Postgraduate medical journal (Postgrad Med)

Publisher: BMJ Publishing Group

Journal description

Published on behalf of the Fellowship of Postgraduate Medicine, Postgraduate Medical Journal aims to: Help doctors in training to acquire the necessary skills to enable them to deliver the highest possible standards of patient care; Help trainers to develop suitable training programmes for their trainees; Allow doctors, once training is completed, to maintain these high standards by a process of continuing medical education; As well as editorials and original articles, Postgraduate Medical Journal includes up to six review articles in each issue and has a Self-Assessment Corner.

Current impact factor: 1.45

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 1.448
2013 Impact Factor 1.549
2012 Impact Factor 1.608
2011 Impact Factor 1.939
2010 Impact Factor 1.605
2009 Impact Factor 1.384
2008 Impact Factor 1.587
2007 Impact Factor 1.218
2006 Impact Factor 1.093
2005 Impact Factor 0.944
2004 Impact Factor 0.807
2003 Impact Factor 0.676
2002 Impact Factor 0.552
2001 Impact Factor 0.441
2000 Impact Factor 0.339
1999 Impact Factor 0.402
1998 Impact Factor 0.478
1997 Impact Factor 0.496
1996 Impact Factor 0.572
1995 Impact Factor 0.442
1994 Impact Factor 0.448
1993 Impact Factor 0.357
1992 Impact Factor 0.325

Impact factor over time

Impact factor

Additional details

5-year impact 1.76
Cited half-life >10.0
Immediacy index 0.39
Eigenfactor 0.00
Article influence 0.56
Website Postgraduate Medical Journal website
Other titles Postgraduate medical journal
ISSN 1469-0756
OCLC 66425979
Material type Periodical, Internet resource
Document type Internet Resource, Journal / Magazine / Newspaper

Publisher details

BMJ Publishing Group

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • On author's personal website, institutional website or institutional repository
    • Publisher copyright and source must be acknowledged
    • Must link to publisher version
    • Publisher's version/PDF cannot be used
    • Authors retain copyright
    • If funding agency rules apply, authors may post articles in PubMed Central and mirror sites, website, institutional website or institutional repository
    • On PubMed Central after 12 months embargo from print publication, or as required by funding agency
    • On social networks such as ResearchGate and Mendeley after 6 months embargo from print publication
    • Publisher last contacted on 08/12/2014
    • Publisher last reviewed on 29/06/2015
  • Classification

Publications in this journal

  • Postgraduate medical journal 11/2015; DOI:10.1136/postgradmedj-2015-133749
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The usual reference range of serum sodium (typically 135-145 mmol/l) is derived from healthy populations but may not apply to hospital patients. Objectives: To describe the range of serum sodium in inpatients and outpatients of both sexes at different ages. To ascertain correlates of serum sodium among older inpatients. To describe the association between sodium and mortality. Methods: We used routine hospital data on serum sodium in inpatients admitted between 1 January 2011 and 31 December 2014 and patients attending outpatient or community clinics with no record of admission to the same hospitals in the same period. We investigated the distribution of sodium values within these groups and explored the relationship between serum sodium and death using logistic regression. Results: Levels among hospital inpatients were significantly lower than in outpatients of the same age. Emergency admissions had lower levels and those admitted from care homes higher levels, risk of inhospital death began to rise at 140 mmol/L, well within the 'normal' range. Patients with a serum sodium concentration of 145 mmol/L on admission have a risk of inhospital death 3.7 times higher than that of a patient with a concentration of 140 mmol/L. Conclusions: The range for serum sodium concentration on admission in inpatients is broader and lower than the commonly accepted reference range. The risk of mortality increases at sodium concentration >139 mmol/L, well within reference range currently considered normal.
    Postgraduate medical journal 11/2015; DOI:10.1136/postgradmedj-2015-133482
  • [Show abstract] [Hide abstract]
    ABSTRACT: Chemotherapy-induced nausea and vomiting (CINV) remains one of the most debilitating toxicities associated with cancer treatment. In recent decades, significant strides have been made in our understanding of the pathophysiology of CINV, making way to more effective targeted pharmacotherapies, especially 5-hydroxytryptamine3 receptor antagonists and neurokinin-1 (NK-1) receptor antagonists. As much as 70%-80% of CINV can be prevented with appropriate administration of available antiemetics. Nevertheless, fear of CINV still may diminish cancer treatment adherence. To assimilate and summarise the rapidly growing body of clinical research literature on CINV, three professional organisations-the Multinational Association of Supportive Care in Cancer/European Society for Medical Oncology, the American Society of Clinical Oncology and the National Comprehensive Cancer Network-have created CINV management guidelines. While these respective guidelines are developed from similar consensus processes using similar clinical research literature, their results demonstrate several key differences in recommended strategies. This article aims to provide an overview of CINV pathophysiology, compare and contrast three expert guidelines and offer considerations for future clinical and research challenges.
    Postgraduate medical journal 11/2015; DOI:10.1136/postgradmedj-2014-132969

