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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, 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Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Pearce M, Garcia L, Abbas A, Strain T, Schuch FB, Golubic R, Kelly P, Khan S, Utukuri M, Laird Y, Mok A, Smith A, Tainio M, Brage S, Woodcock J. Association Between Physical Activity and Risk of Depression: A Systematic Review and Meta-analysis. JAMA Psychiatry 2022; 79:550-559. [PMID: 35416941 PMCID: PMC9008579 DOI: 10.1001/jamapsychiatry.2022.0609] [Citation(s) in RCA: 230] [Impact Index Per Article: 115.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/10/2022] [Indexed: 02/02/2023]
Abstract
Importance Depression is the leading cause of mental health-related disease burden and may be reduced by physical activity, but the dose-response relationship between activity and depression is uncertain. Objective To systematically review and meta-analyze the dose-response association between physical activity and incident depression from published prospective studies of adults. Data Sources PubMed, SCOPUS, Web of Science, PsycINFO, and the reference lists of systematic reviews retrieved by a systematic search up to December 11, 2020, with no language limits. The date of the search was November 12, 2020. Study Selection We included prospective cohort studies reporting physical activity at 3 or more exposure levels and risk estimates for depression with 3000 or more adults and 3 years or longer of follow-up. Data Extraction and Synthesis Data extraction was completed independently by 2 extractors and cross-checked for errors. A 2-stage random-effects dose-response meta-analysis was used to synthesize data. Study-specific associations were estimated using generalized least-squares regression and the pooled association was estimated by combining the study-specific coefficients using restricted maximum likelihood. Main Outcomes and Measures The outcome of interest was depression, including (1) presence of major depressive disorder indicated by self-report of physician diagnosis, registry data, or diagnostic interviews and (2) elevated depressive symptoms established using validated cutoffs for a depressive screening instrument. Results Fifteen studies comprising 191 130 participants and 2 110 588 person-years were included. An inverse curvilinear dose-response association between physical activity and depression was observed, with steeper association gradients at lower activity volumes; heterogeneity was large and significant (I2 = 74%; P < .001). Relative to adults not reporting any activity, those accumulating half the recommended volume of physical activity (4.4 marginal metabolic equivalent task hours per week [mMET-h/wk]) had 18% (95% CI, 13%-23%) lower risk of depression. Adults accumulating the recommended volume of 8.8 mMET hours per week had 25% (95% CI, 18%-32%) lower risk with diminishing potential benefits and higher uncertainty observed beyond that exposure level. There were diminishing additional potential benefits and greater uncertainty at higher volumes of physical activity. Based on an estimate of exposure prevalences among included cohorts, if less active adults had achieved the current physical activity recommendations, 11.5% (95% CI, 7.7%-15.4%) of depression cases could have been prevented. Conclusions and Relevance This systematic review and meta-analysis of associations between physical activity and depression suggests significant mental health benefits from being physically active, even at levels below the public health recommendations. Health practitioners should therefore encourage any increase in physical activity to improve mental health.
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Affiliation(s)
- Matthew Pearce
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
| | - Leandro Garcia
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
- Centre for Public Health, Institute of Clinical Sciences, Queen’s University Belfast, Belfast, Northern Ireland
| | - Ali Abbas
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
| | - Tessa Strain
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
| | - Felipe Barreto Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Rajna Golubic
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, England
| | - Paul Kelly
- Physical Activity for Health Research Centre, Institute of Sport Physical Education and Health Science, University of Edinburgh, Edinburgh, Scotland
| | - Saad Khan
- University of Cambridge School of Clinical Medicine, Addenbrooke’s Treatment Centre, Cambridge Biomedical Campus, Cambridge, England
| | - Mrudula Utukuri
- University of Cambridge School of Clinical Medicine, Addenbrooke’s Treatment Centre, Cambridge Biomedical Campus, Cambridge, England
| | - Yvonne Laird
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander Mok
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Andrea Smith
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
| | - Marko Tainio
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
- Sustainable Urban Programme, The Finnish Environment Institute, Helsinki, Finland
- Systems Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Søren Brage
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
| | - James Woodcock
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England
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Utukuri M, D'Souza F, Deighton A, Le EPV, Osei-Boadu B, Gadi N, Axiaq A, Aung YYM, Agboola B, Chand CP, Dibblin C, Patel CR, Abedi M, Hirniak J, Ta NH, Rudd JHF, Sethi R. Digital health: a neglected part of health curricula? Future Healthc J 2022; 9:18-20. [DOI: 10.7861/fhj.2021-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Guckian J, Utukuri M, Asif A, Burton O, Adeyoju J, Oumeziane A, Chu T, Rees EL. Social media in undergraduate medical education: A systematic review. Med Educ 2021; 55:1227-1241. [PMID: 33988867 DOI: 10.1111/medu.14567] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION There are over 3.81 billion worldwide active social media (SoMe) users. SoMe are ubiquitous in medical education, with roles across undergraduate programmes, including professionalism, blended learning, well being and mentoring. Previous systematic reviews took place before recent explosions in SoMe popularity and revealed a paucity of high-quality empirical studies assessing its effectiveness in medical education. This review aimed to synthesise evidence regarding SoMe interventions in undergraduate medical education, to identify features associated with positive and negative outcomes. METHODS Authors searched 31 key terms through seven databases, in addition to references, citation and hand searching, between 16 June and 16 July 2020. Studies describing SoMe interventions and research on exposure to existing SoMe were included. Title, abstract and full paper screening were undertaken independently by two reviewers. Included papers were assessed for methodological quality using the Medical Education Research Study Quality Instrument (MERSQI) and/or the Standards for Reporting Qualitative Research (SRQR) instrument. Extracted data were synthesised using narrative synthesis. RESULTS 112 studies from 26 countries met inclusion criteria. Methodological quality of included studies had not significantly improved since 2013. Engagement and satisfaction with SoMe platforms in medical education are described. Students felt SoMe flattened hierarchies and improved communication with educators. SoMe use was associated with improvement in objective knowledge assessment scores and self-reported clinical and professional performance, however evidence for long term knowledge retention was limited. SoMe use was occasionally linked to adverse impacts upon mental and physical health. Professionalism was heavily investigated and considered important, though generally negative correlations between SoMe use and medical professionalism may exist. CONCLUSIONS Social media is enjoyable for students who may improve short term knowledge retention and can aid communication between learners and educators. However, higher-quality study is required to identify longer-term impact upon knowledge and skills, provide clarification on professionalism standards and protect against harms.
