurosurgery, tamponade, and paediatric sepsis, demand tailored approaches due to distinct haemodynamic and pharmacological considerations. Conversely, adrenaline use may be contraindicated or require modification in patients with hypertrophic cardiomyopathies, carcinoid syndrome, or catecholamine-sensitive conditions. Despite its ubiquitous role in acute care, ongoing research is needed to define optimal dosing strategies and identify patient subgroups most likely to benefit from its use. Thoughtful, context-specific administration of adrenaline is essential to balancing efficacy with risk across the spectrum of emergency and perioperative medicine.
Fujikawa H, Tamune H, Nishizaki Y
… +8 more, Mori H, Fukui S, Shikino K, Shimizu T, Yamamoto Y, Kobayashi H, Naito T, Tokuda Y
Postgrad Med J
· 2026 May · PMID 41510963
·
Publisher ↗
PURPOSE: Patient care ownership (PCO) is a critical component of medical professionalism. Although various determinants of PCO among medical residents have been investigated, the impact of workplace social capital (WSC;...PURPOSE: Patient care ownership (PCO) is a critical component of medical professionalism. Although various determinants of PCO among medical residents have been investigated, the impact of workplace social capital (WSC; a social resource concerning employees' perceptions of trust, reciprocity, and network interactions within the workplace) remains unclear. Here, we aimed to examine the association of WSC and PCO. METHODS: This nationwide cross-sectional study was conducted using an anonymous online survey from January to February 2025. The participants were residents who participated in the General Medicine In-Training Examination. The primary and secondary outcomes were PCO and its four dimensions (i.e. assertiveness, sense of ownership, diligence, and being the "go-to" person), measured using the Japanese version of the PCO Scale, respectively. We adopted WSC and its two dimensions (i.e. horizontal and vertical trust) as the primary and secondary explanatory variables, assessed using the Japanese medical resident version of the WSC Scale, respectively. RESULTS: A total of 2811 residents were analyzed. On multivariable linear regression analysis, WSC total score was positively associated with PCO total score after adjustment for possible confounders. WSC total score was also positively associated with all PCO dimension scores. Additionally, we observed a positive association between each WSC domain score, PCO total score, and each PCO domain score. CONCLUSIONS: Our study revealed a significant and consistent association between WSC and PCO. These findings emphasize the importance of fostering a trusting workplace environment, given that PCO constitutes a pivotal component of professionalism and is likely associated with quality patient care.
Yang C, Zhang B, Fan J
… +4 more, Zhang Y, Cao X, Wu X, Li T
Postgrad Med J
· 2026 May · PMID 41510953
·
Publisher ↗
BACKGROUND: Colorectal cancer (CRC) screening is crucial for prevention. This study explored serum complement component 1q (C1QC) and vascular cell adhesion molecule-1 (VCAM-1) expression in CRC/polyp patients and their...BACKGROUND: Colorectal cancer (CRC) screening is crucial for prevention. This study explored serum complement component 1q (C1QC) and vascular cell adhesion molecule-1 (VCAM-1) expression in CRC/polyp patients and their clinical significance for CRC diagnosis/staging. METHODS: Serum samples from 135 CRC patients, 135 polyp/adenoma patients, and 135 healthy controls (collected between 1 January 2023 and October 30 2023) were analyzed retrospectively. Data-independent acquisition proteomics identified differentially expressed proteins. C1QC and VCAM-1 levels were quantified via enzyme-linked immunosorbent assay. Diagnostic performance was evaluated via receiver operating characteristic curves and the area under the curve. Statistical analysis (SPSS 27.0, GraphPad Prism 9.5.1) included analysis of variance, Pearson correlation, and logistic regression (P < .05 was considered significant). RESULTS: C1QC and VCAM-1 levels were significantly greater in the CRC patient group than in the healthy/polyp group (P < .05), with no difference between the polyp and healthy groups (P > .05). Receiver operating characteristic analysis revealed that C1QC (cutoff: 52.34 μg/dl) and VCAM-1 (cutoff: 431.215 ng/ml) had 78.2% and 66.8% diagnostic accuracy, respectively. Combined detection achieved 80.2% accuracy, surpassing that of carcinoembryonic antigen/carbohydrate antigen 199. Both biomarkers increased with disease progression (P < .05) and aided staging assessment. CONCLUSION: Serum C1QC and VCAM-1 demonstrate high diagnostic efficacy in CRC, correlate with pathological features, and hold promise as novel serological screening biomarkers.