  • Postgraduate medical journal 11/2015; DOI:10.1136/postgradmedj-2015-133639
  • [Show abstract] [Hide abstract]
    ABSTRACT: Haemorrhoids present often to primary and secondary care, and haemorrhoidal procedures are among the most common carried out. They may co-exist with more serious pathology, and correct evaluation is important. In most cases a one-off colonoscopy in patients aged 50 or above with flexible sigmoidoscopy in younger patients is reasonable. Many people with haemorrhoids do not require treatment. Topical remedies provide no more than symptomatic relief-and even evidence for this is poor. Bulk laxatives alone may improve symptoms of both bleeding and prolapse and seem as effective as injection sclerotherapy. Rubber band ligation is effective in 75% of patients in the short term, but does not treat prolapsed haemorrhoids or those with a significant external component. Conventional haemorrhoidectomy remains the most effective treatment in the long term, the main limitation being post-operative pain. Metronidazole, topical sphincter relaxants and operative technique have all been shown to reduce pain. Stapled haemorrhoidectomy and haemorrhoidal artery ligation techniques are probably less effective but less painful. Long-term data are poor for all procedures, with many studies reporting only 1-3 years of follow-up data. Haemorrhoids are common in pregnancy, occurring in 40% of women. They can usually be treated conservatively during pregnancy, with any treatment delayed until after delivery. Acutely strangulated haemorrhoids may be treated either conservatively or operatively. There is an increased risk of anal stenosis after acute surgery, but the risks of sepsis and sphincter damage are less significant than previously thought. The majority of patients who are treated conservatively will still require definitive treatment at a later date.
    Postgraduate medical journal 11/2015; DOI:10.1136/postgradmedj-2015-133328
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Acute kidney injury (AKI) is a significant cause of morbidity and mortality. Early identification may improve the outcome and in 2012 our hospital introduced an automated AKI alert system for early detection and management of AKI. Objectives: Using an automated AKI alert system we analysed whether early review and intervention by the Critical Care and Outreach (CCOT) team improved patient outcomes in AKI and whether serum bicarbonate was useful in predicting outcomes in patients with AKI. Methods: In a retrospective analysis we identified patients who triggered an AKI alert from 20 April 2012 to 20 September 2013 and collected data on mortality, length of stay, need for intensive care admission and renal replacement therapy (RRT). Results: 994 AKI alerts were generated and analysed. Patients with bicarbonate outside the normal range had significantly higher mortality. Bicarbonate <22 mmol/L was associated with a mortality of 25.7% (49/191) compared with 16.9% (39/231) when 22-29 mmol/L (p=0.047, χ(2)). Those patients reviewed ≥1 day after AKI alert by CCOT compared with those seen on the day of the alert had a 2.4 times increase in mortality and were 7 times more likely to require RRT acutely. Conclusions: Electronically identified AKI alerts identify patients at high risk of morbidity and mortality. In this group AKI alerts preceded CCOT review by a mean of 2 days. This represents a window for supportive interventions, which may explain improved outcomes in those reviewed earlier. The addition of serum bicarbonate offers a further method of risk stratifying patients at greater risk of death.
    Postgraduate medical journal 10/2015; DOI:10.1136/postgradmedj-2015-133496

