Medical students face significant challenges, including managing uncertainty, impacting their education and careers. Effective doctors prioritize patient care, competence, relationships, and integrity, yet students frequ...Medical students face significant challenges, including managing uncertainty, impacting their education and careers. Effective doctors prioritize patient care, competence, relationships, and integrity, yet students frequently struggle emotionally and idealistically, especially during preclinical years. Clinical rotations expose the inherent uncertainty in medicine, requiring students to develop contextual, sufficient knowledge. Uncertainty arises from knowledge gaps, complex systems, ambiguous scenarios, emotional challenges, negative role models, and unclear team roles, often causing psychological distress. Differentiating between ambiguity (unclear answers) and uncertainty (individual responses) is essential. Medical education should cultivate traits such as curiosity, courage, empathy, and tolerance for ambiguity, which can be fostered through medical humanities and simulation-based learning. Emphasizing reflection, peer support, and addressing the hidden curriculum are vital strategies. Enhancing professional development and mentorship tailored to students' needs can better equip future doctors, making embracing uncertainty integral to their professional growth and resilience in medical practice.
Li N, Xu G, Lin J
… +7 more, Li H, He X, Huang J, Du X, Xiang Z, Shi Z, Wang Y
Postgrad Med J
· 2026 Jan · PMID 41052150
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BACKGROUND: Previous studies suggest acupuncture may be effective for various chronic conditions, but its impact on type 2 diabetes (T2DM) remains debated. OBJECTIVE: To evaluate the effect of acupuncture on blood glucos...BACKGROUND: Previous studies suggest acupuncture may be effective for various chronic conditions, but its impact on type 2 diabetes (T2DM) remains debated. OBJECTIVE: To evaluate the effect of acupuncture on blood glucose-related outcome indicators in T2DM. METHODS: We searched four databases (PubMed, Embase, Web of Science, and Cochrane Library) from inception to 3 July 2025 to identify randomised controlled trials that enrolled patients with T2DM and compared acupuncture and non-acupuncture. The analysis employed standardized mean differences with 95% confidence intervals and incorporated Prediction Intervals (PI) for each outcome. Subgroup analysis, meta-regression, sensitivity analysis, and publication bias evaluation were also performed. RESULTS: Twenty RCTs involved 1479 patients were included. The results demonstrated that the acupuncture group had significant reduction in FBG (SMD: -0.52; 95% CI:-0.91 to -0.13; P = 0.009), HbA1c (SMD:-0.76; 95% CI:-1.24 to -0.27; P = 0.002), 2hPG (SMD:-0.69; 95% CI:-1.00 to -0.39; P < 0.00001) and HOMA-IR (SMD:-1.72; 95% CI: -2.57 to -0.86; P < 0.0001), but not reveal statistically significant difference in insulin level (SMD:-1.16; 95% CI:-2.36 to 0.04; P = 0.06). The Hartung-Knapp adjustment showed consistent results, with the PI indicating potential variability in future studies. CONCLUSIONS: Acupuncture effectively reduces FBG, HbA1c, 2hPG, and HOMA-IR in patients with T2DM, but does not significantly affect insulin levels. Our study suggests that acupuncture may serve as a valuable complementary treatment for glycemic control in T2DM. Future research should focus on optimizing acupuncture protocols, assessing its long-term effects, and investigating the biological mechanisms behind its impact.