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Affiliation(s)
- Jonathan Guckian
- Dermatology Department, Leeds Teaching Hospitals NHS Trust, Yorkshire, UK
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
| | - Mrudula Utukuri
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Aqua Asif
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Oliver Burton
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Joshua Adeyoju
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Adam Oumeziane
- School of Medicine, Anglia Ruskin University, Chelmsford, UK
| | - Timothy Chu
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
| | - Eliot L Rees
- School of Medicine, Keele University, Newcastle-under-Lyme, UK
- Research Department of Primary Care and Population Health, University College London, London, UK
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Im YR, Hunter H, de Gracia Hahn D, Duret A, Cheah Q, Dong J, Fairey M, Hjalmarsson C, Li A, Lim HK, McKeown L, Mitrofan CG, Rao R, Utukuri M, Rowe IA, Mann JP. A Systematic Review of Animal Models of NAFLD Finds High-Fat, High-Fructose Diets Most Closely Resemble Human NAFLD. Hepatology 2021; 74:1884-1901. [PMID: 33973269 DOI: 10.1002/hep.31897] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Animal models of human disease are a key component of translational hepatology research, yet there is no consensus on which model is optimal for NAFLD. APPROACH AND RESULTS We generated a database of 3,920 rodent models of NAFLD. Study designs were highly heterogeneous, and therefore, few models had been cited more than once. Analysis of genetic models supported the current evidence for the role of adipose dysfunction and suggested a role for innate immunity in the progression of NAFLD. We identified that high-fat, high-fructose diets most closely recapitulate the human phenotype of NAFLD. There was substantial variability in the nomenclature of animal models: a consensus on terminology of specialist diets is needed. More broadly, this analysis demonstrates the variability in preclinical study design, which has wider implications for the reproducibility of in vivo experiments both in the field of hepatology and beyond. CONCLUSIONS This systematic analysis provides a framework for phenotypic assessment of NAFLD models and highlights the need for increased standardization and replication.
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Affiliation(s)
- Yu Ri Im
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Harriet Hunter
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Dana de Gracia Hahn
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Amedine Duret
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Qinrong Cheah
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jiawen Dong
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Madison Fairey
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Alice Li
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Hong Kai Lim
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Lorcán McKeown
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Raunak Rao
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Mrudula Utukuri
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Ian A Rowe
- Leeds Institute for Medical Research and Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Jake P Mann
- Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
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Teo K, Abeysekera KWM, Adams L, Aigner E, Anstee QM, Banales JM, Banerjee R, Basu P, Berg T, Bhatnagar P, Buch S, Canbay A, Caprio S, Chatterjee A, Ida Chen YD, Chowdhury A, Daly AK, Datz C, de Gracia Hahn D, DiStefano JK, Dong J, Duret A, Emdin C, Fairey M, Gerhard GS, Guo X, Hampe J, Hickman M, Heintz L, Hudert C, Hunter H, Kelly M, Kozlitina J, Krawczyk M, Lammert F, Langenberg C, Lavine J, Li L, Lim HK, Loomba R, Luukkonen PK, Melton PE, Mori TA, Palmer ND, Parisinos CA, Pillai SG, Qayyum F, Reichert MC, Romeo S, Rotter JI, Im YR, Santoro N, Schafmayer C, Speliotes EK, Stender S, Stickel F, Still CD, Strnad P, Taylor KD, Tybjærg-Hansen A, Umano GR, Utukuri M, Valenti L, Wagenknecht LE, Wareham NJ, Watanabe RM, Wattacheril J, Yaghootkar H, Yki-Järvinen H, Young KA, Mann JP. rs641738C>T near MBOAT7 is associated with liver fat, ALT and fibrosis in NAFLD: A meta-analysis. J Hepatol 2021; 74:20-30. [PMID: 32882372 PMCID: PMC7755037 DOI: 10.1016/j.jhep.2020.08.027] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/29/2020] [Accepted: 08/20/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS A common genetic variant near MBOAT7 (rs641738C>T) has been previously associated with hepatic fat and advanced histology in NAFLD; however, these findings have not been consistently replicated in the literature. We aimed to establish whether rs641738C>T is a risk factor across the spectrum of NAFLD and to characterise its role in the regulation of related metabolic phenotypes through a meta-analysis. METHODS We performed a meta-analysis of studies with data on the association between rs641738C>T genotype and liver fat, NAFLD histology, and serum alanine aminotransferase (ALT), lipids or insulin. These included directly genotyped studies and population-level data from genome-wide association studies (GWAS). We performed a random effects meta-analysis using recessive, additive and dominant genetic models. RESULTS Data from 1,066,175 participants (9,688 with liver biopsies) across 42 studies were included in the meta-analysis. rs641738C>T was associated with higher liver fat on CT/MRI (+0.03 standard deviations [95% CI 0.02-0.05], pz = 4.8×10-5) and diagnosis of NAFLD (odds ratio [OR] 1.17 [95% CI 1.05-1.3], pz = 0.003) in Caucasian adults. The variant was also positively associated with presence of advanced fibrosis (OR 1.22 [95% CI 1.03-1.45], pz = 0.021) in Caucasian adults using a recessive model of inheritance (CC + CT vs. TT). Meta-analysis of data from previous GWAS found the variant to be associated with higher ALT (pz = 0.002) and lower serum triglycerides (pz = 1.5×10-4). rs641738C>T was not associated with fasting insulin and no effect was observed in children with NAFLD. CONCLUSIONS Our study validates rs641738C>T near MBOAT7 as a risk factor for the presence and severity of NAFLD in individuals of European descent. LAY SUMMARY Fatty liver disease is a common condition where fat builds up in the liver, which can cause liver inflammation and scarring (including 'cirrhosis'). It is closely linked to obesity and diabetes, but some genes are also thought to be important. We did this study to see whether one specific change ('variant') in one gene ('MBOAT7') was linked to fatty liver disease. We took data from over 40 published studies and found that this variant near MBOAT7 is linked to more severe fatty liver disease. This means that drugs designed to work on MBOAT7 could be useful for treating fatty liver disease.
