Postgraduate Medical Journal最新文献

A systematic review and meta-analysis of real-world studies on tirzepatide is essential to strengthen evidence of its effectiveness in improving glycated hemoglobin (HbA1c) and body weight in patients with type 2 diabetes. 13 real-world studies (N = 89 296; duration 3-18 months) with moderate to serious bias revealed a mean HbA1c reduction of 0.91% (95% confidence interval [CI]: -1.04 to -0.79), weight loss of 9.7 kg (95% CI: -14.05 to -5.35), and body mass index decrease of 2.09 kg/m2 (95% CI: -3.27 to -0.92). Overall, 64% of tirzepatide users reached HbA1c <7%. Furthermore, tirzepatide lowered HbA1c (mean difference [MD] -0.38%; 95% CI: -0.44 to -0.33) and body weight (MD -6.27 kg; 95% CI: -9.22 to -0.33) more than the control. 47%, 23%, 9%, and 4% of tirzepatide users lost ≥5%, ≥10%, ≥15%, and ≥ 20% of their baseline weight, respectively. Tirzepatide's effects on HbA1c and weight in observational studies support clinical trial findings.

Introduction: In 2024, the UK Foundation Programme Office introduced Preference Informed Allocation (PIA) to replace the Educational Performance Measure and Situational Judgement Test (SJT) for allocating Foundation Year 1 (FY1) posts. This study evaluates FY1 doctors' perceptions of PIA's fairness and effectiveness.

Methods: A nationwide survey was distributed to FY1 doctors following induction (n = 9702 eligible). Perceptions on PIA fairness, SJT removal, and Specialised Foundation Programme (SFP) allocation were collected using a five-point Likert scale (1 = strongly disagree, 5 = strongly agree). Quantitative data were analysed using non-parametric statistics, and free-text responses were examined using reflexive thematic analysis.

Results: A total of 1340 FY1s responded (13.8%), representing graduates from 56 medical schools. Overall, 75.2% received their first-choice foundation school, and 91.5% were placed within their top five. Most respondents disagreed that PIA was equitable (median 2 [IQR 1-3]) or should be used for SFP allocation (median 2 [IQR 1-3]), but agreed they were pleased not to have taken the SJT [median 4 (IQR 3-5)]. UK trained graduates and younger, white respondents viewed PIA less favourably than international, older, and minority-ethnic graduates. Thematic analysis emphasized loss of perceived control, calls for greater transparency, and preferences for merit-based or hybrid allocation models.

Conclusions: While PIA maintained high first-choice placements, concerns about fairness were prominent, particularly among UK graduates. Many respondents favoured reintroducing merit-based components. Continued evaluation is needed to ensure a fair, transparent, and acceptable allocation process for future graduates. Key messages What is already known on this topic: The UK Foundation Programme Office replaced performance-based allocation with preference informed allocation (PIA) in 2024, aiming to improve fairness, reduce stress, and align placements with applicant preferences. However, graduate perceptions of this change have not been fully explored. What this study adds: Most respondents disagreed that PIA was a fair allocation system and opposed its use for the specialized foundation programme, particularly younger, white, and UK graduates. Many expressed preferences for reintroducing merit-based elements, such as a standardized clinical examination. How this study might affect research, practice, or policy: The findings highlight the need for ongoing evaluation of the PIA system to ensure fairness, transparency, and acceptability among medical graduates, and may help inform future postgraduate allocation reforms.

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.

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.

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.

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.