Zhu S, Da X, Wang J
… +4 more, Hu Y, Wang X, Liu Y, Xu G
Postgrad Med J
· 2026 Mar · PMID 41025727
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BACKGROUND: This study evaluated whether the innovative multipoint incision-based rectus sheath block (IBRSB) tailored to surgical site and trauma level, could reduce opioid use and improve analgesia in laparoscopic-assi...BACKGROUND: This study evaluated whether the innovative multipoint incision-based rectus sheath block (IBRSB) tailored to surgical site and trauma level, could reduce opioid use and improve analgesia in laparoscopic-assisted colorectal surgery (LACS) compared to bilateral rectus sheath block (RSB). METHODS: A total of 72 patients undergoing LACS, with quantium consciousness index monitoring were randomized to receive either IBRSB or bilateral RSB using 40 ml of 0.4% ropivacaine (n = 36 for both). The primary outcome was intraoperative dosage of remifentanil. RESULTS: Seventy patients completed the study, with 35 in each group. The IBRSB group had significantly lower remifentanil use (mean [SD]: 4.42 [2.01] vs 5.92 [2.53] μg/kg/h; 95% confidence intervals: -2.59 to -0.41; P = 0.008) and less postoperative sufentanil use via patient-controlled intravenous analgesia within 24 h. Intraoperative hemodynamics were more stable in the IBRSB group. Pain scores at rest and with movement similar between groups at all six postoperative time points. No block-related complications occurred. CONCLUSION: Compared to bilateral RSB, IBRSB based on incision location and trauma severity significantly reduced intraoperative and postoperative opioid requirements, improved hemodynamic stability, and showed no increase in complications in patients undergoing LACS. Key messages What is already known on this topic: Laparoscopic surgery requires small midline incisions and multiple trocars, resulting in scattered wounds. An incision-based precision multipoint rectus sheath block (RSB), tailored to the surgical site and providing dual analgesia through local infiltration and nerve blockade, may be more suitable for laparoscopic-assisted colorectal surgery than bilateral RSB. What this study adds: The main finding was that ultrasound-guided incision-based precision multipoint RSB, compared to bilateral RSB, significantly reduced intraoperative and postoperative morphine equivalents in patients undergoing laparoscopic-assisted colorectal surgery. How this study might affect research, practice, or policy: The incision-based precision multipoint represents a safe and efficacious technique, which is recommended for routine implementation in patients subjected to laparoscopic-assisted colorectal surgery.
Cooksley T, Weaver JMJ, Adam S
… +3 more, Lasserson D, Lee R, Lorigan P
Postgrad Med J
· 2026 Mar · PMID 41025712
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BACKGROUND: Immune-mediated hepatitis is a common toxicity and accounts for ⁓20% of immune checkpoint inhibitor (ICI) related deaths. There is broad consensus as to the current approach for acute management for immune-me...BACKGROUND: Immune-mediated hepatitis is a common toxicity and accounts for ⁓20% of immune checkpoint inhibitor (ICI) related deaths. There is broad consensus as to the current approach for acute management for immune-mediated hepatitis. There is little data regarding the duration of immunosuppression in severe immune-mediated hepatitis. METHODS: A prospective observational analysis was performed at a specialist oncology hospital in England from 20th May 2018 to 19th April 2024. The need for second-line immunosuppression, the agents used and their duration were analyzed. The primary outcome was duration of second-line immunosuppression and whether there was a relapse in immune-mediated hepatitis following their cessation. RESULTS: During the study period, 82 patients presented with grade ≥3 immune-mediated hepatitis. Thirty-five (42.7%) had grade 3 hepatitis with 47 (57.3%) having grade 4 hepatitis. All patients received corticosteroids as first line treatment. Twenty-six (31.7%) patients required second-line immunosuppression therapy with mycophenolate mofetil. Four of those required further immunosuppression with a calcineurin inhibitor. The cohort requiring second-line immunosuppression had higher transaminases (mean alanine aminotransferase (ALT) = 889 u/L vs 677 u/L) at presentation. The median duration of therapy was 3 months (6 weeks to 22 months); all patients except for one had stopped their immunosuppression at 6 months. Ten patients who initially received combination ICI therapy had a rechallenge with maintenance nivolumab without a relapse of their hepatitis. CONCLUSION: Most patients with ICI-mediated hepatitis respond to first line immune suppression but approximately one third require second line therapy. Most patients discontinued immune suppression within 3 months. Key messages What is already known on this topic: Hepatitis is a common complication of immune checkpoint inhibition often requiring treatment with steroids and immunosuppression. What this study adds: This prospective observational study of patients presenting with severe ICI induced hepatitis found 26 (31.7%) patients required second-line immunosuppression therapy with a further four requiring third-line agents. The median duration of therapy was 3 months. How this study might affect practice: Most patients with ICI induced hepatitis respond to first line immune suppression but approximately one third require second line therapy, which can often be stopped 3 months post initiation.