  • Postgraduate medical journal 10/2015; DOI:10.1136/postgradmedj-2015-133661
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Benefits of exposure to global health training during medical education are well documented and residents' demand for this training is increasing. Despite this, it is offered by few US obstetrics and gynaecology (OBGYN) residency training programmes. Objectives: To evaluate interest, perceived importance, predictors of global health interest and barriers to offering global health training among prospective OBGYN residents, current OBGYN residents and US OGBYN residency directors. Methods: We designed two questionnaires using Likert scale questions to assess perceived importance of global health training. The first was distributed to current and prospective OBGYN residents interviewing at a US residency programme during 2012-2013. The second questionnaire distributed to US OBGYN programme directors assessed for existing global health programmes and global health training barriers. A composite Global Health Interest/Importance score was tabulated from the Likert scores. Multivariable linear regression was performed to assess for predictors of Global Health Interest/Importance. Results: A total of 159 trainees (77%; 129 prospective OBGYN residents and 30 residents) and 69 (28%) programme directors completed the questionnaires. Median Global Health Interest/Importance score was 7 (IQR 4-9). Prior volunteer experience was predictive of a 5-point increase in Global Health Interest/Importance score (95% CI -0.19 to 9.85; p=0.02). The most commonly cited barriers were cost and time. Conclusion: Interest and perceived importance of global health training in US OBGYN residency programmes is evident among trainees and programme directors; however, significant financial and time barriers prevent many programmes from offering opportunities to their trainees. Prior volunteer experience predicts global health interest.
    Postgraduate medical journal 10/2015; DOI:10.1136/postgradmedj-2014-133144
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Iodine-containing disinfectants are widely used for skin preparation before caesarean section. Current evidence suggests that maternal exposure to these disinfectants results in thyroid dysfunction in the newborns, but its extent is not known. Objectives: The purpose of this study was to explain the quality of the effect of these disinfectants on the thyroid function of newborns. Methods: This cohort study was performed on all the healthy mothers with a term pregnancy who underwent caesarean section in the obstetrics emergency department of an educational hospital affiliated with Tehran University of Medical Sciences from December 2013 to December 2014. We divided this 12-month period into two consecutive 6 months. Povidone-iodine 10% (PVP-I) and chlorhexidine gluconate 4% (CHX) were used in the first and second 6 months, respectively, for skin preparation before caesarean section and also for umbilical cord disinfection. Cord blood thyroid stimulating hormone (TSH) and thyroxine (T4) were assayed by the ELISA method. Results: We included 326 cases in this study, 153 in the PVP-I group and 173 in the CHX group. The incidence of cord blood TSH ≥10 mIU/L and T4 ≤7.3 µg/dL was significantly higher in the PVP-I than the CHX group. Cord blood TSH concentration showed a significant positive correlation with cord blood T4 concentration in the CHX group. Through selection of cases with cord blood T4 <13 µg/dL, we found a negative correlation between cord blood TSH and T4 concentration in the PVP-I group. Conclusions: It seems that PVP-I has the potential to cause false-positive screening-test results and increase recall rates, which should be evaluated in further studies. Trial registration number: Iranian Registry of Clinical Trials (IRCT) number IRCT201204289568N1.
    Postgraduate medical journal 10/2015; DOI:10.1136/postgradmedj-2015-133540

  • Postgraduate medical journal 10/2015; 91(1081):662. DOI:10.1136/postgradmedj-2015-133667