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Affiliation(s)
- Kevin Teo
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Leon Adams
- Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia; Department of Hepatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Elmar Aigner
- First Department of Medicine, Paracelsus Medical University Salzburg, Austria
| | - Quentin M Anstee
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jesus M Banales
- Department on Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain
| | | | | | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | | | - Stephan Buch
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Ali Canbay
- Gastroenterology, Hepatology and Infectiology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Sonia Caprio
- Yale University, Department of Pediatrics, New Haven, CT, USA
| | | | - Yii-Der Ida Chen
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Abhijit Chowdhury
- Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Ann K Daly
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Christian Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Oberndorf, Austria
| | | | - Johanna K DiStefano
- Diabetes and Fibrotic Disease Unit Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
| | - Jiawen Dong
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Amedine Duret
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Connor Emdin
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Boston, MA, USA
| | - Madison Fairey
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Glenn S Gerhard
- Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jochen Hampe
- Medical Department 1, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Matthew Hickman
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - Lena Heintz
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Christian Hudert
- Department of Pediatric Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Harriet Hunter
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Julia Kozlitina
- Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany; Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Joel Lavine
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Lin Li
- BioStat Solutions LLC, Frederick, MD, USA
| | - Hong Kai Lim
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology and Epidemiology, University of California at San Diego, La Jolla, CA, USA
| | - Panu K Luukkonen
- Minerva Foundation Institute for Medical Research, Helsinki, Finland; Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Yale University School of Medicine, New Haven, CT, USA
| | - Phillip E Melton
- School of Global Population Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia; School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Trevor A Mori
- Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Nicholette D Palmer
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Constantinos A Parisinos
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | | | - Faiza Qayyum
- Department of Clinical Biochemistry, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Matthias C Reichert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Stefano Romeo
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; Cardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden; Clinical Nutrition Unit, Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Yu Ri Im
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Nicola Santoro
- Yale University, Department of Pediatrics, New Haven, CT, USA; Department of Medicine and Health Sciences 'V. Tiberio' University of Molise, Campobasso, Italy
| | - Clemens Schafmayer
- Department of Visceral and Thoracic Surgery, Kiel University, Kiel, Germany
| | - Elizabeth K Speliotes
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Michigan Health System, Ann Arbor, MI, USA; Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stefan Stender
- Department of Clinical Biochemistry, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Felix Stickel
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland
| | | | - Pavel Strnad
- Medical Clinic III, University Hospital RWTH Aachen, Aachen, Germany
| | - Kent D Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Anne Tybjærg-Hansen
- Department of Clinical Biochemistry, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Giuseppina Rosaria Umano
- Yale University, Department of Pediatrics, New Haven, CT, USA; Department of the Woman, the Child, of General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mrudula Utukuri
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; Translational Medicine, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Lynne E Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Richard M Watanabe
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Julia Wattacheril
- Department of Medicine, Center for Liver Disease and Transplantation, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY, USA
| | - Hanieh Yaghootkar
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Hannele Yki-Järvinen
- Minerva Foundation Institute for Medical Research, Helsinki, Finland; Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kendra A Young
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Jake P Mann
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
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7
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Hunter H, de Gracia Hahn D, Duret A, Im YR, Cheah Q, Dong J, Fairey M, Hjalmarsson C, Li A, Lim HK, McKeown L, Mitrofan CG, Rao R, Utukuri M, Rowe IA, Mann JP. Weight loss, insulin resistance, and study design confound results in a meta-analysis of animal models of fatty liver. eLife 2020; 9:56573. [PMID: 33063664 PMCID: PMC7647398 DOI: 10.7554/elife.56573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 10/15/2020] [Indexed: 12/30/2022] Open
Abstract
The classical drug development pipeline necessitates studies using animal models of human disease to gauge future efficacy in humans, however there is a low conversion rate from success in animals to humans. Non-alcoholic fatty liver disease (NAFLD) is a complex chronic disease without any established therapies and a major field of animal research. We performed a meta-analysis with meta-regression of 603 interventional rodent studies (10,364 animals) in NAFLD to assess which variables influenced treatment response. Weight loss and alleviation of insulin resistance were consistently associated with improvement in NAFLD. Multiple drug classes that do not affect weight in humans caused weight loss in animals. Other study design variables, such as age of animals and dietary composition, influenced the magnitude of treatment effect. Publication bias may have increased effect estimates by 37-79%. These findings help to explain the challenge of reproducibility and translation within the field of metabolism.
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Affiliation(s)
- Harriet Hunter
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Dana de Gracia Hahn
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Amedine Duret
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Yu Ri Im
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Qinrong Cheah
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jiawen Dong
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Madison Fairey
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Alice Li
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Hong Kai Lim
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Lorcan McKeown
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Raunak Rao
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Mrudula Utukuri
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Ian A Rowe
- Leeds Institute for Medical Research & Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Jake P Mann
- Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
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8
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Devine OP, Harborne AC, Horsfall HL, Joseph T, Marshall-Andon T, Samuels R, Kearsley JW, Abbas N, Baig H, Beecham J, Benons N, Caird C, Clark R, Cope T, Coultas J, Debenham L, Douglas S, Eldridge J, Hughes-Gooding T, Jakubowska A, Jones O, Lancaster E, MacMillan C, McAllister R, Merzougui W, Phillips B, Phillips S, Risk O, Sage A, Sooltangos A, Spencer R, Tajbakhsh R, Adesalu O, Aganin I, Ahmed A, Aiken K, Akeredolu AS, Alam I, Ali A, Anderson R, Ang JJ, Anis FS, Aojula S, Arthur C, Ashby A, Ashraf A, Aspinall E, Awad M, Yahaya AMA, Badhrinarayanan S, Bandyopadhyay S, Barnes S, Bassey-Duke D, Boreham C, Braine R, Brandreth J, Carrington Z, Cashin Z, Chatterjee S, Chawla M, Chean CS, Clements C, Clough R, Coulthurst J, Curry L, Daniels VC, Davies S, Davis R, De Waal H, Desai N, Douglas H, Druce J, Ejamike LN, Esere M, Eyre A, Fazmin IT, Fitzgerald-Smith S, Ford V, Freeston S, Garnett K, General W, Gilbert H, Gowie Z, Grafton-Clarke C, Gudka K, Gumber L, Gupta R, Harlow C, Harrington A, Heaney A, Ho WHS, Holloway L, Hood C, Houghton E, Houshangi S, Howard E, Human B, Hunter H, Hussain I, Hussain S, Jackson-Taylor RT, Jacob-Ramsdale B, Janjuha R, Jawad S, Jelani M, Johnston D, Jones M, Kalidindi S, Kalsi S, Kalyanasundaram A, Kane A, Kaur S, Al-Othman OK, Khan Q, Khullar S, Kirkland P, Lawrence-Smith H, Leeson C, Lenaerts JER, Long K, Lubbock S, Burrell JMD, Maguire R, Mahendran P, Majeed S, Malhotra PS, Mandagere V, Mantelakis A, McGovern S, Mosuro A, Moxley A, Mustoe S, Myers S, Nadeem K, Nasseri R, Newman T, Nzewi R, Ogborne R, Omatseye J, Paddock S, Parkin J, Patel M, Pawar S, Pearce S, Penrice S, Purdy J, Ramjan R, Randhawa R, Rasul U, Raymond-Taggert E, Razey R, Razzaghi C, Reel E, Revell EJ, Rigbye J, Rotimi O, Said A, Sanders E, Sangal P, Grandal NS, Shah A, Shah RA, Shotton O, Sims D, Smart K, Smith MA, Smith N, Sopian AS, South M, Speller J, Syer TJ, Ta NH, Tadross D, Thompson B, Trevett J, Tyler M, Ullah R, Utukuri M, Vadera S, Van Den Tooren H, Venturini S, Vijayakumar A, Vine M, Wellbelove Z, Wittner L, Yong GHK, Ziyada F, McManus IC. The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning. BMC Med 2020; 18:126. [PMID: 32404194 PMCID: PMC7222546 DOI: 10.1186/s12916-020-01571-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 03/24/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL). METHOD The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times. RESULTS A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content. DISCUSSION UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training.
