Background: Numerous reports indicate the educational deficiencies of medical students in delivering bad-news-related skills. Evaluation of the performance of training programs in this area should be one of the key components of the educational process. The purpose of this study was to analyze medical students’ preferences and educational needs regarding DBN (delivering bad news). The effect of clinical experience on the self-assessment of skills was analyzed. Methods: The quantitative survey was conducted using the CAWI technique. The study involved 321 fifth- and sixth-year medical students from 14 medical universities in Poland. Pearson’s χ² test was used for statistical analysis. The profile of respondents for categorical variables was determined by KMeans analysis. Results: As many as 75.1% of students revealed that they did not feel sufficiently prepared for DBN. Only 18.7% reported having adequate competence in this area. More than half of the inquired students (63.6%) witnessed a situation during their clinical practice in which a physician provided a patient with information about an unfavorable diagnosis. These students were less likely to declare that they could not deliver BN (43.4%) than students who had no such experience (58.2%). As many as 86.3% of the respondents reported the need for more time in DBN skills training. Students mostly preferred active teaching methods. Conclusions: Understanding students’ learning needs and preferences can help medical schools optimize their education programs to develop DBN-related competencies.

Purpose: The aim of our study was to analyze students’ emotional experiences and coping mechanisms regarding the situation of delivering bad news (DBN). Patients and Methods: 291 fifth- and sixth-year students from 14 medical universities took part in our study. Their responses were analyzed from the perspective of their experience – whether the individuals received bad news, delivered bad news themselves, witnessed bad news being delivered, or had no experience at all. We used content analysis (CA) to examine the responses and analyzed classified variables using χ² tests, logistic regression, and predictive modeling with multiple correspondence analysis (MCA). Results: Students who had experience as a deliverer were more likely to experience failure and guilt (p=0.005). Predictions of anxiety (59.3%), stress (41.9%), and sadness (33.7%) were the highest in the students with no DBN experience. These students were most likely to make statements suggesting lack of methods and strategies for coping with difficult emotions. Students, who were immersed in DBN experiences, more often expressed the need to talk about their emotions with an experienced doctor, a family member or a friend, and used those conversations as a coping strategy. Conclusion: The most important aspects that influence the quality of delivering bad news are both communication skills and emotional context. Training regarding DBN should not only contain those two elements, but also consider the development of coping mechanisms.

Background: We aimed to identify which attitudes and emotions accompany latter-year medical students as they experience situations where bad news is communicated. Methods: A cross-sectional study was conducted using the computer-assisted web interview (CAWI) methodology in a group of 321 fifth- and sixth-year medical students from 14 medical universities in Poland. Correlations were analyzed using Pearson’s χ² test. For the categorical variables, subject profiles were analyzed using K-means clustering. Results: Students’ self-assessments of their competence in delivering bad news (DBN) differed depending on the type of experience they had with it. More than half of the students had observed a situation of DBN (63.6%) and as many as 26.5% of the participants had received bad news themselves. These two groups were less likely to declare a lack of DBN-related skills (43.4% and 33.4%, respectively) than others. In this study, 9% of the students had personally delivered bad news. Only 13.4% of these students rated their DBN skills as insufficient. They were also the least likely to express concern regarding high levels of stress (29.6%) and anxiety (48%). Conclusions: The ability to personally deliver bad medical news to a patient was the most effective form of gaining experience in DBN. Being a bearer of bad news may help students develop their own strategies for coping with difficult emotions and develop their professional competences, leading to improved medical care and patient comfort.

Research objective: Environmental exposure to endocrine-disrupting chemicals (EDCs), micro- and nanoplastics (MNPs), particulate matter (PM2.5), heavy metals, and pesticides represents an increasing global health concern. This review aimed to summarize the major mechanisms underlying their toxicity and their links to human disease. Methodology: A narrative review of experimental and epidemiological literature was conducted to synthesize current evidence on the toxicity mechanisms and health effects of environmental pollutants. Main conclusions: The major mechanisms underlying pollutant toxicity include oxidative stress, chronic inflammation, endocrine disruption, epigenetic modification, and genotoxicity. These processes have been linked to reproductive dysfunction, neurodegeneration, cardiovascular disease, immune dysregulation, and carcinogenesis. EDCs interfere with hormonal signaling, while MNPs can cross biological barriers and act as carriers for toxic co-contaminants such as heavy metals and persistent organic pollutants. Experimental and epidemiological evidence suggests that chronic exposure may impair fertility, disrupt fetal development, promote systemic inflammation, and contribute to cancer-related pathways. Additional pollutants, including PM2.5 and pesticides, further exacerbate oxidative stress, endothelial dysfunction, and gut microbiome imbalance. Although mechanistic evidence is substantial, human studies remain limited by methodological variability and insufficient longitudinal data. Application of the study: The findings may support clinicians, researchers, and policymakers in recognizing the contribution of environmental pollutants to the burden of non-communicable diseases, informing preventive measures and stronger regulatory strategies. Originality/Novelty of the study: This review integrates mechanistic and epidemiological evidence across multiple classes of environmental pollutants, highlighting their shared toxicity pathways and combined contribution to non-communicable disease risk, while identifying key methodological gaps that warrant further research.

