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.

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.

BackgroundStandard treatment of Duchenne muscular dystrophy (DMD) includes regular physiotherapy. There are no data to show whether adding aquatic therapy (AT) to land-based exercises helps maintain motor function. We assessed the feasibility of recruiting and collecting data from boys with DMD in a parallel-group pilot randomised trial (primary objective), also assessing how intervention and trial procedures work.MethodsAmbulant boys with DMD aged 7–16 years established on steroids, with North Star Ambulatory Assessment (NSAA) score ≥8, who were able to complete a 10-m walk test without aids or assistance, were randomly allocated (1:1) to 6 months of either optimised land-based exercises 4 to 6 days/week, defined by local community physiotherapists, or the same 4 days/week plus AT 2 days/week. Those unable to commit to a programme, with >20% variation between NSAA scores 4 weeks apart, or contraindications to AT were excluded.The main outcome measures included feasibility of recruiting 40 participants in 6 months from six UK centres, clinical outcomes including NSAA, independent assessment of treatment optimisation, participant/therapist views on acceptability of intervention and research protocols, value of information (VoI) analysis and cost-impact analysis.ResultsOver 6 months, 348 boys were screened: most lived too far from centres or were enrolled in other trials; 12 (30% of the targets) were randomised to AT (n = 8) or control (n = 4). The mean change in NSAA at 6 months was −5.5 (SD 7.8) in the control arm and −2.8 (SD 4.1) in the AT arm. Harms included fatigue in two boys, pain in one. Physiotherapists and parents valued AT but believed it should be delivered in community settings. Randomisation was unattractive to families, who had already decided that AT was useful and who often preferred to enrol in drug studies. The AT prescription was considered to be optimised for three boys, with other boys given programmes that were too extensive and insufficiently focused. Recruitment was insufficient for VoI analysis.ConclusionsNeither a UK-based RCT of AT nor a twice weekly AT therapy delivered at tertiary centres is feasible. Our study will help in the optimisation of AT service provision and the design of future research.Trial registration ISRCTN41002956 Electronic supplementary materialThe online version of this article (doi:10.1186/s40814-017-0132-0) contains supplementary material, which is available to authorized users.

BackgroundDuchenne muscular dystrophy (DMD) is a rare disease that causes the progressive loss of motor abilities such as walking. Standard treatment includes physiotherapy. No trial has evaluated whether or not adding aquatic therapy (AT) to land-based therapy (LBT) exercises helps to keep muscles strong and children independent.ObjectivesTo assess the feasibility of recruiting boys with DMD to a randomised trial evaluating AT (primary objective) and to collect data from them; to assess how, and how well, the intervention and trial procedures work.DesignParallel-group, single-blind, randomised pilot trial with nested qualitative research.SettingSix paediatric neuromuscular units.ParticipantsChildren with DMD aged 7–16 years, established on corticosteroids, with a North Star Ambulatory Assessment (NSAA) score of 8–34 and able to complete a 10-m walk without aids/assistance. Exclusions: > 20% variation between baseline screens 4 weeks apart and contraindications.InterventionsParticipants were allocated on a 1 : 1 ratio to (1) optimised, manualised LBT (prescribed by specialist neuromuscular physiotherapists) or (2) the same plus manualised AT (30 minutes, twice weekly for 6 months: active assisted and/or passive stretching regime; simulated or real functional activities; submaximal exercise). Semistructured interviews with participants, parents (n = 8) and professionals (n = 8) were analysed using Framework analysis. An independent rater reviewed patient records to determine the extent to which treatment was optimised. A cost-impact analysis was performed. Quantitative and qualitative data were mixed using a triangulation exercise.Main outcome measuresFeasibility of recruiting 40 participants in 6 months, participant and therapist views on the acceptability of the intervention and research protocols, clinical outcomes including NSAA, independent assessment of treatment optimisation and intervention costs.ResultsOver 6 months, 348 children were screened – most lived too far from centres or were enrolled in other trials. Twelve (30% of target) were randomised to AT (n = 8) or control (n = 4). People in the AT (n = 8) and control (n = 2: attrition because of parental report) arms contributed outcome data. The mean change in NSAA score at 6 months was –5.5 [standard deviation (SD) 7.8] for LBT and –2.8 (SD 4.1) in the AT arm. One boy suffered pain and fatigue after AT, which resolved the same day. Physiotherapists and parents valued AT and believed that it should be delivered in community settings. The independent rater considered AT optimised for three out of eight children, with other children given programmes that were too extensive and insufficiently focused. The estimated NHS costs of 6-month service were between £1970 and £2734 per patient.LimitationsThe focus on delivery in hospitals limits generalisability.ConclusionsNeither a full-scale frequentist randomised controlled trial (RCT) recruiting in the UK alone nor a twice-weekly open-ended AT course delivered at tertiary centres is feasible. Further intervention development research is needed to identify how community-based pools can be accessed, and how families can link with each other and community physiotherapists to access tailored AT programmes guided by highly specialised physiotherapists. Bayesian RCTs may be feasible; otherwise, time series designs are recommended.Trial registrationCurrent Controlled Trials ISRCTN41002956.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 27. See the NIHR Journals Library website for further project information.