Zheng Y, Liu Y, Zheng X
… +4 more, Tse G, Lip GYH, Chen KY, Liu T
Postgrad Med J
· 2026 Feb · PMID 41020767
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BACKGROUND: New-onset atrial fibrillation (AF) in the setting of acute myocardial infarction (AMI) is associated with higher risks of stroke and mortality. However, current guidelines lack specific antithrombotic recomme...BACKGROUND: New-onset atrial fibrillation (AF) in the setting of acute myocardial infarction (AMI) is associated with higher risks of stroke and mortality. However, current guidelines lack specific antithrombotic recommendations for this population. This study aimed to explore the association between rivaroxaban and the prognosis of patients with AMI and new-onset AF. METHODS: This retrospective cohort study included patients with AMI and new-onset AF receiving dual antiplatelet therapy between August 2016 and June 2023 in Tianjin, China. New-onset AF (transient or nontransient) was defined as the first diagnosis of AF following AMI. The primary outcome was stroke. RESULTS: 2477 patients were identified, including 141 rivaroxaban users and 2336 patients without oral anticoagulants (OAC). Over a median follow-up of 922 days, rivaroxaban users had a 5.7% lower risk of stroke than non-OAC users, although this was not statistically significant (19.9% vs. 25.6%; P = .152). Despite the suggestion of a protective trend, multivariable Cox regression showed that rivaroxaban use was not associated with a lower risk of stroke (hazard ratio, 0.77; 95% confidence interval, 0.52-1.13, P = .187). After propensity score matching, 155 transient (rivaroxaban: 42; non-OAC: 113) and 295 nontransient AF patients (rivaroxaban: 85; non-OAC: 210) were included. No significant association was observed between rivaroxaban and stroke, ischemic stroke, hemorrhagic stroke, all-cause mortality, cardiovascular mortality, bleeding, or major bleeding. CONCLUSION: No significant association was observed between rivaroxaban and clinical outcomes in patients with AMI and new-onset AF. Given the small sample size and limited statistical power, the findings are exploratory and require further validation. Key messages What is already known on this topic: Evidence from previous studies indicates that acute myocardial infarction (AMI) patients with new-onset atrial fibrillation (AF) are associated with higher risks of ischemic stroke and mortality. However, the association between rivaroxaban and the prognosis of patients with AMI and new-onset AF remains uncertain. What this study adds: Among patients with AMI and new-onset AF receiving dual antiplatelet therapy, no significant differences were observed between rivaroxaban users and non-oral anticoagulant users in terms of the risks of stroke, ischemic stroke, hemorrhagic stroke, all-cause mortality, cardiovascular mortality, bleeding, or major bleeding. However, these results should be interpreted with caution due to the small sample size and limited statistical power of the study. How this study might affect research, practice or policy: Future prospective large-scale studies and randomized controlled trials are needed to further examine the role of rivaroxaban and other types of oral anticoagulants in patients with AMI and new-onset AF.
Yu TL, Chung KC, Huang HC
… +7 more, Chuang YC, Lai YR, Tsai YA, Wang CY, Lin CL, Shen TC, Cho DY
Postgrad Med J
· 2026 May · PMID 41020762
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Publisher ↗
BACKGROUND: Pneumoconiosis has been recognized as a risk factor for systemic diseases; however, its association with dementia remains unclear. This study aims to investigate the association of pneumoconiosis with the sub...BACKGROUND: Pneumoconiosis has been recognized as a risk factor for systemic diseases; however, its association with dementia remains unclear. This study aims to investigate the association of pneumoconiosis with the subsequent risk of dementia. METHODS: This retrospective cohort study used data from Taiwan's National Health Insurance database. The pneumoconiosis cohort included 17 871 patients diagnosed with pneumoconiosis from 2009 to 2020. A comparison cohort of 71 484 individuals without pneumoconiosis was matched in a 1:4 ratio in terms of age, sex, and diagnostic date. All study participants were followed up until the end of 2020 to evaluate dementia incidence. RESULTS: The incidence of dementia in the pneumoconiosis cohort was 17.6 per 1000 person-years, which was significantly higher than the 12.3 per 1000 person-years in the control group. Age-stratified analysis revealed that patients aged 65-74 years (aHR = 1.26, 95% CI = 1.15-1.38) and ≥75 years (aHR = 1.49, 95% CI = 1.38-1.60) demonstrated a significantly increased risk. Sex-specific analysis revealed that both men (aHR = 1.39, 95% CI = 1.31-1.48) and women (aHR = 1.30, 95% CI = 1.11-1.51) exhibited a significantly increased risk. Further, the frequency of emergency department visits among patients with pneumoconiosis was positively associated with dementia risk. CONCLUSION: Utilizing a large-scale medical database, this study reveals that patients with pneumoconiosis demonstrated a significantly increased risk of developing dementia. Early cognitive function screening is recommended for this population to reduce disability and improve long-term outcomes. Key messages What is already known on this topic: Pneumoconiosis has considerable comorbidities, particularly pulmonary and cardiovascular diseases. However, the association between pneumoconiosis and dementia is largely unknown. What this study adds: The nationwide, population-based, retrospective cohort study revealed that patients with pneumoconiosis had a significantly higher risk of dementia than those without pneumoconiosis. How this study might affect research, practice, or policy: Greater emphasis on early cognitive function screening in this population may help to reduce disability rates and enhance long-term outcomes.
