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  1. Article ; Online: Preschool children who are frequent attenders in emergency departments: an observational study of associated demographics and clinical characteristics.

    Blair, Mitch / Poots, Alan J / Lim, Valencia / Hiles, Stephen / Greenfield, Geva / Crehan, Caroline / Kugler, Beverley / Boreham, Charlotte

    Archives of disease in childhood

    2017  

    Abstract: Background: Unscheduled visits to emergency departments (ED) have increased in the UK in recent years. Children who are repeat attenders are relatively understudied.: Aims: To describe the sociodemographic and clinical characteristics of preschoolers ...

    Abstract Background: Unscheduled visits to emergency departments (ED) have increased in the UK in recent years. Children who are repeat attenders are relatively understudied.
    Aims: To describe the sociodemographic and clinical characteristics of preschoolers who attend ED a large District General Hospital.
    Method/study design: Observational study analysing routinely collected ED operational data. Children attending four or more visits per year were considered as 'frequent attenders'. Poisson regression was used with demographic details (age, sex, ethnicity, sociodemographic status) to predict number of attendances seen in the year. We further analysed detailed diagnostic characteristics of a random sample of 10% of attendees.
    Main findings: 10 169 patients visited in the 12-month period with 16 603 attendances. 655 individuals attended on 3335 occasions. 6.4% of this population accounted for 20.1% of total visits. In the 10% sample, there were 304 attendances, and 69 (23%) had an underlying chronic long-standing illness (CLSI). This group were 2.4 times more likely to be admitted as inpatients compared with those without such conditions, median length of stay of 6.2 hours versus 2.5 hours (p=NS).
    Conclusions: Frequent ED attenders fall broadly into two distinct clinical groups: those who habitually return with self-limiting conditions and those with or without exacerbation of underlying CLSI. Both groups may be amenable to both additional nursing and other forms of community support to enhance self-care and continuity of care. Further research is required to increase our understanding of specific individual family and health system factors that predict repeat attendance in this age group.
    Language English
    Publishing date 2017-08-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 524-1
    ISSN 1468-2044 ; 0003-9888 ; 1359-2998
    ISSN (online) 1468-2044
    ISSN 0003-9888 ; 1359-2998
    DOI 10.1136/archdischild-2016-311952
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Functional IL6R 358Ala allele impairs classical IL-6 receptor signaling and influences risk of diverse inflammatory diseases.

    Ferreira, Ricardo C / Freitag, Daniel F / Cutler, Antony J / Howson, Joanna M M / Rainbow, Daniel B / Smyth, Deborah J / Kaptoge, Stephen / Clarke, Pamela / Boreham, Charlotte / Coulson, Richard M / Pekalski, Marcin L / Chen, Wei-Min / Onengut-Gumuscu, Suna / Rich, Stephen S / Butterworth, Adam S / Malarstig, Anders / Danesh, John / Todd, John A

    PLoS genetics

    2013  Volume 9, Issue 4, Page(s) e1003444

    Abstract: Inflammation, which is directly regulated by interleukin-6 (IL-6) signaling, is implicated in the etiology of several chronic diseases. Although a common, non-synonymous variant in the IL-6 receptor gene (IL6R Asp358Ala; rs2228145 A>C) is associated with ...