BackgroundSwimming Induced Pulmonary Edema (SIPE) is life-threatening condition that can affect healthy triathletes. There have been several reported cases amongst triathletes, however the current estimation of incidence is derived from a survey of triathletes with self-reported symptoms suggestive of SIPE.ObjectiveTo investigate the incidence of SIPE and associated risk factors in mass participation Triathlon Competitions (TC).DesignA retrospective analysis of Competitors' Medical Records (CMR).Setting11 consecutive UK-based TCs between 2011 and 2016. The competitions involved elite and non-elite competitors who raced Super Sprint, Sprint, Olympic and Olympic Plus distances.ParticipantsCMR of patients presenting to Triathlon Medical Team (TMT) with medical complaints/injuries were analysed. Those diagnosed with SIPE were included. Diagnostic criteria included absence of water aspiration, acute onset of dyspnoea, cough and/or expectoration of frothy sputum, with evidence of pulmonary oedema on physical examination.Assessment of Risk FactorsPatients' Age, gender, race distance, co-morbidities and medical management were recorded.Main Outcome MeasurementsThe incidence of SIPE in TCs.Results68557 competitors started the TCs and 429 competitors presented to the TMT. Five case of SIPE were recorded, giving rise to an incidence of 0.73/10,000 competitors and 1.2% of all presentations to the TMT. Mean age was 42 (21–58) and a third were female. All were non-elite athletes competing in a variety of race distances; one patient had pre-existing cardiac comorbidities; and in 3 cases participants were competing in their first triathlon. All required supplementary oxygen and transfer to hospital for definitive management.ConclusionThis report is the first to describe the incidence of SIPE in mass participation triathlon competitions. Event organisers and TMTs should be prepared for competitors developing SIPE which appears not to be bound by age, gender, race distance or co-morbidities. Further research is required to identity those who are at risk of SIPE.

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BackgroundExertional heat stroke (EHS) is a potentially life-threatening condition to the endurance athlete. Early recognition and rapid on-site treatment with aggressive cooling measures significantly reduces mortality, improves outcome and avoids hospital transfers.ObjectiveDetermine the incidence of EHS in triathlon competition.DesignA retrospective analysis of competitor medical records.SettingData was collected across two UK-based triathlons over six years (11 consecutive triathlons).Patients (or Participants)All casualties diagnosed with EHS by the Triathlon Medical team (TMT). Diagnostic criteria of EHS included a core temperature >40°C and evidence of an altered mental state indicating neurological dysfunction.Interventions (or Assessment of Risk Factors)Age, gender, race distance, co-morbidities and medical management required were recorded.Main Outcome MeasurementsIncidence of EHS amongst triathlon competitors.ResultsOf 68557 starting competitors, 429 casualties presented to the TMT. Twelve (2.8%) were diagnosed with EHS, giving an incidence of 1.74/10000 starters. Eight EHS casualties (67%) collapsed during the run phase, with three collapsing after the finish line. One EHS casualty presented during the swim phase in cardiac arrest. This patient was successfully resuscitated with CPR before ice-bath cooling for EHS. Four (36%) EHS casualties were discharged directly from the TMT and the remaining transferred to hospital.ConclusionsEHS is a significant risk in mass-participation triathlon events. EHS can be successfully managed on-site with aggressive cooling measures which may reduce hospital transfers. The majority of EHS cases occur during or after the run phase and therefore we recommend event organisers focus both medical resources and prevention strategies at this phase.

Introduction Osteoarthritis is a leading cause of global disability and is set to worsen with the concurrent rise in rates of obesity and an ageing population [1]. Current clinical solutions are sub-optimal with regards to their invasiveness and outcomes. Orthopaedic biologics is an emerging field that offers alternative and parallel treatment options to address this problem. Determining which patients will benefit most from these novel treatments is key in developing clinical pathways. Methods Our dataset included 329 patients treated with microfragmented fat injection (MFAT) over a 2 year period. Clinicodemographic data was recorded as well as 1-year Oxford Knee Score (OKS). The data was modelled to predict OKS 1-year response using Random Forest Regressors. Gender-bias was mitigated and outliers were hidden from the training model. The model was validated on raw test data and on a subset of patients with Kellgren-Lawrence grade 3 and 4 radiological evidence of arthritis, age greater than 64, preoperative OKS less than or equal to 27 and idiopathic aetiology of arthritis. Results The mean age and mean body mass index (BMI) of patients in our dataset was 66.4 years, 26.9 respectively. 53.5% of patients had Kellgren-Lawrence grade 4 arthritis. The final models RMSE was 6.72, MAE was 5.38 and r-squared was 0.23 on raw test data. An RMSE of 9.77 and MAE of 7.81 was achieved when validating the model on our subset of patients. Wilcoxon signed rank tests found no evidence of predicted results being statistically significantly different to ground truth values (p > 0.05). Preoperative OKS and Kellgren-Lawrence arthritis grade was the most important feature in our model. Discussion Our model is performant and able to predict 1 year OKS response outcome within our set of patients. We have found key features of prediction and would recommend these are researched further to improve model performance. Our dataset does not compare outcomes with other standard treatments. We also do not compare outcomes with other biologic treatments. Ultimately, this research can be used as a tool to benefit both patients and clinicians in a combined decision-making process.