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Affiliation(s)
| | | | | | - Tobin Joseph
- UCL Medical School, 74 Huntley Street, London, WC1E 6BT UK
| | - Tess Marshall-Andon
- School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0SP UK
| | - Ryan Samuels
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | | | - Nadine Abbas
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO17 1BJ UK
| | - Hassan Baig
- University of Aberdeen, Suttie Centre, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Joseph Beecham
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK
| | - Natasha Benons
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH UK
| | - Charlie Caird
- Imperial College School of Medicine, South Kensington Campus, London, SW7 2AZ UK
| | - Ryan Clark
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, G12 8QQ UK
| | - Thomas Cope
- John Hughlings Jackson Building, University of York, Heslington, York, YO10 5DD UK
| | - James Coultas
- School of Medicine, Keele University, David Weatherall Building, Keele University Campus, Staffordshire, ST5 5BG UK
| | - Luke Debenham
- Birmingham Medical School, Vincent Drive, Edgbaston, Birmingham, West Midlands B15 2TT UK
| | - Sarah Douglas
- University of Edinburgh Medical School, 47 Little France Cres, Edinburgh, EH16 4TJ UK
| | - Jack Eldridge
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, BN1 9PX UK
| | - Thomas Hughes-Gooding
- The Medical School, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
| | - Agnieszka Jakubowska
- Barts and The London Medical School, 4 Newark St, Whitechapel, London, E1 2AT UK
| | - Oliver Jones
- Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ UK
| | - Eve Lancaster
- Birmingham Medical School, Vincent Drive, Edgbaston, Birmingham, West Midlands B15 2TT UK
| | - Calum MacMillan
- University of Dundee School of Medicine, 4 Kirsty Semple Way, Dundee, DD2 4BF UK
| | - Ross McAllister
- The University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | - Wassim Merzougui
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO17 1BJ UK
| | - Ben Phillips
- Whiston Hospital, Warrington Road, Prescot, L35 5DR UK
| | - Simon Phillips
- Medical Sciences Divisional Office, University of Oxford, Level 3, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Omar Risk
- Guy’s, King’s and St Thomas’ School of Medical Education, Henriette Raphael Building, Guy’s Campus, London, SE1 1UL UK
| | - Adam Sage
- Queen’s University Belfast, University Road, Belfast, BT7 1NN UK
| | - Aisha Sooltangos
- Manchester Medical School, Stopford Building, Oxford Rd, Manchester, M13 9PT UK
| | - Robert Spencer
- Cardiff University School of Medicine, Cochrane Building, Heath Park Way, Cardiff, CF14 4YU UK
| | - Roxanne Tajbakhsh
- School of Medicine, Worsley Building, University of Leeds, Leeds, LS2 9NL UK
| | - Oluseyi Adesalu
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Ivan Aganin
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, BN1 9PX UK
| | - Ammar Ahmed
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE UK
| | - Katherine Aiken
- Queen’s University Belfast, University Road, Belfast, BT7 1NN UK
| | | | - Ibrahim Alam
- University of Aberdeen, Suttie Centre, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Aamna Ali
- School of Medicine, Worsley Building, University of Leeds, Leeds, LS2 9NL UK
| | - Richard Anderson
- School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0SP UK
| | - Jia Jun Ang
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Fady Sameh Anis
- The University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | - Sonam Aojula
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Catherine Arthur
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, BN1 9PX UK
| | - Alena Ashby
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE UK
| | - Ahmed Ashraf
- University of Aberdeen, Suttie Centre, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Emma Aspinall
- Whiston Hospital, Warrington Road, Prescot, L35 5DR UK
| | - Mark Awad
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH UK
| | | | - Shreya Badhrinarayanan
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, BN1 9PX UK
| | - Soham Bandyopadhyay
- Medical Sciences Divisional Office, University of Oxford, Level 3, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Sam Barnes
- George Davies Centre, University of Leicester School of Medicine, Lancaster Road, Leicester, LE1 7HA UK
| | - Daisy Bassey-Duke
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH UK
| | - Charlotte Boreham
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Rebecca Braine
- Medical Sciences Divisional Office, University of Oxford, Level 3, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Joseph Brandreth
- The University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | - Zoe Carrington
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE UK
| | - Zoe Cashin
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, BN1 9PX UK
| | - Shaunak Chatterjee
- Birmingham Medical School, Vincent Drive, Edgbaston, Birmingham, West Midlands B15 2TT UK
| | - Mehar Chawla
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK
| | - Chung Shen Chean
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE UK
| | - Chris Clements
- St James’s University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF UK
| | - Richard Clough
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Jessica Coulthurst
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE UK
| | - Liam Curry
- George Davies Centre, University of Leicester School of Medicine, Lancaster Road, Leicester, LE1 7HA UK
| | - Vinnie Christine Daniels
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Simon Davies
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Rebecca Davis
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE UK
| | - Hanelie De Waal
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, BN1 9PX UK
| | - Nasreen Desai
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE UK
| | - Hannah Douglas
- University of Edinburgh Medical School, 47 Little France Cres, Edinburgh, EH16 4TJ UK
| | - James Druce
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | | | - Meron Esere
- Medical Sciences Divisional Office, University of Oxford, Level 3, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Alex Eyre
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Ibrahim Talal Fazmin
- School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0SP UK
| | - Sophia Fitzgerald-Smith
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH UK
| | - Verity Ford
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO17 1BJ UK
| | - Sarah Freeston
- Homerton University Hospital, Homerton Row, London, E9 6SR UK
| | | | - Whitney General
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH UK
| | - Helen Gilbert
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Zein Gowie
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO17 1BJ UK
| | - Ciaran Grafton-Clarke
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE UK
| | - Keshni Gudka
- The University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | - Leher Gumber
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, BN1 9PX UK
| | - Rishi Gupta
- UCL Medical School, 74 Huntley Street, London, WC1E 6BT UK
| | - Chris Harlow
- St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
| | - Amy Harrington
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO17 1BJ UK
| | - Adele Heaney
- Queen’s University Belfast, University Road, Belfast, BT7 1NN UK
| | - Wing Hang Serene Ho
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE UK
| | - Lucy Holloway
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Christina Hood
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Eleanor Houghton
- The University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | - Saba Houshangi
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK
| | - Emma Howard
- School of Medicine, Keele University, David Weatherall Building, Keele University Campus, Staffordshire, ST5 5BG UK
| | - Benjamin Human
- School of Medicine, Worsley Building, University of Leeds, Leeds, LS2 9NL UK
| | - Harriet Hunter
- School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0SP UK
| | - Ifrah Hussain
- Imperial College School of Medicine, South Kensington Campus, London, SW7 2AZ UK
| | - Sami Hussain
- UCL Medical School, 74 Huntley Street, London, WC1E 6BT UK
| | | | | | - Ryan Janjuha
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK
| | - Saleh Jawad
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO17 1BJ UK
| | - Muzzamil Jelani
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - David Johnston
- School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0SP UK
| | - Mike Jones
- University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW UK
| | - Sadhana Kalidindi
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH UK
| | - Savraj Kalsi
- John Hughlings Jackson Building, University of York, Heslington, York, YO10 5DD UK
| | - Asanish Kalyanasundaram
- School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0SP UK
