A rare cause of shoulder pain
A 23-year-old woman presented to the emergency department with a 1-year history of atraumatic right shoulder pain. Over the preceding few months, the pain had worsened and her range of movement had reduced considerably. She was otherwise fit and healthy. On examination, her shoulder appeared normal and there was no obvious neurovascular deficit, including the axillary nerve. She had no movement in any direction actively, but passively could bring her shoulder to 60° of abduction and forward flexion. A plain radiograph of the shoulder (figure 1) shows a lobulated, expansile, ill-defined lytic lesion within the right hum...
Source: Postgraduate Medical Journal - December 6, 2022 Category: General Medicine Authors: Jaconelli, T., Auplish, S. Tags: Images Source Type: research

A fortunate writer: reflections of a medical columnist
I started to write this monthly column in the Postgraduate Medical Journal in January 2008. Since then I have commented in each issue on topics related to reflective practice and medical humanities. Two successive editors have been tolerant enough to allow me to interpret that remit very broadly, and they have known how to nudge me diplomatically towards more clarity or circumspection when I strayed into waffle or ranting. As some readers may know, I have now joined the panel of columnists for the BMJ so this article will be my last in the back pages of this journal. In future, the column will be open to submissions from a...
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Launer, J. Tags: On reflection Source Type: research

Wide-ranging clinical spectrum of paradoxical embolism
The purpose of this review is to raise the index of suspicion for paradoxical embolism among generalists. The review is based solely on anecdotal reports compiled from EMBASE, MEDLINE, Googlescholar and Pubmed. Search terms were ‘paradoxical embolism’, ‘pulmonary embolism’ and ‘pulmonary arteriovenous malformations’. What emerged was that right-to-left paradoxical embolism could occur with or without concurrent pulmonary embolism, and also with and without proof of the presence of an ‘embolus-in-transit’. Potential sites of single or multiple systemic involvement included the...
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Jolobe, O. Tags: Reviews Source Type: research

Clinicopathological and prognostic values of PD-L1 expression in oesophageal squamous cell carcinoma: a meta-analysis of 31 studies with 5368 patients
Several immune checkpoint inhibitors targeting programmed death ligand 1 (PD-L1)/programmed death 1 have successfully improved the prognosis of oesophageal squamous cell carcinoma (ESCC) with approval in certain countries. However, whether the expression of PD-L1 is associated with the degree of benefit is unclear yet and a unified standard of antibody and cut-off value of PD-L1 detection is also lacking. The current meta-analysis then aimed to explore the association between PD-L1 expression and clinicopathological features as well as prognosis in ESCC. A systematic search on PubMed, Embase, Cochrane Library and Web of Sc...
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Liu, Z., Sun, L., Cai, L., Guo, M., Xu, G., Liu, S., Zheng, G., Wang, Q., Lian, X., Feng, F., Zhang, H. Tags: Reviews Source Type: research

Motivations of medical students and doctors leaving the NHS explored in a residency training application webinar series
Conclusion Future work on the quality of life for doctors in the UK should be explored, especially among those considering leaving the NHS. Policymakers should focus on assessing the difference in working hours, on-call hours and wages that may differ among healthcare systems. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Ooi, S. Z. Y., Ooi, R., Godoi, A., Foo, E. F., Woo, T., Li, C., Ganesananthan, S., Cardiff Healthcare International Perspectives Society (CHIPS), Ban, Chidowe, Chiu, Fong, Goldenberg, Janardanan, Leow, Ng, Ooi, Raudaschl, Syed, Tam, Tan, Tan, Tan, Tan, Ta Tags: Original research Source Type: research

Influence of medical trainee sleep pattern (chronotype) on burn-out and satisfaction with work schedules: a multicentre observational study
Conclusion Burn-out is prevalent among medical trainees. Improving alignment between trainee preferences may improve performance, reduce human errors and burn-out. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Gohar, A. A., Knauert, M., Kalot, M. A., Khan, A., Sider, D., Javed, M. A., Wooldridge, D., Eck, L., Buckhold, F., Colaco, B., Bhat, A., Castillo, D. M., Newman, R., Mustafa, R. A. Tags: Original research Source Type: research

What gets resident physicians stressed and how would they prefer to be supported? A best-worst scaling study
Conclusion BWS can identify relative differences in surveyed stressors, allowing for the generation of specialty-specific stressor rankings and preferences for specific wellness interventions that can be used to drive institution-wide changes to improve clinician wellness. BWS surveys are a potential methodology for clinician wellness programmes to gather specific information on preferences to determine best practices for resident wellness. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Wu, A., Parris, R. S., Scarella, T. M., Tibbles, C. D., Torous, J., Hill, K. P. Tags: Original research Source Type: research