  • Postgraduate medical journal 10/2015; 91(1081):663-664. DOI:10.1136/postgradmedj-2015-133766
  • [Show abstract] [Hide abstract]
    ABSTRACT: Budd-Chiari syndrome is a rare disorder characterised by hepatic venous outflow obstruction. It affects 1.4 per million people, and presentation depends upon the extent and rapidity of hepatic vein occlusion. An underlying myeloproliferative neoplasm is present in 50% of cases with other causes including infection and malignancy. Common symptoms are abdominal pain, hepatomegaly and ascites; however, up to 20% of cases are asymptomatic, indicating a chronic onset of hepatic venous obstruction and the formation of large hepatic vein collaterals. Doppler ultrasonography usually confirms diagnosis with cross-sectional imaging used for complex cases and to allow temporal comparison. Myeloproliferative neoplasms should be tested for even if a clear causative factor has been identified. Management focuses on anticoagulation with low-molecular-weight heparin and warfarin, with the new oral anticoagulants offering an exciting prospect for the future, but their current effectiveness in Budd-Chiari syndrome is unknown. A third of patients require further intervention in addition to anticoagulation, commonly due to deteriorating liver function or patients identified as having a poorer prognosis. Prognostic scoring systems help guide treatment, but management is complex and patients should be referred to a specialist liver centre. Recent studies have shown comparable procedure-related complications and long-term survival in patients who undergo transjugular intrahepatic portosystemic shunting and liver transplantation in Budd-Chiari syndrome compared with other liver disease aetiologies. Also, the optimal timing of these interventions and which patients benefit from liver transplantation instead of portosystemic shunting remains to be answered.
    Postgraduate medical journal 10/2015; DOI:10.1136/postgradmedj-2015-133402
  • [Show abstract] [Hide abstract]
    ABSTRACT: In 1925, Sir Thomas Horder, a leading physician of his day, gave a lecture, published in this journal, entitled 'Some cases of pyrexia without physical signs'. The paper highlighted what was already a familiar clinical presentation "which taxes our resources to the utmost". Fast-forward through 90 years of careful clinical description, technological innovation in diagnosis and treatment, emergent infections, novel diagnoses, demographic shifts, and radical changes in the health economy. Sir Thomas would find certain aspects familiar, and others revolutionary, in the differential diagnosis and management of the 21st century patient with pyrexia of unknown origin (PUO). Within high-income settings, the proportion of cases due to infection has declined, albeit unevenly. The era of untreated HIV, and the consequences of iatrogenic intervention and immunosuppression, led to Durack and Street's subclassification of the condition in the early 1990s into classic, nosocomial, neutropenic and HIV-associated PUO. Shifts towards ambulatory care have driven a change in the definition of many diseases. An era of observant clinicians, who lent their names to eponymous syndromes, followed by meticulous serological, genetic and clinicopathological correlation, generated a battery of diagnoses that, along with malignancy, form a large proportion of diagnoses in more recent clinical care. In the current era, universal access to cross-sectional imaging and an infinite array of laboratory tests has undermined the attention paid to history and examination. In some areas of the clinical assessment, such as assessing the fever pattern, this shift is supported by research evidence. The issues that need to be addressed in the next 90 years of technological innovation, information sharing and health service transformation are likely to include: transcriptomic approaches to diagnosis; the place of positron emission tomography (PET) in the diagnostic pathway; the optimal management of high ferritin states; and the most cost-effective diagnostic environment, in the face of this era of specialisation and fragmentation of care. In the meantime, this review covers some important early 21st century lessons to be shared in avoiding diagnostic pitfalls and choosing empirical therapy.
    Postgraduate medical journal 10/2015; DOI:10.1136/postgradmedj-2015-133554