| | - Anna Kane
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Sahaj Kaur
- School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0SP UK
| | | | - Qaisar Khan
- University of Aberdeen, Suttie Centre, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Sajan Khullar
- School of Medicine, Keele University, David Weatherall Building, Keele University Campus, Staffordshire, ST5 5BG UK
| | - Priscilla Kirkland
- University of Edinburgh Medical School, 47 Little France Cres, Edinburgh, EH16 4TJ UK
| | - Hannah Lawrence-Smith
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE UK
| | - Charlotte Leeson
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK
| | | | - Kerry Long
- Nottingham University Hospitals NHS Trust, Hucknall Rd, Nottingham, NG5 1PB UK
| | - Simon Lubbock
- The University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | | | - Rachel Maguire
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Praveen Mahendran
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE UK
| | - Saad Majeed
- University of Aberdeen, Suttie Centre, Foresterhill, Aberdeen, AB25 2ZD UK
| | | | - Vinay Mandagere
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH UK
| | | | - Sophie McGovern
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Anjola Mosuro
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH UK
| | - Adam Moxley
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Sophie Mustoe
- Guy’s, King’s and St Thomas’ School of Medical Education, Henriette Raphael Building, Guy’s Campus, London, SE1 1UL UK
| | - Sam Myers
- UCL Medical School, 74 Huntley Street, London, WC1E 6BT UK
| | - Kiran Nadeem
- Manchester Medical School, Stopford Building, Oxford Rd, Manchester, M13 9PT UK
| | - Reza Nasseri
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH UK
| | - Tom Newman
- School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0SP UK
| | - Richard Nzewi
- George Davies Centre, University of Leicester School of Medicine, Lancaster Road, Leicester, LE1 7HA UK
| | - Rosalie Ogborne
- St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
| | - Joyce Omatseye
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE UK
| | - Sophie Paddock
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK
| | - James Parkin
- St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
| | - Mohit Patel
- John Hughlings Jackson Building, University of York, Heslington, York, YO10 5DD UK
| | - Sohini Pawar
- School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0SP UK
| | - Stuart Pearce
- St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
| | - Samuel Penrice
- University of Dundee School of Medicine, 4 Kirsty Semple Way, Dundee, DD2 4BF UK
| | - Julian Purdy
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Raisa Ramjan
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK
| | - Ratan Randhawa
- UCL Medical School, 74 Huntley Street, London, WC1E 6BT UK
| | - Usman Rasul
- University of Aberdeen, Suttie Centre, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Elliot Raymond-Taggert
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH UK
| | - Rebecca Razey
- Imperial College School of Medicine, South Kensington Campus, London, SW7 2AZ UK
| | - Carmel Razzaghi
- Queen’s University Belfast, University Road, Belfast, BT7 1NN UK
| | - Eimear Reel
- Queen’s University Belfast, University Road, Belfast, BT7 1NN UK
| | - Elliot John Revell
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Joanna Rigbye
- University of Edinburgh Medical School, 47 Little France Cres, Edinburgh, EH16 4TJ UK
| | | | - Abdelrahman Said
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK
| | - Emma Sanders
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH UK
| | - Pranoy Sangal
- University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW UK
| | - Nora Sangvik Grandal
- John Hughlings Jackson Building, University of York, Heslington, York, YO10 5DD UK
| | - Aadam Shah
- University of Aberdeen, Suttie Centre, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Rahul Atul Shah
- School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0SP UK
| | - Oliver Shotton
- Medical Sciences Divisional Office, University of Oxford, Level 3, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Daniel Sims
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, BN1 9PX UK
| | - Katie Smart
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK
| | - Martha Amy Smith
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Nick Smith
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK
| | - Aninditya Salma Sopian
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Matthew South
- The University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | - Jessica Speller
- George Davies Centre, University of Leicester School of Medicine, Lancaster Road, Leicester, LE1 7HA UK
| | - Tom J. Syer
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK
| | - Ngan Hong Ta
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ UK
| | - Daniel Tadross
- School of Medicine, Worsley Building, University of Leeds, Leeds, LS2 9NL UK
| | - Benjamin Thompson
- John Hughlings Jackson Building, University of York, Heslington, York, YO10 5DD UK
| | - Jess Trevett
- John Hughlings Jackson Building, University of York, Heslington, York, YO10 5DD UK
| | - Matthew Tyler
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Roshan Ullah
- Birmingham Medical School, Vincent Drive, Edgbaston, Birmingham, West Midlands B15 2TT UK
| | - Mrudula Utukuri
- School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0SP UK
| | - Shree Vadera
- UCL Medical School, 74 Huntley Street, London, WC1E 6BT UK
| | | | - Sara Venturini
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN UK
| | - Aradhya Vijayakumar
- George Davies Centre, University of Leicester School of Medicine, Lancaster Road, Leicester, LE1 7HA UK
| | - Melanie Vine
- George Davies Centre, University of Leicester School of Medicine, Lancaster Road, Leicester, LE1 7HA UK
| | - Zoe Wellbelove
- John Hughlings Jackson Building, University of York, Heslington, York, YO10 5DD UK
| | - Liora Wittner
- UCL Medical School, 74 Huntley Street, London, WC1E 6BT UK
| | - Geoffrey Hong Kiat Yong
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Farris Ziyada
- Guy’s, King’s and St Thomas’ School of Medical Education, Henriette Raphael Building, Guy’s Campus, London, SE1 1UL UK
| | - I. C. McManus
- Research Department of Medical Education, UCL Medical School, Gower Street, London, WC1E 6BT UK
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McManus IC, Harborne AC, Horsfall HL, Joseph T, Smith DT, Marshall-Andon T, Samuels R, Kearsley JW, Abbas N, Baig H, Beecham J, Benons N, Caird C, Clark R, Cope T, Coultas J, Debenham L, Douglas S, Eldridge J, Hughes-Gooding T, Jakubowska A, Jones O, Lancaster E, MacMillan C, McAllister R, Merzougui W, Phillips B, Phillips S, Risk O, Sage A, Sooltangos A, Spencer R, Tajbakhsh R, Adesalu O, Aganin I, Ahmed A, Aiken K, Akeredolu AS, Alam I, Ali A, Anderson R, Ang JJ, Anis FS, Aojula S, Arthur C, Ashby A, Ashraf A, Aspinall E, Awad M, Yahaya AMA, Badhrinarayanan S, Bandyopadhyay S, Barnes S, Bassey-Duke D, Boreham C, Braine R, Brandreth J, Carrington Z, Cashin Z, Chatterjee S, Chawla M, Chean CS, Clements C, Clough R, Coulthurst J, Curry L, Daniels VC, Davies S, Davis R, De Waal H, Desai N, Douglas H, Druce J, Ejamike LN, Esere M, Eyre A, Fazmin IT, Fitzgerald-Smith S, Ford V, Freeston S, Garnett K, General W, Gilbert H, Gowie Z, Grafton-Clarke C, Gudka K, Gumber L, Gupta R, Harlow C, Harrington A, Heaney A, Ho WHS, Holloway L, Hood C, Houghton E, Houshangi S, Howard E, Human B, Hunter H, Hussain I, Hussain S, Jackson-Taylor RT, Jacob-Ramsdale B, Janjuha R, Jawad S, Jelani M, Johnston D, Jones M, Kalidindi S, Kalsi S, Kalyanasundaram A, Kane A, Kaur S, Al-Othman OK, Khan Q, Khullar S, Kirkland P, Lawrence-Smith H, Leeson C, Lenaerts JER, Long K, Lubbock S, Burrell JMD, Maguire R, Mahendran P, Majeed S, Malhotra PS, Mandagere V, Mantelakis A, McGovern S, Mosuro A, Moxley A, Mustoe S, Myers S, Nadeem K, Nasseri R, Newman T, Nzewi R, Ogborne R, Omatseye J, Paddock S, Parkin J, Patel M, Pawar S, Pearce S, Penrice S, Purdy J, Ramjan R, Randhawa R, Rasul U, Raymond-Taggert E, Razey R, Razzaghi C, Reel E, Revell EJ, Rigbye J, Rotimi O, Said A, Sanders E, Sangal P, Grandal NS, Shah A, Shah RA, Shotton O, Sims D, Smart K, Smith MA, Smith N, Sopian AS, South M, Speller J, Syer TJ, Ta NH, Tadross D, Thompson B, Trevett J, Tyler M, Ullah R, Utukuri M, Vadera S, Van Den Tooren H, Venturini S, Vijayakumar A, Vine M, Wellbelove Z, Wittner L, Yong GHK, Ziyada F, Devine OP. Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise. BMC Med 2020; 18:136. [PMID: 32404148 PMCID: PMC7222458 DOI: 10.1186/s12916-020-01572-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 03/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors. METHOD Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail. RESULTS Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs. CONCLUSIONS Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety.