Lu BR, Shi XY, An L
… +3 more, He K, Guo M, Sun ZG
Postgrad Med J
· 2026 May · PMID 41510950
·
Publisher ↗
PURPOSE: This study employed meta-analysis to systematically assess the effects of case-based learning (CBL) combined with problem-based learning (PBL) teaching versus lecture-based learning (LBL) in clinical medical edu...PURPOSE: This study employed meta-analysis to systematically assess the effects of case-based learning (CBL) combined with problem-based learning (PBL) teaching versus lecture-based learning (LBL) in clinical medical education, focusing on the comparison of knowledge acquisition, clinical skill development, and learning satisfaction, aiming to provide an evidence-based basis for medical education reform. METHODS: PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched to include randomized controlled trials comparing CBL combined with PBL instruction with LBL. Literature screening, data extraction, and quality assessment were conducted independently by two researchers, and meta-analysis was performed using RevMan 5.4 and Stata 17.0 software. RESULTS: A total of seven studies were included, covering a total of 604 participants. The meta-analysis revealed that CBL-PBL significantly improved students' theoretical examination scores [standardized mean difference (SMD) = 2.161, 95% confidence interval (CI): 1.215-3.106, P < .0001], practical skills scores (standardized mean difference = 1.594, 95% CI: 1.037-2.152, P < .0001), and learning satisfaction (pooled effect size = 0.860, 95% CI: 0.811-0.909, P < .0001), Furthermore, CBL-PBL showed significant advantages in enhancing clinical thinking skills (standardized mean difference = 3.661, 95% CI: 1.748-5.574, P < .0001). CONCLUSION: CBL-PBL is effective in enhancing clinical medical students' knowledge acquisition, clinical skills, and comprehensive competencies, and is superior to LBL. It is recommended that this teaching strategy be further promoted and optimized in clinical medical education to promote the comprehensive development of students' abilities.
Postgrad Med J
· 2026 Jan · PMID 41501438
·
Publisher ↗
As healthcare becomes increasingly globalized, postgraduate medical education must evolve to prepare clinicians for an increasingly interconnected, diverse, and intercultural healthcare landscape. This article offers nin...As healthcare becomes increasingly globalized, postgraduate medical education must evolve to prepare clinicians for an increasingly interconnected, diverse, and intercultural healthcare landscape. This article offers nine practical tips for designing and sustaining global learning networks-virtual, collaborative frameworks that connect trainees, educators, and institutions across borders. The recommendations are organized under four themes: (1) designing equitable curricula, (2) facilitating global collaboration, (3) developing culturally competent educators and learners, and (4) sustaining and evaluating learning networks. These recommendations are grounded in the theoretical frameworks of systems thinking and communities of practice. We emphasize co-created curricula, digital platforms for international engagement, culturally responsive pedagogy, inclusive assessment strategies, and decentralized leadership models. Each tip is grounded in peer-reviewed literature, international case studies, and lessons from our collaborative experiences. We address barriers such as time zones, resource inequities, and quality assurance. By embedding global perspectives into postgraduate programmes, global learning networks strengthen intercultural competence, enhance professional identity formation, expand access to medical education in low-resource settings, and foster mutual learning across diverse health systems. This guide supports postgraduate medical educators in cultivating culturally competent clinicians and advancing a more equitable, collaborative, and resilient global healthcare workforce.
Postgrad Med J
· 2026 May · PMID 41474143
·
Publisher ↗
BACKGROUND: While the non-conventional tobacco products have recently gained popularity among young adults, the link between occupational exposures and tobacco use behaviors has been scarcely explored. We investigated th...BACKGROUND: While the non-conventional tobacco products have recently gained popularity among young adults, the link between occupational exposures and tobacco use behaviors has been scarcely explored. We investigated the association of long working hours with tobacco product use in young adults. METHODS: A nationwide sample of 10 451 young workers in South Korea aged 19-34 years was analyzed. Weekly working hours and the consumption of combustible cigarettes, electronic cigarettes, and heated tobacco products were assessed. Logistic regressions were employed to determine the relation between working hours and tobacco products use, with odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Among the participants, 20.9%, 55.8%, 12.7%, 5.9%, and 4.6% reported working <35, 35-40, 41-48, 49-54, and ≥ 55 h/week, respectively. Compared to working 35-40 h/week, working 49-54 h/week (OR: 1.48; 95% CI: 1.21-1.82) and ≥ 55 h/week (OR: 1.41; 95% CI: 1.13-1.77) were associated with using combustible cigarettes. Similarly, working 49-54 h/week (OR: 1.39; 95% CI: 1.05-1.81) and ≥ 55 h/week (OR: 1.43; 95% CI: 1.06-1.90) were linked to using electronic cigarettes. Additionally, working ≥55 h/week was associated with using heated tobacco products (OR: 2.07; 95% CI: 1.43-1.93) compared to working 35-40 h/week. Furthermore, compared to working 35-40 h/week, working ≥55 h/week was linked to the use of multiple tobacco products (OR: 2.00; 95% CI: 1.28-3.13). CONCLUSION: Long working hours is linked to the use of various forms of tobacco products among young adults.
