Postgraduate Medical Journal最新文献

Purpose: Observational studies have suggested a potential link between emotions and inflammatory dermatoses. However, research on the causal relationship between different types of emotions and inflammatory dermatoses is lacking. This study is aimed to investigate the causal relationship between negative emotions and inflammatory dermatoses through Mendelian randomization (MR) analysis.

Methods: Summary data of seven negative emotions were obtained from a genome-wide association study (GWAS) conducted by the MRC-IEU consortium. Seven inflammatory dermatoses including vitiligo, psoriasis, systemic lupus erythematosus, eczema, atopic dermatitis, acne, and rosacea were obtained from published GWAS. The MR analysis primarily employed the Inverse variance weighted (IVW) method, and supplemented by MR-Egger and other three MR methods.

Results: The IVW method revealed that guilty feelings have potential to increase the risk of psoriasis (OR = 1.02, 95% CI: 1.00-1.05, P = 0.019), while worrier/anxious feelings have a potential risk effect on eczema (OR = 1.07, 95% CI: 1.00-1.13, P = 0.042). Psoriasis could increase the occurrence of miserableness (OR = 1.41, 95% CI: 1.18-1.68, P = 0.0001), worrier/anxious feelings (OR = 1.26, 95% CI: 1.02-1.57, P = 0.033), nervous feelings (OR = 1.25, 95% CI: 1.05-1.49, P = 0.012), and loneliness/isolation (OR = 1.19, 95% CI: 1.04-1.36, P = 0.009). Eczema might cause an increased incidence of worrier/anxious feelings (OR = 1.038, 95% CI: 1.007-1.070, P = 0.014).

Conclusion: This MR study revealed bidirectional causality between worrier/anxious feelings and eczema. It also found that guilty feelings may elevate the risk of psoriasis, and individuals with psoriasis may experience increased rates of miserableness, worrier/anxious feelings, nervous feelings, and loneliness/isolation.

Systemic sclerosis is a rare rheumatic disease characterized by immune cell activation, tissue fibrosis, and endothelial dysfunction. Extracellular matrix synthesis disorder causes widespread fibrosis, primarily in skin and internal organs. Various factors such as TGFβ, VEGF, Galectin-3, and signaling pathways like Wnt/β-catenin are involved in pathophysiological processes. Treatment lacks a unified approach but combines diverse modalities tailored to disease subtype and progression. Current therapeutic strategies include biologics, JAK inhibitors, and IL-6 pathway modulators. Monoclonal antibodies and hypomethylating agents demonstrate potential in fibrosis inhibition. This review focuses on emerging therapeutic evidence regarding drugs targeting collagen, cytokines, and cell surface molecules in systemic sclerosis, aiming to provide insight into potential innovative treatment strategies.

Rather than looking at which instruments to put in the traditional physician's black bag, the changing face of medicine suggests that some virtual assets assume prime importance. With a solid background of core knowledge and skills acquired through medical school but continuously developed and updated, several habitual attitudes are advocated-each aiming to address a different facet of concerns in today's time-constrained, often impersonal, fast-changing, information-overloaded, and highly technological practice. They include humility, curiosity, "red flag" identification, and reflexive database consultation-each with myriad, diverse advantages.

Purpose: To evaluate the effectiveness of ChatGPT-generated feedback compared to expert-written feedback in improving clinical reasoning skills among first-year medical students.

Methods: This is a randomized controlled trial conducted at a single medical school and involved 129 first-year medical students who were randomly assigned to two groups. Both groups completed three formative tests with feedback on urinary tract infections (UTIs; uncomplicated, complicated, pyelonephritis) over five consecutive days as a spaced repetition, receiving either expert-written feedback (control, n = 65) or ChatGPT-generated feedback (experiment, n = 64). Clinical reasoning skills were assessed using Key-Features Questions (KFQs) immediately after the intervention and 10 days later. Students' critical approach to artificial intelligence (AI) was also measured before and after disclosing the AI involvement in feedback generation.