Research objective: The gut microbiome has emerged as a major regulator of cardiovascular health through its influence on inflammation, immune signaling, endothelial function, and metabolic homeostasis. This review aimed to summarize current evidence on the role of the gut microbiome in cardiovascular disease pathogenesis and progression, focusing on hypertension, heart failure with reduced ejection fraction, and atrial fibrillation, and to examine its interactions with cardiovascular pharmacotherapy. Methodology: A narrative review of the literature was conducted, summarizing current evidence on microbiome-cardiovascular interactions, including microbiota-derived metabolites, drug-microbiome interactions, and emerging microbiota-targeted therapeutic strategies. Main conclusions: Increasing evidence indicates that gut dysbiosis contributes to the development and progression of multiple cardiovascular diseases, including hypertension, heart failure, coronary artery disease, and atrial fibrillation. Microbiota-derived metabolites such as trimethylamine N-oxide (TMAO), lipopolysaccharides (LPS), and short-chain fatty acids (SCFAs) play central roles by modulating oxidative stress, systemic inflammation, vascular dysfunction, and myocardial remodeling. Bidirectional interactions between the gut microbiome and cardiovascular pharmacotherapy are increasingly recognized, with microbiota composition potentially influencing the metabolism, efficacy, and adverse effects of agents such as statins, ACE inhibitors, ARBs, digoxin, warfarin, and SGLT2 inhibitors. Emerging microbiota-targeted strategies, including dietary interventions, probiotics, prebiotics, and microbiome modulation, show therapeutic promise. However, most available evidence remains observational or preclinical, highlighting the need for large-scale clinical studies to establish causality and therapeutic applicability. Application of the study: The findings may support clinicians and researchers in understanding the gut microbiome as a modifiable contributor to cardiovascular disease, informing individualized therapeutic approaches and the consideration of microbiota-drug interactions in cardiovascular pharmacotherapy. Originality/Novelty of the study: This review integrates evidence on microbiome-driven mechanisms of cardiovascular disease with the emerging field of microbiota-drug interactions, bringing together pathophysiology, pharmacology, and microbiota-targeted therapeutic strategies within a single framework.

Research objective: The aim of this work is to review the adverse effects, limitations, and major safety concerns associated with sodium–glucose cotransporter-2 (SGLT2) inhibitors used in the treatment of type 2 diabetes mellitus, heart failure, and chronic kidney disease. Particular attention was given to complications affecting the urinary tract, kidneys, pancreas, skeletal system, and the risk of drug interactions and hypoglycemia. Methodology: This study is based on a narrative review using the PubMed database as the sole data source. Extracted data covered treatment protocols, injected substances, clinical outcomes, and reported adverse effects. Relevant studies evaluating the mechanisms, incidence, and clinical significance of adverse events were analyzed and compared. Main conclusions: The reviewed evidence indicates that SGLT2 inhibitors are generally well tolerated; however, they may increase the risk of genital fungal infections, volume depletion, and euglycemic diabetic ketoacidosis. Transient reductions in estimated glomerular filtration rate and potential electrolyte disturbances were also observed. Concerns regarding bone mineral density reduction, particularly with canagliflozin, remain inconsistent across studies. Clinically significant pharmacokinetic drug interactions appear uncommon, although concomitant use with diuretics, insulin, or sulfonylureas may increase the risk of adverse outcomes. Despite their proven cardioprotective and nephroprotective benefits, SGLT2 inhibitors require careful clinical monitoring, especially in patients at increased risk of dehydration, hypoglycemia, or renal impairment. Further long-term studies are needed to better characterize their safety profile. Application of the study: The findings may support clinicians in the safe prescribing and monitoring of SGLT2 inhibitors, helping to identify patients at increased risk of urinary, renal, metabolic, or skeletal complications and to individualize therapy in type 2 diabetes mellitus, heart failure, and chronic kidney disease. Originality/Novelty of the study: This review consolidates current evidence on the adverse effects, limitations, and safety concerns of SGLT2 inhibitors across multiple organ systems, highlighting areas of ongoing uncertainty — such as bone mineral density effects and drug interactions — and underscoring the need for further long-term safety studies.