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.

Observational research suggests that micronutrients may be protective for sarcopenia, a key health issue during ageing, potentially via effects on hormone synthesis and metabolism. We aimed to carry out a systematic review of RCTs investigating effects of increasing dietary or supplemental micronutrient intake on sex hormones and IGF-1 in individuals aged 45 years or older. We searched MEDLINE, EMBASE and Cochrane databases for RCTs reporting the effects of different micronutrients (vitamins A, C, D, or E; carotenoids; iron; copper; zinc; magnesium; selenium; and potassium) on sex hormones or IGF-1. Of the 26 RCTs identified, nine examined effects of vitamin D, nine of multi-nutrients, four of carotenoids, two of selenium, one of zinc, and one of vitamin E. For IGF-1 increasing vitamin D (MD: −0.53 nmol/L, 95% CI: −1.58, 0.52), multi-nutrients (MD: 0.60 nmol/L, 95% CI −1.12 to 2.33) and carotenoids (MD −1.32 nmol/L; 95% CI −2.76 to 0.11) had no significant effect on circulating concentrations. No significant effects on sex hormones of other micronutrients were found, but data were very limited. All trials had significant methodological limitations making effects of micronutrient supplementation on sex hormones unclear. Further high quality RCTs with physiological doses of micronutrients in people with low baseline intakes or circulating concentrations, using robust methodology, are required to assess effects of supplementation adequately.

Age-related sarcopenia is an international problem, involving the loss of muscle mass and function. The process begins at the age of 40 years old in both males and females (1). Currently, there are no accepted management guidelines for the condition, which has the potential to significantly adversely affect mobility, activities of daily living, and independence. Sarcopenia is multifactorial in aetiology and one potential mechanism for its onset is the physiological age-related decline in sex hormones and insulin-like growth hormone-1 (IGF-1) (2). Decline in these hormones occurs at a similar age to the onset of sarcopenia and micronutrients may be important in regulating their concentrations. Sex hormones and IGF-1 concentrations may be affected by oxidative stress, or by up-regulation of inflammatory cytokines, and therefore the antioxidant vitamins A, C, and E, as well as the carotenoids and zinc (Zn) may be important. Previous research has shown total antioxidant binding capacity is related to sex hormone concentration (3) ; Vitamin D increases testosterone levels in men (4) ; and supplementation with some micronutrients, for example: selenium (5) (Se), or Zn (6) , increases IGF-1 levels in both men and women. However, the relationship between micronutrients and sex hormones or IGF-1 in adults over 45 years has not been extensively researched. Therefore, the aim of this systematic review (SR), is to use established Cochrane methodology, to investigate the effect of dietary or supplemental intake of specific micronutrients and associations or changes on sex hormones and IGF-1. Only randomised controlled trials, prospective cohort studies or cross-sectional studies were eligible for inclusion in this review. Searches in MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials utilised a variety of free text words, index terms and synonyms relating to: Vitamin A, C, D, E, carotenoids, minerals (Zn, Magnesium (Mg), Se, potassium, iron and copper), sex hormones (androgens, oestrogens, dehydroepiandrosterone (DHEAS), and sex hormone binding globulin (SHBG)), and IGF-1. A comprehensive search strategy was created after combining both micronutrient terms and terms for sex hormones. All screening, application of eligibility criteria, and data extraction will be conducted in duplicate. Studies will be considered eligible providing participants are over 45 years and without renal disease. The study protocol will be registered on PROSPERO. A total of 5372 unique papers have been identified, and from this, 71 studies have been found to be eligible for inclusion. These studies provide data on vitamin D (44 %), multi-vitamins (25 %), Zn (9 %), vitamin E (7 %), Carotenoids (6 %), Se (4 %), Mg (3 %) and vitamin C (1 %). Data extraction has yet to commence, however, the analysis will include a narrative synthesis and meta-analyses if this is viable with the final data. The majority of studies on micronutrients are cross-sectional in design (55 %), with remaining as randomised (37 %) or cohort studies (8 %). The studie...

There is variation in the treatment of lower limb cellulitis (LLC) with no agreement on the most effective antibiotic regimen. Many patients with cellulitis fail to respond to first-line antibiotics. This can negatively affect patient care and result in unnecessary hospital admissions. The aim of this systematic review was to determine the clinical response and safety of antibiotic regimens for the management of LLC. A systematic review for randomized controlled trials (RCTs) was conducted using OVID MEDLINE, Ovid Embase and Cochrane Central Register of Controlled Trials in January 2019. Outcomes of interest included the clinical response to antibiotic regimens (type, dose, route, duration) and the safety of antibiotics in LLC. Trial quality was identified using the Cochrane Risk of Bias tool. Four RCTs were included. All included studies showed no significant differences between the clinical response to different antibiotic type, administration route, treatment duration or dose. LLC may be overtreated and shorter courses of oral antibiotics, possibly with lower doses, may be more suitable. There is a lack of published data on the clinical response and safety of antibiotics in LLC. Three studies were high risk for bias overall. Further high-quality studies may help determine whether less intensive antibiotic regimens can effectively treat LLC.