Postgrad Med J
· 2026 Mar · PMID 40985856
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Healthcare systems globally face unprecedented pressures, with increasing patient volumes and resource constraints affecting care delivery. While systemic factors contribute to patient dissatisfaction, individual healthc...Healthcare systems globally face unprecedented pressures, with increasing patient volumes and resource constraints affecting care delivery. While systemic factors contribute to patient dissatisfaction, individual healthcare professional behaviours significantly impact patient experience regardless of system constraints. Despite communication skills being fundamental to medical training, evidence suggests that bedside manner-historically a marker for quality of care through the eyes of patients-has deteriorated due to multiple factors, including increased workload, professional burnout, shifts from bedside to simulation-based teaching, and evolving hospital cultures that prioritize efficiency over patient-centred care. Bedside manner may seem to have little relevance against this backdrop, yet its importance has never been greater as the National Health Service (NHS) in the UK prepares to undergo reform, and medicine as a profession begins to evolve and redefine the doctor's role in the era of artificial intelligence. This commentary synthesises literature on doctor-patient communication and presents both experience- and evidence-based recommendations for three core professional behaviours that doctors can demonstrate now to positively impact patient and carer experiences. Each example is presented with relevant context, and instructions for behaving through the lens of 'good manners'. Adhering to social norms and aspiring to behave courteously will enable doctors to manage difficult situations more effectively, rebuild trust among patients or their carers, and regrow confidence in the profession. Training in interactions with patients should therefore be seen as a fundamental aspect of medical education and behavioural coaching should ensure that resident doctors never talk down to their patients.
Li X, Xie J, Zhang X
… +3 more, Guo X, Li Y, Yin Q
Postgrad Med J
· 2026 Feb · PMID 40984654
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Publisher ↗
OBJECTIVES: This prospective, randomized, double-blind, controlled study aimed to assess the effectiveness of a 5% glucose solution compared to normal saline for treating frozen shoulder via shoulder joint hydraulic dist...OBJECTIVES: This prospective, randomized, double-blind, controlled study aimed to assess the effectiveness of a 5% glucose solution compared to normal saline for treating frozen shoulder via shoulder joint hydraulic distension. METHODS: A total of 100 participants were randomly assigned to either the 5% glucose group (1 ml compound betamethasone +4 ml 2% lidocaine +15 ml 5% glucose) or the saline group (1 ml compound betamethasone +4 ml 2% lidocaine +15 ml normal saline). Patients were assessed at 1, 4, and 12 weeks post-treatment using the Shoulder Pain and Disability Index, the Numerical Rating Scale for pain, and active range of motion. RESULTS: Substantial improvements were demonstrated by both treatment groups at all follow-up points (1, 4, and 12 weeks), as reflected by a decrease in Shoulder Pain and Disability Index score. However, the 5% glucose group showed significantly lower Shoulder Pain and Disability Index scores than the saline group at 4 and 12 weeks (P = 0.003 and P < 0.05, respectively). This group also experienced significantly greater improvements in shoulder abduction at 4 weeks (P = 0.003) and extension at 12 weeks (P = 0.001) than the saline group. No significant differences were noted between the groups in Numerical Rating Scale scores or shoulder range of motion at other time points. CONCLUSION: For patients with painful frozen shoulder lasting over a month, both treatments resulted in substantial pain relief and improved function. The 5% glucose solution produced more pronounced benefits at 4 and 12 weeks, particularly with regard to pain relief and increased shoulder mobility. Key messages What is already known about this topic: Although extensive research has been conducted on frozen shoulder, the most effective treatment has yet to be identified. What does this study contribute: This is the first study to use a 5% glucose solution as the primary distending agent in shoulder joint hydraulic distension for frozen shoulder (FS), which is a novel approach not previously explored in the literature. How might this study affect research, practice or policy: This study provides a new clinical protocol for the treatment of frozen shoulder.