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Affiliation(s)
- I C McManus
- Research Department of Medical Education, UCL Medical School, Gower Street, London, WC1E 6BT, UK.
| | | | | | - Tobin Joseph
- UCL Medical School, 74 Huntley Street, London, WC1E 6BT, UK
| | - Daniel T Smith
- General Medical Council, Regent's Place, 350 Euston Road, London, NW1 3JN, UK
| | - Tess Marshall-Andon
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0SP, UK
| | - Ryan Samuels
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | | | - Nadine Abbas
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Hassan Baig
- University of Aberdeen, Suttie Centre, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Joseph Beecham
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Natasha Benons
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH, UK
| | - Charlie Caird
- Imperial College School of Medicine, South Kensington Campus, London, SW7 2AZ, UK
| | - Ryan Clark
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Thomas Cope
- University of York, John Hughlings Jackson Building, Heslington, York, YO10 5DD, UK
| | - James Coultas
- School of Medicine, Keele University, David Weatherall Building, Keele University Campus, Staffordshire, ST5 5BG, UK
| | - Luke Debenham
- Birmingham Medical School, Vincent Drive, Edgbaston B15 2TT, Birmingham, West Midlands, UK
| | - Sarah Douglas
- University of Edinburgh Medical School, 47 Little France Cres, Edinburgh, EH16 4TJ, UK
| | - Jack Eldridge
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, BN1 9PX, UK
| | - Thomas Hughes-Gooding
- The Medical School, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Agnieszka Jakubowska
- Barts and The London Medical School, 4 Newark St, Whitechapel, London, E1 2AT, UK
| | - Oliver Jones
- Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Eve Lancaster
- Birmingham Medical School, Vincent Drive, Edgbaston B15 2TT, Birmingham, West Midlands, UK
| | - Calum MacMillan
- University of Dundee School of Medicine, 4 Kirsty Semple Way, Dundee, DD2 4BF, UK
| | - Ross McAllister
- The University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Wassim Merzougui
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Ben Phillips
- Whiston Hospital, Warrington Road, Prescot, L35 5DR, UK
| | - Simon Phillips
- Medical Sciences Divisional Office, University of Oxford, Level 3, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Omar Risk
- Guy's, King's and St Thomas' School of Medical Education, Henriette Raphael Building, Guy's Campus, London, SE1 1UL, UK
| | - Adam Sage
- Queen's University Belfast, University Road, Belfast, BT7 1NN, UK
| | - Aisha Sooltangos
- Manchester Medical School, Stopford Building, Oxford Rd, Manchester, M13 9PT, UK
| | - Robert Spencer
- Cardiff University School of Medicine, Cochrane Building, Heath Park Way, Cardiff, CF14 4YU, UK
| | - Roxanne Tajbakhsh
- School of Medicine, University of Leeds, Worsley Building, Leeds, LS2 9NL, UK
| | - Oluseyi Adesalu
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Ivan Aganin
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, BN1 9PX, UK
| | - Ammar Ahmed
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE, UK
| | - Katherine Aiken
- Queen's University Belfast, University Road, Belfast, BT7 1NN, UK
| | | | - Ibrahim Alam
- University of Aberdeen, Suttie Centre, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Aamna Ali
- School of Medicine, University of Leeds, Worsley Building, Leeds, LS2 9NL, UK
| | - Richard Anderson
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0SP, UK
| | - Jia Jun Ang
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Fady Sameh Anis
- The University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Sonam Aojula
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Catherine Arthur
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, BN1 9PX, UK
| | - Alena Ashby
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE, UK
| | - Ahmed Ashraf
- University of Aberdeen, Suttie Centre, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Emma Aspinall
- Whiston Hospital, Warrington Road, Prescot, L35 5DR, UK
| | - Mark Awad
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH, UK
| | | | - Shreya Badhrinarayanan
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, BN1 9PX, UK
| | - Soham Bandyopadhyay
- Medical Sciences Divisional Office, University of Oxford, Level 3, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Sam Barnes
- University of Leicester School of Medicine, George Davies Centre, Lancaster Road, Leicester, LE1 7HA, UK
| | - Daisy Bassey-Duke
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH, UK
| | - Charlotte Boreham
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Rebecca Braine
- Medical Sciences Divisional Office, University of Oxford, Level 3, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Joseph Brandreth
- The University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Zoe Carrington
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE, UK
| | - Zoe Cashin
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, BN1 9PX, UK
| | - Shaunak Chatterjee
- Birmingham Medical School, Vincent Drive, Edgbaston B15 2TT, Birmingham, West Midlands, UK
| | - Mehar Chawla
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Chung Shen Chean
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE, UK
| | - Chris Clements
- St James's University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
| | - Richard Clough
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Jessica Coulthurst
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE, UK
| | - Liam Curry
- University of Leicester School of Medicine, George Davies Centre, Lancaster Road, Leicester, LE1 7HA, UK
| | - Vinnie Christine Daniels
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Simon Davies
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Rebecca Davis
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE, UK
| | - Hanelie De Waal
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, BN1 9PX, UK
| | - Nasreen Desai
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE, UK
| | - Hannah Douglas
- University of Edinburgh Medical School, 47 Little France Cres, Edinburgh, EH16 4TJ, UK
| | - James Druce
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | | | - Meron Esere
- Medical Sciences Divisional Office, University of Oxford, Level 3, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Alex Eyre
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Ibrahim Talal Fazmin
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0SP, UK
| | - Sophia Fitzgerald-Smith
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH, UK
| | - Verity Ford
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Sarah Freeston
- Homerton University Hospital, Homerton Row E9 6SR, London, UK
| | | | - Whitney General
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH, UK
| | - Helen Gilbert
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Zein Gowie
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Ciaran Grafton-Clarke
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE, UK
| | - Keshni Gudka
- The University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Leher Gumber
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, BN1 9PX, UK
| | - Rishi Gupta
- UCL Medical School, 74 Huntley Street, London, WC1E 6BT, UK
| | - Chris Harlow
- St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Amy Harrington
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Adele Heaney
- Queen's University Belfast, University Road, Belfast, BT7 1NN, UK
| | - Wing Hang Serene Ho
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE, UK
| | - Lucy Holloway
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Christina Hood
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Eleanor Houghton
- The University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Saba Houshangi