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Cerebrospinal fluid (CSF) spectroscopy can identify subarachnoid haemorrhage (SAH) when CT is negative in patients presenting with acute severe headache. The primary objective of this study was to evaluate the clinical use and usefulness of CSF spectrophotometry. Secondary objectives were to identify other causes of elevated CSF bilirubin, to analyse headache descriptions and to compare clinical features in patients with an elevated CSF bilirubin among those with and without an intracranial vascular cause of SAH (avSAH). Methods: Consecutive patients admitted to two hospitals in Enniskillen and Londonderry between 1 January 2004 and 30 September 2014 with CSF spectroscopy bilirubin results were identified from a clinical chemistry laboratory dataset. Patients with elevated CSF bilirubin were studied. Clinical demographics, delays to investigation and final diagnoses were recorded. Patients with avSAH were compared with patients without avSAH. Results: Among 1813 patients with CSF spectrophotometry results, requests increased more than threefold during the study (p<0.001). Fifty-six patients had elevated CSF bilirubin. Ten (17.9%) had avSAH, of which 8 (14.3%) had aneurysmal SAH. Non-vascular causes of elevated CSF bilirubin included meningitis, spontaneous intracranial hypotension and carcinomatous meningitis. Headache descriptions varied. Time from headache onset to admission, CT scan and lumbar puncture did not differ significantly for patients with avSAH and non-avSAH. CSF red cell counts were higher among patients with avSAH than patients with non-avSAH (p=0.005). Conclusions: CSF bilirubin measurement has an important role in identifying avSAH in CT-negative patients presenting with a thunderclap headache. Better clinical selection of patients is required as CSF spectrophotometry, although sensitive, is not specific for SAH.
    Postgraduate medical journal 10/2015; DOI:10.1136/postgradmedj-2015-133360
  • [Show abstract] [Hide abstract]
    ABSTRACT: The last 90 years have seen considerable advances in the management of type 1 and type 2 diabetes. Prof MacLean of Guy's Hospital wrote in the Postgraduate Medical Journal in 1926 about the numerous challenges that faced patients and their healthcare professionals in delivering safe and effective diabetes care at that time. The discovery of insulin in 1922 heralded a new age in enabling long-term glycaemic control, which reduced morbidity and mortality. Thirty years later, the first oral agents for diabetes, the biguanides and sulfonylureas, appeared and freed type 2 patients from having to inject insulin following diagnosis. Improvements in insulin formulations over the decades, including rapid-acting and long-acting insulin analogues that more closely mimic physiological insulin secretion, have increased the flexibility and efficacy of type 1 diabetes management. The last two decades have seen major advances in technology, which has manifested in more accurate glucose monitoring systems and insulin delivery devices ('insulin pump'). Increased understanding of the pathophysiological deficits underlying type 2 diabetes has led to the development of targeted therapeutic approaches such as on the small intestine (glucagon-like peptide-1 receptor analogues and dipeptidyl-peptidase IV inhibitors) and kidneys (sodium-glucose cotransporter-2 inhibitors). A patient-centred approach delivered by a multidisciplinary team is now advocated. Glycaemic targets are set according to individual circumstances, taking into account factors such as weight, hypoglycaemia risk and patient preference. Stepwise treatment guidelines devised by international diabetes organisations standardise and rationalise management. Structured education programmes and psychological support are now well-established as essential for improving patient motivation and self-empowerment. Large multicentre randomised trials have confirmed the effectiveness of intensive glycaemic control on microvascular outcomes, but macrovascular outcomes and cardiovascular safety remain controversial with several glucose-lowering agents. Future directions in diabetes care include strategies such as the 'bionic pancreas', stem cell therapy and targeting the intestinal microbiome. All of these treatments are still being refined, and it may be several decades before they are clinically useful. Prevention and cure of diabetes is the Holy Grail but remain elusive due to lack of detailed understanding of the metabolic, genetic and immunological causes that underpin diabetes. Much progress has been made since the time of Prof MacLean 90 years ago, but there are still great strides to be taken before the life of the patient with diabetes improves even more significantly.
    Postgraduate medical journal 10/2015; 91(1081). DOI:10.1136/postgradmedj-2014-133200