SummaryPatients with multiple myeloma (MM) are at an elevated risk of venous thromboembolism (VTE), which is further increased for those undergoing anti‐myeloma therapy. Current guidelines suggest low‐dose direct oral anticoagulants (DOACs) as an alternative to aspirin for primary thromboprophylaxis in this population, but data comparing these two therapies are limited. We performed a systematic review and meta‐analysis to compare DOACs with aspirin for primary thromboprophylaxis in individuals undergoing outpatient anti‐myeloma therapy. Studies were selected when comparing DOACs versus aspirin for thrombotic and haemorrhagic outcomes. We included 10 randomised controlled trials and observational studies comprising 1026 patients with MM who received primary thromboprophylaxis with DOACs (n = 337) or aspirin (n = 689). DOAC thromboprophylaxis was associated with a significantly lower incidence of VTE compared with aspirin (OR 0.33; 95% CI 0.16–0.68; p < 0.001). Major, clinically relevant non‐major and minor bleeding event rates did not differ significantly between groups. Overall, our meta‐analysis suggests that DOACs may be a preferable option to aspirin for the prevention of MM‐related thrombosis. However, these results should be interpreted in the context of heterogeneous baseline population characteristics and potential bias from including observational studies. Further research is needed to evaluate the optimal thromboprophylaxis strategy, particularly in high‐risk individuals.
BackgroundRecent reports show that about 10% of UK-graduate doctors leave the country to pursue specialty training elsewhere. Our article aims to evaluate the motivating factors for UK graduates to leave the National Health Service (NHS), especially during the COVID-19 pandemic and Brexit.Study designCross-sectional study.MethodA novel 22-item questionnaire was disseminated at a webinar series regarding the application process to pursue residency training in six different countries/regions from 2 August 2020 to 13 September 2020. The data was analysed using Kruskal-Wallis rank-sum with post-hoc Wilcoxon test to compare the difference in significance among the motivating factors.Results1118 responses from the UK medical students and doctors were collected; of which, 1001 (89.5%) were medical students, and 88 (7.9%) were junior doctors. There was a higher propensity for leaving after the Foundation Programme compared with other periods (p<0.0001 for all comparisons). There was no difference between desire for leaving after core surgical/medical training and specialty training (p=0.549). However, both were significantly higher than leaving the NHS after medical school (p<0.0001). Quality of life and financial prospects (both p<0.0001) were the most agreed reasons to leave the NHS, followed by clinical and academic opportunities and, subsequently, family reasons.ConclusionFuture work on the quality of life for doctors in the UK should be explored, especially among those considering leaving the NHS. Policymakers should focus on assessing the difference in working hours, on-call hours and wages that may differ among healthcare systems.
To evaluate the status of UK undergraduate urology teaching against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology. Secondary objectives included evaluating the type and quantity of teaching provided, the reported performance rate of General Medical Council (GMC)-mandated urological procedures, and the proportion of undergraduates considering urology as a career. Subjects and MethodsThe uroLogical tEAching in bRitish medical schools Nationally (LEARN) study was a national multicentre cross-sectional evaluation. Year 2 to Year 5 medical students and Foundation Year (FY) 1 doctors were invited to complete a survey between 3 October and 20 December 2020, retrospectively assessing the urology teaching received to date. Results are reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). ResultsIn all, 7063/8346 (84.6%) responses from all 39 UK medical schools were included; 1127/7063 (16.0%) were from FY1 doctors who reported that the most frequently taught topics in undergraduate training were on urinary tract infection (96.5%), acute kidney injury (95.9%) and haematuria (94.4%). The most infrequently taught topics were male urinary incontinence (59.4%), male infertility (52.4%) and erectile dysfunction (43.8%). Male and female catheterisation on patients as undergraduates was performed by 92.1% and 73.0% of FY1 doctors respectively, and 16.9% had considered a career in urology. Theory-based teaching was mainly prevalent in the early years of medical school, with clinical skills teaching, and
Background and objectives: Professional and career enhancing opportunities are essential for developing skills required for a successful career in medicine. Research to date has mainly focused on the extent to which medical schools prepare students for clinical work as junior doctors. However, there remains a need to ascertain how students prepare for their career and what facilitates or hinders learning regarding careers in medicine. The purpose of the XTRA study is to examine career readiness of medical students at UK universities and the support they receive during their studies regarding career planning. Methods: The eXploring medical sTudents caReer reAdiness (XTRA) study is a national cross sectional study of all medical students enrolled at a UK medical school. Data collection will occur via a secure online survey designed as a training need analysis based on the principles of Supers theory (Super, 1953) of career development. A snowball sampling strategy will be used to recruit participants via social media and networks. Results will be analysed using quantitative analysis and thematic analysis to identify themes in qualitative responses. The primary outcome is to understand the perspective of current medical students on how well prepared they are about entering their careers in healthcare. Conclusions: We anticipate that findings from this study will help identify career readiness of medical students to facilitate the development of career development programmes and resources to ensure medical students are well equipped for their future careers. Keywords: medical education; medical school; medical students; careers; hidden curriculum; extracurriculars; career readiness.