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Emma Howard
- School of Medicine, Keele University, David Weatherall Building, Keele University Campus, Staffordshire, ST5 5BG, UK
| | - Benjamin Human
- School of Medicine, University of Leeds, Worsley Building, Leeds, LS2 9NL, UK
| | - Harriet Hunter
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0SP, UK
| | - Ifrah Hussain
- Imperial College School of Medicine, South Kensington Campus, London, SW7 2AZ, UK
| | - Sami Hussain
- UCL Medical School, 74 Huntley Street, London, WC1E 6BT, UK
| | | | | | - Ryan Janjuha
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Saleh Jawad
- Faculty of Medicine, University of Southampton, Building 85, Life Sciences Building, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Muzzamil Jelani
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - David Johnston
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0SP, UK
| | - Mike Jones
- University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK
| | - Sadhana Kalidindi
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH, UK
| | - Savraj Kalsi
- University of York, John Hughlings Jackson Building, Heslington, York, YO10 5DD, UK
| | - Asanish Kalyanasundaram
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0SP, UK
| | - Anna Kane
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Sahaj Kaur
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0SP, UK
| | | | - Qaisar Khan
- University of Aberdeen, Suttie Centre, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Sajan Khullar
- School of Medicine, Keele University, David Weatherall Building, Keele University Campus, Staffordshire, ST5 5BG, UK
| | - Priscilla Kirkland
- University of Edinburgh Medical School, 47 Little France Cres, Edinburgh, EH16 4TJ, UK
| | - Hannah Lawrence-Smith
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE, UK
| | - Charlotte Leeson
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | | | - Kerry Long
- Nottingham University Hospitals NHS Trust, Hucknall Rd, Nottingham, NG5 1PB, UK
| | - Simon Lubbock
- The University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | | | - Rachel Maguire
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Praveen Mahendran
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE, UK
| | - Saad Majeed
- University of Aberdeen, Suttie Centre, Foresterhill, Aberdeen, AB25 2ZD, UK
| | | | - Vinay Mandagere
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH, UK
| | - Angelos Mantelakis
- St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Sophie McGovern
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Anjola Mosuro
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH, UK
| | - Adam Moxley
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Sophie Mustoe
- Guy's, King's and St Thomas' School of Medical Education, Henriette Raphael Building, Guy's Campus, London, SE1 1UL, UK
| | - Sam Myers
- UCL Medical School, 74 Huntley Street, London, WC1E 6BT, UK
| | - Kiran Nadeem
- Manchester Medical School, Stopford Building, Oxford Rd, Manchester, M13 9PT, UK
| | - Reza Nasseri
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH, UK
| | - Tom Newman
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0SP, UK
| | - Richard Nzewi
- University of Leicester School of Medicine, George Davies Centre, Lancaster Road, Leicester, LE1 7HA, UK
| | - Rosalie Ogborne
- St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Joyce Omatseye
- University of Liverpool Medical School, Cedar House, Ashton St, Liverpool, L69 3GE, UK
| | - Sophie Paddock
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - James Parkin
- St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Mohit Patel
- University of York, John Hughlings Jackson Building, Heslington, York, YO10 5DD, UK
| | - Sohini Pawar
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0SP, UK
| | - Stuart Pearce
- St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Samuel Penrice
- University of Dundee School of Medicine, 4 Kirsty Semple Way, Dundee, DD2 4BF, UK
| | - Julian Purdy
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Raisa Ramjan
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Ratan Randhawa
- UCL Medical School, 74 Huntley Street, London, WC1E 6BT, UK
| | - Usman Rasul
- University of Aberdeen, Suttie Centre, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Elliot Raymond-Taggert
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH, UK
| | - Rebecca Razey
- Imperial College School of Medicine, South Kensington Campus, London, SW7 2AZ, UK
| | - Carmel Razzaghi
- Queen's University Belfast, University Road, Belfast, BT7 1NN, UK
| | - Eimear Reel
- Queen's University Belfast, University Road, Belfast, BT7 1NN, UK
| | - Elliot John Revell
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Joanna Rigbye
- University of Edinburgh Medical School, 47 Little France Cres, Edinburgh, EH16 4TJ, UK
| | | | - Abdelrahman Said
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Emma Sanders
- Faculty of Health Sciences, University of Bristol Medical School, First Floor South, Senate House, Tyndall Avenue, Bristol, BS8 1TH, UK
| | - Pranoy Sangal
- University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK
| | - Nora Sangvik Grandal
- University of York, John Hughlings Jackson Building, Heslington, York, YO10 5DD, UK
| | - Aadam Shah
- University of Aberdeen, Suttie Centre, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Rahul Atul Shah
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0SP, UK
| | - Oliver Shotton
- Medical Sciences Divisional Office, University of Oxford, Level 3, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Daniel Sims
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, BN1 9PX, UK
| | - Katie Smart
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Martha Amy Smith
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Nick Smith
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Aninditya Salma Sopian
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Matthew South
- The University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Jessica Speller
- University of Leicester School of Medicine, George Davies Centre, Lancaster Road, Leicester, LE1 7HA, UK
| | - Tom J Syer
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Ngan Hong Ta
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Daniel Tadross
- School of Medicine, University of Leeds, Worsley Building, Leeds, LS2 9NL, UK
| | - Benjamin Thompson
- University of York, John Hughlings Jackson Building, Heslington, York, YO10 5DD, UK
| | - Jess Trevett
- University of York, John Hughlings Jackson Building, Heslington, York, YO10 5DD, UK
| | - Matthew Tyler
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Roshan Ullah
- Birmingham Medical School, Vincent Drive, Edgbaston B15 2TT, Birmingham, West Midlands, UK
| | - Mrudula Utukuri
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0SP, UK
| | - Shree Vadera
- UCL Medical School, 74 Huntley Street, London, WC1E 6BT, UK
| | | | - Sara Venturini
- Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK
| | - Aradhya Vijayakumar
- University of Leicester School of Medicine, George Davies Centre, Lancaster Road, Leicester, LE1 7HA, UK
| | - Melanie Vine
- University of Leicester School of Medicine, George Davies Centre, Lancaster Road, Leicester, LE1 7HA, UK
| | - Zoe Wellbelove
- University of York, John Hughlings Jackson Building, Heslington, York, YO10 5DD, UK
| | - Liora Wittner
- UCL Medical School, 74 Huntley Street, London, WC1E 6BT, UK
| | - Geoffrey Hong Kiat Yong
- Medical Student Office, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Farris Ziyada
- Guy's, King's and St Thomas' School of Medical Education, Henriette Raphael Building, Guy's Campus, London, SE1 1UL, UK
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10