Prevalence of methylphenidate use by Master of Medicine students at a South African university
Conclusions Off-label use of methylphenidate is prevalent in MMed students registered at this South African university. The prevalence is significantly higher than in undergraduate medical students. The non-conventional means of access is of great concern. Efforts should be made to discourage self-prescription, educate students on the dangers of methylphenidate use, promote better access regulation and enhance psychological support. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Louw, W. A. N., Davids, R. A. Tags: Editor's choice Original research Source Type: research

Low level of complement factor H increases the risk of cancer-related death in patients with small-cell lung cancer
Conclusions CFH can be recognised as a biomarker to predict the risk of death in SCLC. The prediction model established based on CFH, C3 and C4 levels has good accuracy in patients’ prognostic assessment. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Xiang, M., Zhang, H., Kou, L., Chen, J., Xu, Z., He, J. Tags: Original research Source Type: research

Cohort study of the APACHE II score and mortality for different types of intensive care unit patients
Conclusion APACHE II has a good discriminant for predicting mortality among ICU patients in Siloam Hospital but poor calibration score. However, it demonstrates poor calibration in neurosurgical and surgical patients while demonstrating adequate calibration in medical emergency patients. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Sungono, V., Hariyanto, H., Soesilo, T. E. B., Adisasmita, A. C., Syarif, S., Lukito, A. A., Widysanto, A., Puspitasari, V., Tampubolon, O. E., Sutrisna, B., Sudaryo, M. K. Tags: Original research Source Type: research

Decreased eosinophil counts and elevated lactate dehydrogenase predict severe COVID-19 in patients with underlying chronic airway diseases
Conclusions Eosinopaenia and elevated LDH are potential predictors of disease severity in patients with COVID-19 with underlying chronic airway diseases. In addition, they could indicate disease progression and treatment effectiveness. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Chen, D., Zhang, S., Feng, Y., Wu, W., Chang, C., Chen, S., Zhen, G., Yi, L. Tags: Open access, COVID-19 Original research Source Type: research

Olfactory evaluation in hospitalised and self-isolated patients with COVID-19: a single-centre experience on 55 cases
Conclusion Contrary to some previous reports suggesting that the presence of olfactory loss may predict milder course of disease, our study found that a vast majority of hospitalised patients with COVID-19 had prominent olfactory impairment. The absence of correlation between self-rated and objective smell evaluation in patients with COVID-19 indicates that subjective smell assessment is unreliable. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Klarendic, M., Zupanic, E., Zalaznik, M., Georgiev, D., Tomazic, J., Kojovic, M. Tags: COVID-19 Original research Source Type: research

Post BNT162b2 mRNA COVID-19 vaccination Henoch-Schönlein Pupura
Introduction Administration of BNT162b2 mRNA COVID-19 vaccine on a large scale was performed to combat the COVID-19 pandemic. Leading to the identification of various rare but significant vaccine-associated side effects one of which is myocarditis and pericarditis post vaccination.1 There have been reports of COVID-19 vaccine-associated vasculitis, both as a new onset IgA-positive leukocytoclastic vasculitis in an otherwise healthy adult man and also a leukocytoclastic vasculitis flare in an adult woman with autoimmune conditions.2 3 Case report Our case is a 15-year-old Indian girl presenting with bilateral lower limb ras...
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Wang, S. S. Y. Tags: COVID-19 Adverse drug reactions Source Type: research

Introduction to the development of complex interventions
This article describes the Medical Research Council’s guidance and introduces two frequently used tools that further support the process of intervention design. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Brewster, S., Holt, R., Price, H. Tags: Education and learning Source Type: research

Residency interviews in the digital era
In the midst of the SARS-CoV-2 pandemic, the US Association of American Medical Colleges (AAMC) required residency programme transition from in-person to virtual interviews for all applicants. The new virtual format upended a system that has relied on programmes and applicants balancing the likelihood of acceptance with the financial and time demands of cross-country travel. In this commentary, we address the history of residency interviewing in the USA and the emerging changes that are taking place in light of virtual interviews. We discuss the advantages of the new online format, including the reduced cost for applicants...
Source: Postgraduate Medical Journal - November 22, 2022 Category: General Medicine Authors: Beshar, I., Tate, W. J., Bernstein, D. Tags: Education and learning Source Type: research