Virtual risk assessment pathway for deep venous thrombosis: a preliminary model
Conclusion
Advances in telecommunication technology can enable clinicians, specialist nurses and hospital departments to develop a virtual examination pathway for remote triage and assessment of patients with suspected DVT. This pathway is not a replacement for conventional ‘face-to-face’ evaluation, but we believe the template can be explored and refined to act as a blueprint for future applications even when the pandemic has stabilised. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: Iyengar, K. P., Jain, V. K., Soni, M., Hakim, Z. Tags: COVID-19 Original research Source Type: research
Routine use of both mammography and MRI surveillance in patients with previous 'mammogram occult breast cancer: experience from a tertiary centre
Conclusions
MRI surveillance leads to higher recalls and false positives compared to mammograms in this specific subgroup of high-risk patients. Large proportion of cancers presented symptomatically, stressing the importance of remaining vigilant of breast symptoms despite imaging surveillance. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: Bansal, G. J., Purchase, D., Wray, M. Tags: Original research Source Type: research
New COL4A5 mutation in IgA nephropathy
Conclusion
Together with other published data, we suggest that genetic screening should be performed in IgAN, particularly for patients with a familial history. The effects of different mutated splice sites of the COL4A5 gene, as well as the tissue specificity of the splicing machinery contributing to the pathogenesis and prognosis of IgAN, remains unclear and warrants further exploration in the future. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: Xu, Z., Chen, J., Yu, W., Li, X., Lin, B., Lai, D., Xu, A., Tang, Y. Tags: Original research Source Type: research
Pantoprazole-induced acute hepatocellular and cholestatic hepatitis
Introduction Pantoprazole is a proton pump inhibitor (PPI) widely used to manage acid-related disorders. It is well tolerated with an excellent safety profile.1 Mild, transient asymptomatic elevations in serum aminotransferases is common with pantoprazole use. They typically resolve without dose modification.1 Pantoprazole-induced clinically apparent liver injury, however, is exceedingly rare. We demonstrate a case of acute, severe symptomatic liver injury from pantoprazole use that reversed on its discontinuation. Case presentation A 47-year-old Caucasian woman with no history of liver disease was admitted to the hospital...
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: Kataria, A., Stolow, E., Hubbard, H. Tags: Adverse drug reactions Source Type: research
Pneumatosis intestinalis induced by targeted therapy
Case presentation A middle aged woman presented to the emergency department with vomiting and diarrhoea for 5 days. She was diagnosed as stage IV lung adenocarcinoma with EGFR mutation. Two weeks ago, she just started a combination of erlotinib and crizotinib based on the discovery of MET amplification after failure of afatinib and subsequent chemotherapy treatment. At the emergency department, she appeared with acute ill-looking, low-grade fever (37.6°C), hypotension (SBP/DBP 87/57 mm Hg) and tachycardia (140 bpm). Physical examination showed a soft and mildly distended abdomen with hypoactive bowel sounds and no tend...
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: Chang, C.-J., Shen, C.-I., Wu, C.-L., Chiu, C.-H. Tags: Adverse drug reactions Source Type: research
Effect of medical school attended on the chances of successfully embarking on a clinical-academic career in the UK
Conclusions
Students attending a medical school with greater academic performance and research focus are more likely to apply and subsequently embark on a clinical-academic career. However, students wishing to embark a clinical-academic career from any medical school have an equal chance of success. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: Donaldson, C. J., Sequeira Campos, M., Ridgley, J., Light, A. Tags: Education and learning Source Type: research
Evolution of the prevalence of pre-residency peer-reviewed publications among incoming junior residents
Pre-residency peer-reviewed publications (PRP) have been associated with subsequent resident choice of academic versus private practice career. The evolution of PRP prevalence among radiation oncology resident classes has yet to be examined. A list of radiation oncology residents from the graduating classes of 2016 and 2022 were obtained, and PRP was compiled as the number of publications a resident had listed in PubMed as of the end of the calendar year of residency application. Statistical analysis was conducted using Fisher’s exact test. Analysis of 163 residents from the 2016 class compared with 195 from the 2022...
Source: Postgraduate Medical Journal - December 15, 2021 Category: General Medicine Authors: McClelland III, S., Murphy, B., Jaboin, J. J., Zellars, R. C. Tags: Education and learning Source Type: research
Patients as ethnographers
I recently spent 2 weeks as an inpatient on a hospital ward. It was not an experience I would have chosen, but I had several advantages by comparison with many of the other patients. I was ambulant for most of the time. As a doctor, I was able to understand many of the technical details of my condition and its treatment. By a strange coincidence, a colleague and friend of mine was also admitted to the same ward a few days after me, so we could support each other. As we are both involved professionally in healthcare education and organisational development, we were able to exchange our reflections on what was going on aroun...
Source: Postgraduate Medical Journal - May 25, 2017 Category: General Medicine Authors: Launer, J. Tags: On reflection Source Type: research
Pleural empyema: a case of failing to see the discharge leading to discharge failure
A 54-year-old heavy smoker was admitted with a 2-week history of pleuritic chest pain, cough, shortness of breath and weight loss. He had not improved despite a course of antibiotics from his general practitioner. He was commenced on intravenous antibiotics for presumed pneumonia based on his chest X-ray, which seemed to show left middle zone opacification (figure 1), and after 2 days, he was discharged with a further oral antibiotic course. Figure 1Posteroanterior chest X-ray showing pleural-based shadowing with cavitation abutting the left lateral chest wall with a characteristic convex ‘D’ shape of...