    Abstract Inflammation, which is directly regulated by interleukin-6 (IL-6) signaling, is implicated in the etiology of several chronic diseases. Although a common, non-synonymous variant in the IL-6 receptor gene (IL6R Asp358Ala; rs2228145 A>C) is associated with the risk of several common diseases, with the 358Ala allele conferring protection from coronary heart disease (CHD), rheumatoid arthritis (RA), atrial fibrillation (AF), abdominal aortic aneurysm (AAA), and increased susceptibility to asthma, the variant's effect on IL-6 signaling is not known. Here we provide evidence for the association of this non-synonymous variant with the risk of type 1 diabetes (T1D) in two independent populations and confirm that rs2228145 is the major determinant of the concentration of circulating soluble IL-6R (sIL-6R) levels (34.6% increase in sIL-6R per copy of the minor allele 358Ala; rs2228145 [C]). To further investigate the molecular mechanism of this variant, we analyzed expression of IL-6R in peripheral blood mononuclear cells (PBMCs) in 128 volunteers from the Cambridge BioResource. We demonstrate that, although 358Ala increases transcription of the soluble IL6R isoform (P = 8.3×10⁻²²) and not the membrane-bound isoform, 358Ala reduces surface expression of IL-6R on CD4+ T cells and monocytes (up to 28% reduction per allele; P≤5.6×10⁻²²). Importantly, reduced expression of membrane-bound IL-6R resulted in impaired IL-6 responsiveness, as measured by decreased phosphorylation of the transcription factors STAT3 and STAT1 following stimulation with IL-6 (P≤5.2×10⁻⁷). Our findings elucidate the regulation of IL-6 signaling by IL-6R, which is causally relevant to several complex diseases, identify mechanisms for new approaches to target the IL-6/IL-6R axis, and anticipate differences in treatment response to IL-6 therapies based on this common IL6R variant.
    MeSH term(s) Alleles ; Amino Acid Substitution/genetics ; Diabetes Mellitus, Type 1/blood ; Diabetes Mellitus, Type 1/genetics ; Genetic Association Studies ; Humans ; Inflammation/blood ; Inflammation/genetics ; Inflammation/metabolism ; Leukocytes, Mononuclear/metabolism ; Mutation ; Phosphorylation ; Protein Isoforms/blood ; Protein Isoforms/genetics ; Protein Isoforms/metabolism ; Receptors, Interleukin-6/blood ; Receptors, Interleukin-6/genetics ; Receptors, Interleukin-6/metabolism ; Risk Factors ; Signal Transduction
    Chemical Substances IL6R protein, human ; Protein Isoforms ; Receptors, Interleukin-6
    Language English
    Publishing date 2013-04-04
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2186725-2
    ISSN 1553-7404 ; 1553-7390
    ISSN (online) 1553-7404
    ISSN 1553-7390
    DOI 10.1371/journal.pgen.1003444
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise.

    McManus, I C / Harborne, Andrew Christopher / Horsfall, Hugo Layard / Joseph, Tobin / Smith, Daniel T / Marshall-Andon, Tess / Samuels, Ryan / Kearsley, Joshua William / Abbas, Nadine / Baig, Hassan / Beecham, Joseph / Benons, Natasha / Caird, Charlie / Clark, Ryan / Cope, Thomas / Coultas, James / Debenham, Luke / Douglas, Sarah / Eldridge, Jack /