Yaluri AS, Ürgeová A, Maršálek M
… +2 more, Javorský M, Tkáč I
Postgrad Med J
· 2025 Dec · PMID 41474140
·
Publisher ↗
Interindividual variability in the efficacy of various glucose-lowering drugs has been previously reported and partly explained by genetic variants. The aim of this review was to summarize currently available information...Interindividual variability in the efficacy of various glucose-lowering drugs has been previously reported and partly explained by genetic variants. The aim of this review was to summarize currently available information on pharmacogenetic studies of the efficacy of incretin-based therapies such as glucagon-like peptide 1 (GLP-1) receptor agonists (GLP1RA) and dipeptidyl peptidase 4 (DPP-4i) inhibitors. Several missense variants of the GLP1R gene have been associated with the effects of GLP1RA or DPP-4 inhibitors on glycaemic compensation or weight. Pharmacogenetic effects have also been reported for several type 2 diabetes-associated loci, such as TCF7L2, THADA, MTNR1B, CDKAL1, KCNQ1, KCNJ11, and PAM in candidate gene approach studies. Genome-wide pharmacogenetic studies have identified new genes with potentially relevant pharmacogenetic effects (CTRB1/2, ARRB1, PRKD1). Although none of these genetic associations are currently used in guiding the treatment choices in clinical practice, they offer valuable insights bringing us a little closer to precision medicine.
The prevalence of thyroid dysfunction is rising in India and thus so is Graves' disease (GD). The phenotype of Indian GD is different than in Caucasians and is characterized by lower age at onset, lower female to male ra...The prevalence of thyroid dysfunction is rising in India and thus so is Graves' disease (GD). The phenotype of Indian GD is different than in Caucasians and is characterized by lower age at onset, lower female to male ratio, delayed diagnosis, more signs and symptoms, lower body mass index (BMI) and weight, lower prevalence of Graves' orbitopathy (GO), more inactive GO, lower doses of carbimazole being more effective, different markers of remission, and other things. Mechanistic studies are urgently needed to characterize the pathophysiology of Indian GD. Prevention, early diagnosis, and adequate treatment of GD should become urgently a public health priority in India.
Postgrad Med J
· 2025 Dec · PMID 41451862
·
Publisher ↗
Despite several studies affirming the safety of mesh hernia repairs, over 26 000 mesh-related lawsuits are pending in the USA as of July 2025. These lawsuits stem from alleged design flaws, lack of proper warnings, and s...Despite several studies affirming the safety of mesh hernia repairs, over 26 000 mesh-related lawsuits are pending in the USA as of July 2025. These lawsuits stem from alleged design flaws, lack of proper warnings, and severe postoperative complications. While mesh has revolutionized hernia surgery, the surge in litigation and multi-million-dollar out-of-court settlements by mesh manufacturers raise serious ethical, clinical, and legal concerns. This article examines the root causes behind this paradox, outlines strategies for surgeons and manufacturers to mitigate harm and restore trust, and explores the role of emerging mesh-free techniques and artificial intelligence-driven risk prediction tools in shaping the future of hernia repair.
Postgrad Med J
· 2025 Dec · PMID 41430538
·
Publisher ↗
The rapid integration of generative artificial intelligence (AI) is transforming scientific writing and publishing, creating both unprecedented opportunities and critical ethical challenges. This article investigates how...The rapid integration of generative artificial intelligence (AI) is transforming scientific writing and publishing, creating both unprecedented opportunities and critical ethical challenges. This article investigates how the use of AI tools affects research integrity, authorship accountability, and peer review processes in scientific publishing. Methodologically, the review synthesizes literature on current AI policies, detection tools, and empirical surveys of author and reviewer practices. Three key hypotheses are proposed for future empirical testing: (H1) mandatory AI disclosure improves the detection of fabricated content; (H2) AI-assisted language refinement enhances manuscript clarity without compromising originality; and (H3) undisclosed AI use by reviewers diminishes the depth of critique. The main findings indicate dominant reliance on descriptive studies, highlighting the need for hypothesis-driven, cross-disciplinary research frameworks and greater transparency to ensure that AI adoption fortifies the trustworthiness of scholarly communication.