Source: Postgraduate Medical Journal - May 25, 2017 Category: General Medicine Authors: Ashkir, Z., Tsaknis, G., Jeffrey, A. Tags: Journalology, General practice / family medicine, Drugs: infectious diseases, Pain (neurology), Alcohol-related disorders, Drugs misuse (including addiction), Radiology, Pneumonia (respiratory medicine), Clinical diagnostic tests, Cardiothoracic surgery, Source Type: research
Lead pipe sign in mixed inflammatory bowel disease
A middle-aged female with inflammatory bowel disease (IBD) (with mixed features of ulcerative colitis and Crohn's disease), iron deficiency anaemia and recurrent Clostridium difficile colitis presented to the emergency department with complaints of abdominal pain, haematochezia and diarrhoea. An abdominal plain film obtained during her work-up demonstrated a portion of the distal transverse, descending and sigmoid colon lacking normal haustral patterns (lead pipe sign) (figure 1, arrows). Figure 1Lead pipe sign—abdominal X-ray showing a large burden of stool throughout the colon to the descending colon where the...
Source: Postgraduate Medical Journal - May 25, 2017 Category: General Medicine Authors: Ekeledo, O. J., Scelsi, C., Keshavamurthy, J. H. Tags: Drugs: gastrointestinal system, GI bleeding, Inflammatory bowel disease, Emergency medicine, Journalology, Immunology (including allergy), Pain (neurology), Malnutrition, Connective tissue disease, Dermatology, Ethics, Metabolic disorders Images in medi Source Type: research
Neuroblastoma in a 6-year-old boy
A previously healthy 6-year-old boy presented to the children's Accident and Emergency Department with right-sided abdominal pain. On examination, there was a palpable, non-tender abdominal mass, with no lymphadenopathy. Initial investigations revealed pancytopenia (haemoglobin was 5.7 g/dL, white cell count 3.7 x 109/L, platelets 134 x 109/L) and lactate dehydrogenase 1690 (normal range 240–480) with normal urea and electrolytes/liver function tests. Abdominal ultrasound showed a large central mass extending from the epigastrium to the level of the aortic bifurcation. A chest X-ray showed a ...
Source: Postgraduate Medical Journal - May 25, 2017 Category: General Medicine Authors: Russell-Jones, E., Iliadis, K., Wynne, C. Tags: Emergency medicine, Journalology, Immunology (including allergy), Pain (neurology), Paediatric oncology, Screening (oncology), Radiology, Surgical diagnostic tests, General surgery, Radiology (diagnostics), Ethics Images in medicine Source Type: research
Osborn waves of hypothermia
A 38-year-old patient with paranoid schizophrenia presented to our institution from the crisis response centre for unusual behaviour over the last 24 hours. Rectal temperature measured in the emergency department was 28.9°C (84.2°F) with an ECG (figure 1) showing Osborn waves in leads V1–V5 with reciprocal depression in lead aVR. ‘Shivering artefacts’ can also be seen in leads V1 and V2 (figure 1). His ECG normalised on rewarming (figure 2). Figure 1ECG on presentation at 28.9°C. Figure 2ECG on rewarming. Osborn waves that were definitively described in 1953 are classically s...
Source: Postgraduate Medical Journal - May 25, 2017 Category: General Medicine Authors: Ram, P., George, G. Tags: Journalology, Drugs: cardiovascular system, Psychotic disorders (incl schizophrenia), Ethics, Arrhythmias Images in medicine Source Type: research
Advising residents on how to present an article in a journal club
Introduction Reading and appreciating medical literature is an important aspect of continuing medical education.1 Residents need to learn this important aspect during their training period.2–4 Evidence-based medicine involves updating, critiquing and using the evidence for patient care. It is the explicit use of the best available evidence combined with intuition of the clinician and the intentions of patients in a given clinical situation.5 To practice evidence-based medicine, it is important to analyse the literature critically. Journal club is an effective way to teach critical appraisal skills to residents.6 Use ...
Source: Postgraduate Medical Journal - May 25, 2017 Category: General Medicine Authors: Prakash, S., Soundrarajan, J. Tags: Letter Source Type: research
Why diets fail: a hypothesis for discussion
Weight regulation depends on the difference between weights of absorbed and metabolised carbon and excretion of the end products of metabolism, calories and carbon dioxide, which can be independently and variably excreted. Calories can be variably excreted as heat by vasoconstriction or vasodilation and carbon dioxide can be excreted variably as exhaled carbon dioxide (the major route of carbon excretion). Unless there are changes in ventilatory carbon excretion, ‘metabolism,’ ‘genetic factors,’ ‘hormones’ or ‘exercise’ do not provide complete explanatory mechanisms for weigh...
Source: Postgraduate Medical Journal - May 25, 2017 Category: General Medicine Authors: Welsby, P. D. Tags: Original article Source Type: research
Lower limb immobilisation and venous thromboembolism risk: combined case-control studies
Conclusions
Lower limb immobilisation is associated with a markedly increased risk of VTE and represents the most common potentially preventable cause in the 18–65-year age group, being present in one in seven cases treated for VTE. Consideration should be given to pharmacological prophylaxis in patients with lower limb immobilisation to reduce the substantial burden of preventable VTE. (Source: Postgraduate Medical Journal)
Source: Postgraduate Medical Journal - May 25, 2017 Category: General Medicine Authors: Braithwaite, I., Healy, B., Cameron, L., Weatherall, M., Beasley, R. Tags: Drugs: cardiovascular system, Stroke, Venous thromboembolism, Pulmonary embolism, Epidemiology Original article Source Type: research