    Hughes-Gooding, Thomas / Jakubowska, Agnieszka / Jones, Oliver / Lancaster, Eve / MacMillan, Calum / McAllister, Ross / Merzougui, Wassim / Phillips, Ben / Phillips, Simon / Risk, Omar / Sage, Adam / Sooltangos, Aisha / Spencer, Robert / Tajbakhsh, Roxanne / Adesalu, Oluseyi / Aganin, Ivan / Ahmed, Ammar / Aiken, Katherine / Akeredolu, Alimatu-Sadia / Alam, Ibrahim / Ali, Aamna / Anderson, Richard / Ang, Jia Jun / Anis, Fady Sameh / Aojula, Sonam / Arthur, Catherine / Ashby, Alena / Ashraf, Ahmed / Aspinall, Emma / Awad, Mark / Yahaya, Abdul-Muiz Azri / Badhrinarayanan, Shreya / Bandyopadhyay, Soham / Barnes, Sam / Bassey-Duke, Daisy / Boreham, Charlotte / Braine, Rebecca / Brandreth, Joseph / Carrington, Zoe / Cashin, Zoe / Chatterjee, Shaunak / Chawla, Mehar / Chean, Chung Shen / Clements, Chris / Clough, Richard / Coulthurst, Jessica / Curry, Liam / Daniels, Vinnie Christine / Davies, Simon / Davis, Rebecca / De Waal, Hanelie / Desai, Nasreen / Douglas, Hannah / Druce, James / Ejamike, Lady-Namera / Esere, Meron / Eyre, Alex / Fazmin, Ibrahim Talal / Fitzgerald-Smith, Sophia / Ford, Verity / Freeston, Sarah / Garnett, Katherine / General, Whitney / Gilbert, Helen / Gowie, Zein / Grafton-Clarke, Ciaran / Gudka, Keshni / Gumber, Leher / Gupta, Rishi / Harlow, Chris / Harrington, Amy / Heaney, Adele / Ho, Wing Hang Serene / Holloway, Lucy / Hood, Christina / Houghton, Eleanor / Houshangi, Saba / Howard, Emma / Human, Benjamin / Hunter, Harriet / Hussain, Ifrah / Hussain, Sami / Jackson-Taylor, Richard Thomas / Jacob-Ramsdale, Bronwen / Janjuha, Ryan / Jawad, Saleh / Jelani, Muzzamil / Johnston, David / Jones, Mike / Kalidindi, Sadhana / Kalsi, Savraj / Kalyanasundaram, Asanish / Kane, Anna / Kaur, Sahaj / Al-Othman, Othman Khaled / Khan, Qaisar / Khullar, Sajan / Kirkland, Priscilla / Lawrence-Smith, Hannah / Leeson, Charlotte / Lenaerts, Julius Elisabeth Richard / Long, Kerry / Lubbock, Simon / Burrell, Jamie Mac Donald / Maguire, Rachel / Mahendran, Praveen / Majeed, Saad / Malhotra, Prabhjot Singh / Mandagere, Vinay / Mantelakis, Angelos / McGovern, Sophie / Mosuro, Anjola / Moxley, Adam / Mustoe, Sophie / Myers, Sam / Nadeem, Kiran / Nasseri, Reza / Newman, Tom / Nzewi, Richard / Ogborne, Rosalie / Omatseye, Joyce / Paddock, Sophie / Parkin, James / Patel, Mohit / Pawar, Sohini / Pearce, Stuart / Penrice, Samuel / Purdy, Julian / Ramjan, Raisa / Randhawa, Ratan / Rasul, Usman / Raymond-Taggert, Elliot / Razey, Rebecca / Razzaghi, Carmel / Reel, Eimear / Revell, Elliot John / Rigbye, Joanna / Rotimi, Oloruntobi / Said, Abdelrahman / Sanders, Emma / Sangal, Pranoy / Grandal, Nora Sangvik / Shah, Aadam / Shah, Rahul Atul / Shotton, Oliver / Sims, Daniel / Smart, Katie / Smith, Martha Amy / Smith, Nick / Sopian, Aninditya Salma / South, Matthew / Speller, Jessica / Syer, Tom J / Ta, Ngan Hong / Tadross, Daniel / Thompson, Benjamin / Trevett, Jess / Tyler, Matthew / Ullah, Roshan / Utukuri, Mrudula / Vadera, Shree / Van Den Tooren, Harriet / Venturini, Sara / Vijayakumar, Aradhya / Vine, Melanie / Wellbelove, Zoe / Wittner, Liora / Yong, Geoffrey Hong Kiat / Ziyada, Farris / Devine, Oliver Patrick

