Postgraduate Medical Journal最新文献

There is a lack of suitable screeners for dyslexia for doctors in training, as the typical adult screeners do not cater for the needs of capable medical graduates. The aim of this research is to create an inclusive screening and training process for doctors with undiagnosed dyslexia. This involved working with doctors to co-create a new dyslexia screener tool. We designed an innovative holistic dyslexia screening, assessment, and support system as part of a 3-year longitudinal study. Qualitative data was collected through the use of a dyslexia screener and case-study interviews with trainees in general practice and psychiatry. Interviews were thematically analyzed to explore dyslexic trainees' experiences of an inclusive approach to dyslexia screening and assessment. Out of the 103 trainees that were screened, 10 were found to have dyslexia, one dyspraxia, and another ADHD trait. Dyslexia-specific coaching, exam, and workplace accommodations were beneficial in dispelling stigma about dyslexia as well as supporting examination success. International Medical Graduate (IMG) trainees were also supported in this process. The case study participants' progression was tracked over 3 years, and all subsequently passed their examinations. We recommend that all trainees are given access to this inclusive, holistic, medical-focused dyslexia screening process. Specifically, this can enable newly diagnosed trainees to access support and exam accommodation. In particular, greater understanding of dyslexia helps dispel stigma and enable better support, which has a positive impact on trainee well-being as well as progression.

Studying medicine is not a passive activity; it demands dedication, curiosity, and continuous learning through observation, reading, and repetition. The Latin root of "student" reflects eagerness, and similarly, "aluno" derives from "alere," meaning "to nourish," symbolizing the nourishment of knowledge. As students, it is crucial to understand not just the scientific knowledge but also the human side of medicine. Learning goes beyond textbooks. Patients themselves are the greatest source of wisdom. Medicine is the art of care, offering comfort and understanding of what is hidden beneath the surface. Growth in this field requires seeing beyond the obvious and developing strategies to understand patients' stories. The medical student may develop strategies to know how to listen, build trust, and empathize with patients, guiding them through their fears. Carrying their burdens and interpreting their unspoken words is essential for providing both medical care and comfort.

Purpose: To understand senior clinicians' current thinking regarding retirement at a large teaching hospital trust, the reasons behind it, and what the trust can do to improve retention of these valuable staff.

Methods: An anonymized survey followed by qualitative study from a focus group. Data from these were analysed using a thematic analysis. Participants were senior clinicians currently employed or who had taken retirement from the trust in the preceding 12 months. In total 140 respondents completed the survey, giving a response rate of 65%; 8 senior clinicians attended the focus group.

Results: The commonest reasons for taking retirement were wanting to pursue leisure interests, reaching a pensionable age, and feeling unable to sustain their workloads. A significant proportion, 29%, also cited that they did not feel valued. The commonest factors that would encourage respondents to remain at work included increased flexibility, reduced hours, and ability to come off on-call rotas. The main themes from the focus group were focusing on well-being, personalized conversations, and better/more accessible information.

Conclusion: Our project identified a number of reasons why clinicians are considering taking retirement, with a major theme of feeling valued underpinning decisions. This could influence strategies to help retain these experienced members of staff. We made a series of recommendations. If enacted, these would have a wider-reaching impact on more junior medical staff, aiding them to consider their own late-stage careers. They are also applicable and could easily be adapted when considering retention of other valued professionals within the trust. Key messages What is already known on this topic-We know that there is currently a medical workforce crisis at a time of greatest patient need, with an ageing workforce and senior staff who are choosing to retire early. Previous studies have reviewed the reasons behind these decisions but not specifically looked at changes that can be implemented at a local level to improve retention. What this study adds-We combined both quantitative and qualitative data from senior clinicians at a large teaching hospital trust in the North of England to understand current thinking regarding retirement and what the trust could do to improve their retention. How this study might affect research, practice, or policy-From our study we were able to make a series of recommendations that can be implemented at a local level to inform medical retention policies. These will also have wider impacts on junior medical staff and could be expanded to other healthcare professionals.