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Jones OT, Jurascheck LC, Utukuri M, Pannebakker MM, Emery J, Walter FM. Dermoscopy use in UK primary care: a survey of GPs with a special interest in dermatology. J Eur Acad Dermatol Venereol 2019; 33:1706-1712. [PMID: 30977937 PMCID: PMC6767170 DOI: 10.1111/jdv.15614] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/01/2019] [Indexed: 12/19/2022]
Abstract
Background Melanoma accounts for 90% of skin cancer mortality and typically presents in primary care, where it can be challenging to distinguish from benign lesions. Dermoscopy is a tool for skin visualization that is routinely used for melanoma diagnosis in secondary care. However, the role of dermoscopy in primary care remains unclear. Objectives To determine views on, and use of, dermoscopy by dermatology‐interested general practitioners (GPs). Methods An online questionnaire was emailed to the UK Primary Care Dermatology Society members in February 2018, and responses collected over the following 4 weeks. Results A total of 205 responses were analysed. Most respondents were GPs (94%), aged over 50 (53%), had a postgraduate dermatological qualification (67%) and used dermoscopy regularly when reviewing pigmented skin lesions (97%). Dermoscopy use was commoner amongst GPs who had worked longer in primary care and had experience of secondary care dermatology. Most had undertaken training in dermoscopy (91%), although one‐fifth (20%) had not updated their training in over 5 years. Most of those who had received only 1 day of face‐to‐face training reported feeling confident using a dermatoscope. Few respondents (11%) reported access to teledermatology or teledermoscopy for urgent or routine referrals. Conclusions UK GPs with a special interest in dermatology are routinely using dermoscopy in the primary care setting. More research is needed to establish optimal approaches to training and updating GP dermoscopy skills. When dermoscopy has been shown to be safe, effective, acceptable and cost‐effective in this setting, more GPs may also be able to gain and maintain the skills to implement dermoscopy into routine primary care. Technological advances, including incorporation of artificial intelligence (AI) and algorithms to guide GPs, could also contribute to widening use of dermoscopy among GPs.
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Affiliation(s)
- O T Jones
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - M Utukuri
- Clinical School, University of Cambridge, Cambridge, UK
| | - M M Pannebakker
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - J Emery
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,Faculty of Medicine, Dentistry and Health Science, Department of General Practice and the Centre for Cancer Research, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia
| | - F M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,Faculty of Medicine, Dentistry and Health Science, Department of General Practice and the Centre for Cancer Research, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia
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11
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Schön T, Matuschek E, Mohamed S, Utukuri M, Heysell S, Alffenaar JW, Shin S, Martinez E, Sintchenko V, Maurer FP, Keller PM, Kahlmeter G, Köser CU. Standards for MIC testing that apply to the majority of bacterial pathogens should also be enforced for Mycobacterium tuberculosis complex. Clin Microbiol Infect 2019; 25:403-405. [PMID: 30771527 DOI: 10.1016/j.cmi.2019.01.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/25/2019] [Accepted: 01/26/2019] [Indexed: 11/25/2022]
Affiliation(s)
- T Schön
- Department of Infectious Diseases and Clinical Microbiology, Kalmar County Hospital, Kalmar, Sweden; Department of Clinical and Experimental Medicine, Division of Medical Microbiology, Linköping University, Linköping, Sweden
| | - E Matuschek
- EUCAST Development Laboratory, Växjö, Sweden
| | - S Mohamed
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - M Utukuri
- School of Clinical Medicine, University of Cambridge, UK
| | - S Heysell
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - J-W Alffenaar
- Faculty of Medicine and Health, School of Pharmacy and Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - S Shin
- Korean Institute of Tuberculosis, Cheongju, Republic of Korea
| | - E Martinez
- Centenary Institute and Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia; NSW Mycobacterium Reference Laboratory, Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research-Pathology West, Sydney, NSW, Australia; Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
| | - V Sintchenko
- Centenary Institute and Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia; NSW Mycobacterium Reference Laboratory, Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research-Pathology West, Sydney, NSW, Australia; Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Western Sydney Local Health District, Sydney, NSW, Australia
| | - F P Maurer
- National and Supranational Reference Centre for Mycobacteria, Research Centre Borstel, Borstel, Germany
| | - P M Keller
- Institute for Infectious Diseases, University of Berne, Berne, Switzerland
| | - G Kahlmeter
- EUCAST Development Laboratory, Växjö, Sweden
| | - C U Köser
- Department of Genetics, University of Cambridge, UK.
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12
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Khanduja V, Somayaji HS, Harnett P, Utukuri M, Dowd GSE. Combined reconstruction of chronic posterior cruciate ligament and posterolateral corner deficiency. ACTA ACUST UNITED AC 2006; 88:1169-72. [PMID: 16943466 DOI: 10.1302/0301-620x.88b9.17591] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a retrospective analysis of the results of combined arthroscopically-assisted posterior cruciate ligament reconstruction and open reconstruction of the posterolateral corner in 19 patients with chronic (three or more months) symptomatic instability and pain in the knee. All the operations were performed between 1996 and 2003 and all the patients were assessed pre- and post-operatively by physical examination and by applying three different ligament rating scores. All also had weight-bearing radiographs, MR scans and an examination under anaesthesia and arthroscopy pre-operatively. The posterior cruciate ligament reconstruction was performed using an arthroscopically-assisted single anterolateral bundle technique and the posterolateral corner structures were reconstructed using an open Larson type of tenodesis. The mean follow up was 66.8 months (24 to 110). Pre-operatively, all the patients had a grade III posterior sag according to Clancy and demonstrated more than 20° of external rotation compared with the opposite normal knee on the Dial test. Post-operatively, seven patients (37%) had no residual posterior sag, 11 (58%) had a grade I posterior sag and one (5%) had a grade II posterior sag. In five patients (26%) there was persistent minimal posterolateral laxity. The Lysholm score improved from a mean of 41.2 (28 to 53) to 76.5 (57 to 100) (p = 0.0001) and the Tegner score from a mean of 2.6 (1 to 4) to 6.4 (4 to 9) (p = 0.0001). We conclude that while a combined reconstruction of chronic posterior cruciate ligament and posterolateral corner instability improves the function of the knee, it does not restore complete stability.
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Affiliation(s)
- V Khanduja
- Royal Free Hospital and The Wellington Knee Unit, Wellington Place, St John's Wood, London NW8 9LE, UK
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13
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Ramachandran M, Utukuri M, Hill R. Spot the diagnosis. Recurrent Blount's disease. J Postgrad Med 2003; 49:324, 327. [PMID: 14989254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Affiliation(s)
- M Ramachandran
- Department of Paediatric Orthopaedic Surgery, Hospital for Sich Children, Great Ormond Street, London, England WC1N 3JH
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