Aim We aimed to perform a systematic review and meta-analysis of randomised controlled trials (RCTs) to determine the impact of a polypill-based strategy (PBS) on therapeutic adherence and cardiovascular outcomes compared with usual care for secondary prevention of cardiovascular diseases (CVD). Methods We systematically searched PubMed, Cochrane, and Scopus databases from inception to January 2023, including RCTs comparing PBS to usual care in patients with prior CVD. We assessed efficacy outcomes of therapeutic adherence, systolic blood pressure (SBP) and low-density lipoprotein-cholesterol (LDL-C), and safety outcomes of all-cause and cardiovascular mortality. Statistical analysis was performed with Review Manager 5.4.1 and R Version 4.2.1. Results A total of eight RCTs with a population of 6,541 individuals were included, of whom 3,318 (50.7%) were treated with PBS. Follow-up ranged from 6 to 60 months. PBS was associated with a significantly increased therapeutic adherence (risk ratio [RR] 1.22; 95% CI 1.10 to 1.34; p<0.001). Cardiovascular mortality (RR 0.61; 95% CI 0.44 to 0.85; p=0.004), SBP (mean difference [MD] -1.47 mmHg; 95% CI -2.86 to -0.09; p=0.04), and LDL-C (MD -3.83 mg/dL; 95% CI –6.99 to -0.67; p=0.02) were significantly lower in PBS group. The incidence of all-cause mortality was similar between groups (RR 0.83; 95% CI 0.54 to 1.29; p=0.41). Conclusions In patients with pre-existing CVD, a PBS is associated with lower cardiovascular mortality and improved therapeutic adherence, along with a modest decrease in SBP and LDL-C compared with usual care. Thus, PBS may be considered a preferred option for this patient population.
Aim Traditionally, the UK has been highly regarded as a place for doctors to pursue undergraduate medical training and postgraduate training. However, recent reports show that more than 40% of UK-graduate doctors leave the country to pursue specialty training elsewhere. This paper aims to identify and evaluate the motivating factors for UK graduates to leave the NHS. Method An anonymised questionnaire was disseminated at a webinar series regarding the application process to pursue residency overseas. The data was independently analysed by two reviewers. A one-way ANOVA (with Tukey’s Post Hoc test) was utilised to compare the difference between motivating factors. Results were considered statistically significant for p-values <0.05. Results 1,118 responses from the UK medical students and doctors were collected; of which, 1,001 (89.5%) were medical students, and 88 (7.9%) were junior doctors. There was a higher preference for leaving after the Foundation Programme compared to the other periods (p < 0.0001). There was no difference between leaving after core surgical/medical training and specialty training (p = 0.549). However, both were significantly higher than leaving the NHS after medical school (p < 0.0001). Quality of life and financial prospects (both P-corrected<0.0001 compared individually and to other groups) were the most agreed reasons to leave the NHS, followed by clinical and academic opportunities and, subsequently, family reasons. Conclusions Future work on the quality of life for doctors in the UK, especially for prospective surgical trainees, should be explored. Policymakers should focus on assessing the difference in working hours, on-call hours or wages that may differ among the healthcare systems.
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