Results: There was no significant difference between the mean scores of the control (immediate: 78.5 ± 20.6 delayed: 78.0 ± 21.2) and experiment (immediate: 74.7 ± 15.1, delayed: 76.0 ± 14.5) groups in overall performance on Key-Features Questions (out of 120 points) immediately (P = .26) or after 10 days (P = .57), with small effect sizes. However, the control group outperformed the ChatGPT group in complicated urinary tract infection cases (P < .001). The experiment group showed a significantly higher critical approach to AI after disclosing, with medium-large effect sizes.

Conclusions: ChatGPT-generated feedback can be an effective alternative to expert feedback in improving clinical reasoning skills in medical students, particularly in resource-constrained settings with limited expert availability. However, AI-generated feedback may lack the nuance needed for more complex cases, emphasizing the need for expert review. Additionally, exposure to the drawbacks in AI-generated feedback can enhance students' critical approach towards AI-generated educational content.

London Major Trauma System (LMTS) was the first organised trauma system in the United Kingdom. It was created in 2010 in response to multiple reviews that suggested a large number of deaths from trauma may have been preventable. LMTS has all the features of a modern organised trauma system, including regionalisation, integration of care, transfer services, trauma teams, and a world leading research service. Since its introduction the benefits on mortality, morbidity, and other key metrics have been widely demonstrated. Despite its success, LMTS still faces a number of challenges; most notably from the ageing population, but also in ensuring equity of improvements across the entirety of the trauma network and throughout the whole patient journey. The very nature of LMTS being an inclusive and organised trauma system will help it in facing these challenges.

Educators and researchers are reliant upon access to data to drive teaching methods, curricular improvements, and progress in medical education research. However, data are not always accessible, due to resource constraints, institutional policies, and privacy concerns. Researchers have attempted to access novel data sources through surveys, semistructured interviews, and databases; however, these methodologies are limited. To improve access to data, Freedom of Information (FOI) Acts grant researchers the ability to formally request data that any public institute holds. Researchers have been reluctant to use this tool due to negative perceptions, despite its unique benefits. To increase awareness of this underutilized methodology, we summarize the process of FOI Act requests, its strengths and weaknesses, and the ways in which health professions education can leverage FOI requests within research. We provide examples of the use of FOI requests as a research method within adjacent fields and nascent use within the field of health professions research. In doing so, we hope to highlight how FOI requests can be a useful tool in health professions education researchers and its potential to increase access to unique data sources.

Our experience in the Australian context is that medical students and clinicians receive minimal exposure to anatomical pathology throughout the course of their training. In this paper, we bring this topic to light by describing the process of converting an intact specimen into glass slides for microscopic analysis. We also explain how a pathological report is composed, along with brief discussions about ancillary tests, such as immunohistochemistry, special stains, and molecular testing. Our main goal is to familiarize clinicians with anatomical pathology in order to improve communication between clinicians and pathologists, as well as improve the quality of testing and patient care.

Background: Restless legs syndrome (RLS) is a sleep disorder characterized by an irresistible urge to move the legs, with pathogenesis involving genetic, environmental, and neurobiological factors. Recent advancements in imaging techniques have provided valuable insights into the pathophysiological mechanisms of RLS.

Objective: To synthesize recent research on white matter fiber alterations in RLS and their role in disease pathology.

Materials and methods: This review synthesized recent research on RLS, focusing on neuroimaging findings, particularly white matter fiber alterations, and their implications for disease mechanisms. Studies involving structural and functional MRI were analyzed.

Results: Imaging studies suggested that RLS was associated with white matter integrity changes, affecting areas linked to sensory and motor control. These alterations may reflect disruptions in central nervous system pathways regulating movement.

Conclusion: White matter changes provide valuable insights into the pathophysiology of RLS, enhancing our understanding of the disorder and potentially guiding future therapeutic strategies.