    BMC medicine

    2020  Volume 18, Issue 1, Page(s) 136

    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 ...

    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.
    MeSH term(s) Female ; Humans ; Male ; Schools, Medical/standards ; Students, Medical/statistics & numerical data ; United Kingdom
    Language English
    Publishing date 2020-05-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 2131669-7
    ISSN 1741-7015 ; 1741-7015
    ISSN (online) 1741-7015
    ISSN 1741-7015
    DOI 10.1186/s12916-020-01572-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: 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.

    Devine, Oliver Patrick / Harborne, Andrew Christopher / Horsfall, Hugo Layard / Joseph, Tobin / Marshall-Andon, Tess / Samuels, Ryan / Kearsley, Joshua William / Abbas, Nadine / Baig, Hassan / Beecham, Joseph / Benons, Natasha / Caird, Charlie / Clark, Ryan / Cope, Thomas / Coultas, James / Debenham, Luke / Douglas, Sarah / Eldridge, Jack / Hughes-Gooding, Thomas /
    Jakubowska, Agnieszka / Jones, Oliver / Lancaster, Eve / MacMillan, Calum / McAllister, Ross / Merzougui, Wassim / Phillips, Ben / Phillips, Simon / Risk, Omar / Sage, Adam / Sooltangos, Aisha / Spencer, Robert / Tajbakhsh, Roxanne / Adesalu, Oluseyi / Aganin, Ivan / Ahmed, Ammar / Aiken, Katherine / Akeredolu, Alimatu-Sadia / Alam, Ibrahim / Ali, Aamna / Anderson, Richard / Ang, Jia Jun / Anis, Fady Sameh / Aojula, Sonam / Arthur, Catherine / Ashby, Alena / Ashraf, Ahmed / Aspinall, Emma / Awad, Mark / Yahaya, Abdul-Muiz Azri / Badhrinarayanan, Shreya / Bandyopadhyay, Soham / Barnes, Sam / Bassey-Duke, Daisy / Boreham, Charlotte / Braine, Rebecca / Brandreth, Joseph / Carrington, Zoe / Cashin, Zoe / Chatterjee, Shaunak / Chawla, Mehar / Chean, Chung Shen / Clements, Chris / Clough, Richard / Coulthurst, Jessica / Curry, Liam / Daniels, Vinnie Christine / Davies, Simon / Davis, Rebecca / De Waal, Hanelie / Desai, Nasreen / Douglas, Hannah / Druce, James / Ejamike, Lady-Namera / Esere, Meron / Eyre, Alex / Fazmin, Ibrahim Talal / Fitzgerald-Smith, Sophia / Ford, Verity / Freeston, Sarah / Garnett, Katherine / General, Whitney / Gilbert, Helen / Gowie, Zein / Grafton-Clarke, Ciaran / Gudka, Keshni / Gumber, Leher / Gupta, Rishi / Harlow, Chris / Harrington, Amy / Heaney, Adele / Ho, Wing Hang Serene / Holloway, Lucy / Hood, Christina / Houghton, Eleanor / Houshangi, Saba / Howard, Emma / Human, Benjamin / Hunter, Harriet / Hussain, Ifrah / Hussain, Sami / Jackson-Taylor, Richard Thomas / Jacob-Ramsdale, Bronwen / Janjuha, Ryan / Jawad, Saleh / Jelani, Muzzamil / Johnston, David / Jones, Mike / Kalidindi, Sadhana / Kalsi, Savraj / Kalyanasundaram, Asanish / Kane, Anna / Kaur, Sahaj / Al-Othman, Othman Khaled / Khan, Qaisar / Khullar, Sajan / Kirkland, Priscilla / Lawrence-Smith, Hannah / Leeson, Charlotte / Lenaerts, Julius Elisabeth Richard / Long, Kerry / Lubbock, Simon / Burrell, Jamie Mac Donald / Maguire, Rachel / Mahendran, Praveen / Majeed, Saad / Malhotra, Prabhjot Singh / Mandagere, Vinay / Mantelakis, Angelos / McGovern, Sophie / Mosuro, Anjola / Moxley, Adam / Mustoe, Sophie / Myers, Sam / Nadeem, Kiran / Nasseri, Reza / Newman, Tom / Nzewi, Richard / Ogborne, Rosalie / Omatseye, Joyce / Paddock, Sophie / Parkin, James / Patel, Mohit / Pawar, Sohini / Pearce, Stuart / Penrice, Samuel / Purdy, Julian / Ramjan, Raisa / Randhawa, Ratan / Rasul, Usman / Raymond-Taggert, Elliot / Razey, Rebecca / Razzaghi, Carmel / Reel, Eimear / Revell, Elliot John / Rigbye, Joanna / Rotimi, Oloruntobi / Said, Abdelrahman / Sanders, Emma / Sangal, Pranoy / Grandal, Nora Sangvik / Shah, Aadam / Shah, Rahul Atul / Shotton, Oliver / Sims, Daniel / Smart, Katie / Smith, Martha Amy / Smith, Nick / Sopian, Aninditya Salma / South, Matthew / Speller, Jessica / Syer, Tom J / Ta, Ngan Hong / Tadross, Daniel / Thompson, Benjamin / Trevett, Jess / Tyler, Matthew / Ullah, Roshan / Utukuri, Mrudula / Vadera, Shree / Van Den Tooren, Harriet / Venturini, Sara / Vijayakumar, Aradhya / Vine, Melanie / Wellbelove, Zoe / Wittner, Liora / Yong, Geoffrey Hong Kiat / Ziyada, Farris / McManus, I C

    BMC medicine

    2020  Volume 18, Issue 1, Page(s) 126

    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 ... ...

    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.
    MeSH term(s) Curriculum/standards ; Education, Medical, Undergraduate/organization & administration ; Female ; Humans ; Male ; Surveys and Questionnaires ; United Kingdom
    Language English
    Publishing date 2020-05-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 2131669-7
    ISSN 1741-7015 ; 1741-7015
    ISSN (online) 1741-7015
    ISSN 1741-7015
    DOI 10.1186/s12916-020-01571-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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