The prevalence of obesity has continued to rise, and obesity and its attendant metabolic disorders are major global health threat factors. Among the current interventions for obesity, none have demonstrated sustained efficacy in achieving long-term outcomes. So, the identification of therapeutic targets is of paramount importance in the advancement and sustainability of obesity. Resting metabolic rate (RMR) constitutes 60%-75% of total energy expenditure and serves a crucial function in maintaining energy balance. Nevertheless, there exists considerable heterogeneity in RMR among individuals. Low RMR is associated with weight gain, elevating the susceptibility to obesity-related ailments. Hence, RMR will be the main focus of interest in the study of obesity treatment. In this review, we will elucidate the influence factors and mechanisms of action of RMR in obesity, with particular emphasis on the effects of obesity treatment on RMR and the alterations and influence factors of RMR in special types of populations with obesity.

Purpose: This study aims to explore the relationship between basal metabolic rate (BMR) and cognitive impairment and assess the potential of BMR as a protective factor against cognitive decline.

Methods: This investigation initially conducted a cross-sectional study of American adults from 2011 to 2014 using data from the National Health and Nutrition Examination Survey. It examined the correlation between participants' BMR and cognitive functions, exploring the association with cognitive impairment. Subsequently, publicly available genome-wide association study data was used to examine potential causal links between genetically determined BMR and specific cognitive disorders using Mendelian randomization.

Results: Cross-sectional findings revealed a significant positive correlation between higher BMR and cognitive scores. In Mendelian randomization analysis, BMR demonstrated an inverse causal relationship with Alzheimer's disease and Parkinson's dementia, suggesting BMR as a potential protective factor against these diseases. No causal links were found with vascular dementia, Lewy body dementia, and frontotemporal dementia.

Conclusion: This study supports the role of BMR as a potential protective factor against Alzheimer's disease and Parkinson's dementia, suggesting that BMR may play an important role in preventing cognitive decline. However, due to the limitations of cross-sectional studies, further prospective studies and broader demographic samples are necessary to verify these results and explore underlying biological mechanisms. Key messages What is already known on this topic: Existing knowledge suggests a close relationship between BMR and health and cognitive functions, but detailed studies on its connection with specific cognitive impairments are still needed. What this study adds: This study found a significant positive correlation between higher BMR and cognitive improvement, potentially aiding in the prevention of Alzheimer's and Parkinson's dementia. How this study might affect research, practice, or policy: This finding guides public health strategies and personalized medicine, emphasizing the necessity for further research to validate BMR's protective effects.

Objective: Our aim is to explore the relation between benign prostatic hyperplasia (BPH) and prostate cancer (PCa) from a genetic level utilizing Mendelian randomization (MR).

Methods: The IEU genome-wide association studies database was surveyed for single nucleotide polymorphisms (SNPs) associated with BPH, PCa, and PCa (validation cohort). Single nucleotide polymorphisms were subjected to stringent quality control based on rigorous screening criteria. BPH and PCa risk were evaluated using the inverse-variance weighted method (IVW), MR-Egger, simple mode, weighted median, and weighted mode. Horizontal pleiotropy of single nucleotide polymorphisms was assessed using the MR-Egger intercept test, while heterogeneity was evaluated using Cochran's Q test. Reverse causality was assessed by evaluating PCa as the exposure and BPH as the outcome. A validation database was used to verify the exposure and outcome.

Results: The risk of PCa increased significantly with genetically predicted BPH (IVW: OR [95% CI] = 1.3849 × 107 [2330, 8.2294 × 1010], P = 2.0814 × 10-4). In reverse MR analysis, PCa also increased the risk of BPH (IVW: OR [95% CI] = 1.0011 [1.0003, 1.0019], P = 0.0031). The findings were consistent with the MR analysis results of the PCa validation cohort. Sensitivity analyses indicated the presence of heterogeneity but no horizontal pleiotropy.

Conclusion: The study presents proof of a significant bidirectional causal relationship between genetically predicted BPH and an increased risk of PCa. Key message Three research questions and three bullet points  What is already known on this topic?  Observational studies suggest a controversial relationship between BPH and PCa. MR allows investigation of causality using genetic variants as instrumental variables (IVs). What does this study add?  The study presents proof of a significant bidirectional causal relationship between genetically predicted BPH and an increased risk of PCa. How this study might affect research, practice, or policy?  Recognizing the bidirectional relationship between BPH and PCa, men diagnosed with BPH may benefit from more stringent PCa screening protocols.