Ağırağaç MH, Yaman M, Içer M
… +2 more, Urakçı Z, Güloğlu C
Postgrad Med J
· 2026 Feb · PMID 40972019
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Publisher ↗
BACKGROUND: To compare the ability of five risk-stratification tools-the Multinational Association for Supportive Care in Cancer (MASCC) index, Clinical Index of Stable Febrile Neutropenia (CISNE), National Early Warning...BACKGROUND: To compare the ability of five risk-stratification tools-the Multinational Association for Supportive Care in Cancer (MASCC) index, Clinical Index of Stable Febrile Neutropenia (CISNE), National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), and Quick Sequential Organ Failure Assessment (qSOFA)-to predict in-hospital mortality among adults presenting to the emergency department (ED) with febrile neutropenia (FN). METHODS: A single-center retrospective cross-sectional review included all FN visits to a tertiary ED (1 January 2018-31 December 2021). FN was defined as fever ≥38°C with an absolute neutrophil count <1000 cells/μL. After exclusions, 90 encounters were analyzed. Demographics, vital signs, laboratory data, and calculated scores were compared between survivors and non-survivors. Receiver-operating-characteristic curves and areas under the curve (AUC) determined prognostic performance. RESULTS: Median age was 59 years (interquartile range 40-68); 68.9% were male. Fifteen patients died (16.6%). All five scores discriminated mortality (P < 0.001). NEWS showed the highest AUC (0.851; 73.3% sensitivity, 78.7% specificity at cut-off 5.5), followed by MEWS (0.839), qSOFA (0.829), MASCC (0.816), and CISNE (0.798). CONCLUSION: Physiology-based early warning scores, particularly NEWS and MEWS, outperformed oncology-specific indices for early mortality prediction in FN patients in the ED. Incorporating these rapid scores alongside MASCC or CISNE could enhance triage accuracy, inform disposition and ultimately improve outcomes. Key messages What is already known on this topic? Febrile neutropenia (FN) is a life-threatening oncologic emergency requiring rapid risk stratification in the emergency department. Multinational Association for Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) are commonly used oncology-specific tools for risk assessment, but their performance in acute emergency department (ED) settings is variable. General early warning scores like National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), and Quick Sequential Organ Failure Assessment (qSOFA) have been validated for sepsis but less frequently applied to febrile neutropenic patients. What this study adds? This study is among the few to directly compare MASCC, CISNE, NEWS, MEWS, and qSOFA in predicting in-hospital mortality in FN patients in the ED. NEWS and MEWS demonstrated the highest area under the curve values and more balanced sensitivity-specificity ratios, outperforming oncology-specific scores. Vital sign-based scores, calculated rapidly at presentation, offer strong prognostic value for early identification of high-risk FN patients. How this study might affect research, practice, or policy? Supports the integration of physiologic early warning scores (NEWS and MEWS) into FN triage protocols in emergency departments. Suggests a multidimensional risk assessment model combining both oncologic and general scoring systems for more accurate and efficient patient management. May influence policy and guideline development to enhance outpatient vs. inpatient decision-making and resource allocation in FN care.
BACKGROUND: The myth of Athena's birth from Zeus' forehead presents a symbolic narrative that resonates with modern neuroscientific perspectives. The prefrontal cortex, crucial for decision-making, foresight, and moral r...BACKGROUND: The myth of Athena's birth from Zeus' forehead presents a symbolic narrative that resonates with modern neuroscientific perspectives. The prefrontal cortex, crucial for decision-making, foresight, and moral reasoning, aligns intriguingly with the ancient attribution of wisdom to the head. This study aims to explore the convergence of mythology, philosophy, visual art, and neuroscience in order to examine whether ancient cultural narratives implicitly localized wisdom in the brain. METHODS: A multidisciplinary approach was employed, drawing on classical texts, iconographic traditions, and contemporary neurobiological models of wisdom.Comparative analysis was used to identify symbolic parallels between mythological representations and neurocognitive functions. RESULTS: The cranial emergence of Athena can be interpreted as a cultural archetype that anticipates the modern understanding of higher-order cognition. Artistic depictions reinforce this correspondence by emphasizing the head as the seat of wisdom. Despite the risk of anachronism, the recurrence of this imagery across centuries suggests that myth may encode latent insights into brain function. CONCLUSIONS: The case of Athena's birth highlights how mythological narratives can serve as proto-scientific frameworks for understanding human cognition. Integrating insights from mythology and neuroscience may enrich both historical interpretation and contemporary discussions on the nature of wisdom.