Umit TB, Akdogan HI, Taskin Y
… +4 more, Yavuz Z, Sogut O, Arslan M, Inan G
Postgrad Med J
· 2026 Feb · PMID 41430527
·
Publisher ↗
AIM: To investigate the relationship between the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score and prognosis in patients with acute ischemic stroke (AIS). METHODS: This retrospective, cross-sectional, observ...AIM: To investigate the relationship between the Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score and prognosis in patients with acute ischemic stroke (AIS). METHODS: This retrospective, cross-sectional, observational, single-center study enrolled 1128 patients with AIS who presented to the emergency department and were hospitalized between June 2019 and December 2021. The HALP score was calculated as follows: hemoglobin (g/L) × albumin (g/L) × lymphocytes (/L)/platelets (/L). Demographics, clinical characteristics, and HALP scores were compared between survivors and nonsurvivors to identify factors associated with in-hospital mortality. RESULTS: The HALP scores for nonsurvivors and survivors were 13.9 [7.2-25.9] and 36.4 [22.8-52.8], respectively. Compared to the survivors, the HALP score was significantly lower in nonsurvivor patients. CONCLUSIONS: The HALP score has prognostic value in patients with AIS. Patients with lower HALP scores at admission are at higher risk for prolonged hospital stay, need for intensive care, and mortality, suggesting that a low score may be predictive of poor prognosis in patients with AIS. The cut-off value for predicting mortality was 21.5. Key messages What is already known on this topic: Acute ischemic stroke (AIS) is a leading cause of death and disability worldwide, and accurate early prognostic markers are essential for guiding clinical decisions. Nutritional and inflammatory parameters such as hemoglobin, albumin, lymphocyte, and platelet counts have individually been associated with stroke prognosis. The HALP score-originally validated in cancer and critical illness-has recently emerged as a composite marker reflecting inflammation and nutritional status. However, data on its prognostic value in AIS patients remain limited and inconsistent. What this study adds: This study demonstrates that the HALP score on admission is an independent predictor of in-hospital mortality in AIS patients. A specific cut-off value of 21.5 was identified, below which the risk of death, intensive care unit (ICU) admission, and prolonged hospital stay significantly increased. The HALP score also showed good discriminative ability (Area under the curve (AUC) = 0.781) in predicting adverse outcomes. How this study might affect research, practice or policy: The HALP score, calculated using routine and inexpensive laboratory parameters, may serve as a practical bedside tool for early risk stratification in AIS. Its use could help clinicians identify high-risk patients at triage and prioritize monitoring or interventions. Future prospective studies could support its integration into prognostic models or emergency care pathways for stroke.
Qin R, Qin Q, Xu W
… +4 more, Liang X, Lai X, Xie M, Chen L
Postgrad Med J
· 2026 May · PMID 41411119
·
Publisher ↗
BACKGROUND: Cardiovascular disease (CVD) is the leading global cause of mortality and imposes substantial health and economic burdens. However, the overall relationship between combined lifestyle factors and CVD incidenc...BACKGROUND: Cardiovascular disease (CVD) is the leading global cause of mortality and imposes substantial health and economic burdens. However, the overall relationship between combined lifestyle factors and CVD incidence among Chinese adults remains poorly defined. This study aimed to explore the association between healthy lifestyle factors and CVD risk in a nationwide Chinese cohort. METHODS: We included 7349 participants from 2011-2012 and followed them until 2018. Lifestyle was assessed using seven factors (blood pressure, blood glucose, cholesterol, body mass index (BMI), tobacco exposure, physical activity, and sleep duration), and participants were categorized into three groups based on the number of ideal factors. Cox regression models were used to analyze data. RESULTS: Participants with intermediate and unfavorable lifestyles had 29.74% and 59.71% higher CVD risks, respectively, compared to those with favorable lifestyles. Former smokers, individuals with elevated blood glucose, higher BMI, and inadequate sleep duration also had increased CVD risks. Subgroup and sensitivity analyses showed consistent trends. CONCLUSION: This nationwide cohort study highlights that healthy lifestyle practices are significantly associated with reduced CVD risk. Promoting healthy behaviors through public health strategies is crucial to mitigating CVD risk. Key messages What is already known on this topic: Modifiable lifestyle factors are established drivers of CVD, but composite lifestyle scores lacked nationally representative evidence in China's aging population before this study. What does this study add: Unhealthy lifestyles, including factors such as blood pressure, glucose levels, and BMI, significantly increased the risks of CVD and stroke in Chinese adults. Conditions like obesity, hyperglycemia, and poor sleep independently elevated these risks across all subgroups. How this study might affect research, practice, or policy: This study advocates multifactorial lifestyle interventions into public health policies, targeting high-risk populations, and prioritizing research on the scalability of these interventions.