Introduction: Skin diseases in remote African regions are often exacerbated due to a lack of resources and expertise with little current research addressing the challenges that patients and healthcare systems experience. Although skin diseases in remote African regions are prevalent and pose a substantial health burden, they remain neglected and understudied. This review aims to explore current challenges in the diagnosis and management of skin diseases in African regions and focus on the need for enhanced understanding and improved healthcare strategies.

Methods: We reviewed papers that were retrieved from PubMed, Google Scholar, and other relevant academic search sites to analyze the prevalence, screening techniques, as well as management strategies and obstacles associated with dermatological diseases in remote African regions.

Results: Current literature suggests there is indeed a high prevalence of skin diseases where other infections are predominant. Further, different factors, such as socioeconomic status and environmental conditions, make it challenging for optimal screening and treatment of skin diseases in remote African regions. Common screening methods for skin diseases involve clinical examination and laboratory tests, while management includes pharmacotherapy, surgery, and counseling approaches. Overall, access to medications and adequate healthcare services remains limited.

Conclusion: Early diagnosis and management of skin diseases in remote African regions have significant challenges, including a lack of funding for dermatology, education, and research. Future promising strategies such as teledermatology, point-of-care diagnostic technologies, and task shifting show promise in improving access to care. However, there is a need for sustained efforts to address the underlying socioeconomic factors and improve healthcare delivery in remote African regions.

Glioblastoma (GBM) is a malignant tumor of the nervous system, which is difficult to treat due to its strong invasiveness, rapid progression, and poor prognosis. To understand the complex biological behavior of glioblasts and the interaction between tumors and hosts, a new in vitro platform based on human cells is required, which can summarize the complex cellular structure and cell diversity of the human brain, as well as the biological behavior of GBM. Organoids are 3D self-organizing tissues, partially similar to source tissues, which can simulate the structure and physiological functions of organs or tissues in vitro. In this review, we underline the widespread application of different types of GBOs models in GBM pathogenesis, including cells derived, tumor tissues derived, and other co-culture models, as well as their application and shortcomings in the treatment of GBM.

Background & aims: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common and potentially life-threatening condition. Over-the-scope clips (OTSCs) have emerged as a promising endoscopic treatment option for NVUGIB. We aimed to analyze the efficacy and safety of OTSCs compared to standard endoscopic treatments (ST) in patients with NVUGIB.

Methods: We conducted a comprehensive search of PubMed, Embase, Scopus, and Cochrane Library databases from inception to June 2024 for randomized controlled trials (RCTs) comparing OTSCs with ST for NVUGIB. The primary outcomes were initial hemostasis and persistent bleeding. Secondary outcomes included rebleeding rates, mortality, hospital stays and others. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random/fixed-effects models.

Results: Six RCTs involving 621 patients were included in the meta-analysis. OTSCs demonstrated significantly higher initial hemostasis (OR 4.80, 95% CI 1.78-12.96; P = 0.002) and lower persistent bleeding rates (OR 0.17, 95% CI 0.05-0.56; P = 0.003) compared to ST group. The rebleeding rate was significantly lower in the OTSC group 7-days re-bleeding (OR 0.27, 95% CI 0.14-0.53; P = 0.001); 30-days rebleeding (OR 0.40, 95%CI 0.22, 0.70; P = 0.002). No significant differences were observed in mortality (OR 0.65, 95% CI 0.31-1.33; P = 0.38) and hospital stay (mean difference 0.79 days 95%CI -0.57, 2.15) between the two groups.

Conclusions: OTSCs are more effective than ST for achieving hemostasis and preventing rebleeding in patients with NVUGIB, without increasing mortality. Key message What is Already Known  Previous studies have shown that nonvariceal upper gastrointestinal bleeding (NVUGIB) is a serious medical condition that needs effective endoscopic interventions. The success rates of standard treatments for achieving hemostasis and preventing rebleeding are not consistent. What This Study Adds  According to this study, over-the-scope clips (OTSCs) have the same mortality rate as standard endoscopic treatments, but they significantly improve initial hemostasis and lower rebleeding rates. Impact on Research, Practice, or Policy  The findings support the use of OTSCs as a preferred intervention for NVUGIB, which could affect clinical guidelines and encourage additional research focused on improving endoscopic techniques and patient outcomes in the management of gastrointestinal bleeding.