Can a simple measure of vigorous physical activity predict future mortality? Results from the OXCHECK study.

BACKGROUND: As epidemiological studies have become more complex, demands for short, easily administered measures of risk factors have increased. This study investigates whether such a measure of physical activity is associated with the risk of death from all causes and death from specific causes. METHODS: A prospective follow-up study of 11,090 men and women, aged 35-64 years, recruited from five UK general practices who responded to a postal questionnaire in 1989. Self-reported frequency of vigorous-intensity physical activity and data on confounding factors were collected at baseline survey. Death notifications up to 31 December 2001 were provided by the Office for National Statistics. The relative risk (and 95% confidence interval) of dying associated with each level of exposure to physical activity was estimated by the hazard ratio in a series of Cox regression models. RESULTS: After >10 years' follow-up there were 825 deaths among the 10 522 subjects with no previous history of angina or myocardial infarction. Participation in vigorous exercise was associated with a significantly lower risk of all-cause mortality. Similar associations were found for ischaemic heart disease and cancer mortality, although the relationships were not significant at the 5% level. CONCLUSIONS: Simple measures of self-reported vigorous physical activity are associated with the risk of future mortality, at least all-cause mortality in a somewhat selected group. Interpretation of the finding should be treated with caution due to the reliance on self-report and the possibility that residual confounding may underlie the associations. Because moderate-intensity physical activity is also beneficial to health, short physical activity questionnaires should include measures of such physical activity in the future

When these university staff utilised Facebook for an entire year - no one expected what happened next

With social media integrating itself into every facet of university life, four staff members took the reigns of Facebook to see if they could bring about a difference to how students interacted with opportunities, self development, project work and course identity. Steered clear of, for many potential negative factors, Facebook can often be seen as a double edged sword when used as a tool for interacting with university students. It’s social aspect makes it a difficult tool to utilise professionally within the context of the University ethos. However, after a year of using it to guide group project work (Anne Doncaster), encourage and develop Placement Year success (Arnett Powell), develop concept artwork skills (Martin Jones) and manage four years worth of course students (Melvyn Ternan) the results are not what you might think. See first hand examples and findings on how Facebook has made a difference to both students and staff through a naturally developed ‘best practice’ of this social networking beast

Is primary care ready to embrace e-health? A qualitative study of staff in a London primary care trust

Objectives e-Health refers to the organisation and delivery of health services and information using the internet and related technologies. We investigated the perceptions of primary care staff towards e-health initiatives in the NHS Connecting for Health programme and whether front-line staff are ready to implement such changes. Design Twenty participants from different professional groups were purposively selected for interview, based on their current computer usage. The same practice staff were subsequently observed in order to gain an insight into how they use computers. Subjects Practice staff (doctors, nurses, practice managers and receptionists) who will be expected to use new information technology and primary care trust (PCT) staff who are involved in its implementation were selected to participate in this study. Setting A north London PCT with 62 general practices. Four practices were selected for the study. Results Analysis of the interviews and the observational data yielded six recurrent themes that have a bearing on readiness to use information and communication systems to support clinical care: perceptions of technology and NHS Connecting for Health; issues relating to resources; patient choice; matters relating to confidentiality and security; political pressures; and how information technology is currently used within primary care. Conclusions At the time of the study the systems that form part of NHS Connecting for Health, apart from the Quality Management and Analysis System (QMAS), were not implemented across the PCT. All the practices in the study acknowledged the benefits new technology would bring to the workplace, but there were also some common concerns, which suggest that staff working in primary care practices are not ready for e-health. Successful implementation of the NHS Connecting for Health programme rests on identifying, acknowledging and overcoming these concerns. A different approach might be required for those practices that have made very little progress in using email or moving towards an electronic patient record. This study suggests that a mistrust of technology and fears as to the heavy initial workload involved in becoming fully computerised have dissuaded some practices from embracing e-health. If NHS Connecting for Health is to be a success, implementation teams might need to focus initially on practices that have been reluctant to use technology to support both clinical care and the day-to-day work of the practice

Undergraduate medical teaching with remote consultations in general practice: realist evaluation

BACKGROUND: As a result of Covid-19, students in primary care now experience patient consultations predominantly remotely, with supervisors historically educating students in face-to-face contexts. There is a paucity of evidence regarding the facilitators and barriers to supervising students for excellent educational impact in the remote consultation environment. AIM: To understand the facilitators and barriers to educating medical students using remote consultations in primary care, and the consequences for students in educational impact. DESIGN & SETTING: A realist evaluation methodology was adopted to identify causal chains of contexts, mechanisms, and outcomes describing how the teaching and learning functioned on a sample of medical students, and GP tutors from two UK medical schools. METHOD: An initial programme theory developed from the literature and a scoping exercise informed the data collection tools. We collected qualitative data through online questionnaires (49 students, 19 tutors) and/or a semi-structured interview (8 students, 2 tutors). The data was coded to generate context-mechanisms-outcome configurations outlining how the teaching and learning operated. RESULTS: The results demonstrated a sequential style of supervision can positively impact student engagement and confidence and highlighted a need to address student preparation for remote patient examinations. Students found passive observation of remote patient encounters disengaging, and in addition, reported isolation which impacted negatively on their experiences and perceptions of primary care. CONCLUSION: Student and tutor experiences may improve through considering the supervision style adopted by tutors and interventions to reduce student isolation and disengagement when using remote patient consultations in primary care

An evaluation of a student led career profiling project to support the exploration of a career in general practice and other specialties

BACKGROUND: Choosing medical careers is complex but the undergraduate period is formative. St. George’s University of London (SGUL) students called for greater careers information. AIM: To develop & evaluate students’ careers resources. DESIGN & SETTING: A quality improvement student staff project at SGUL. METHOD: A “Plan, Do, Study, Act” (PDSA) cycle was completed. For the “Plan” element we surveyed students’ career intentions and information preferences. For the “Do” element, video interviews with clinicians and infographic posters were produced and published on SGUL’s virtual learning environment. For the “Study” element, feedback questionnaires were thematically analysed using Kirkpatrick’s framework. For the “Act” element the model was rolled out across SGUL programmes. RESULTS: (Plan) 79 students ranked interest in specialties, with GP second most popular. Students were unconfident how to pursue careers and wanted more information. (Do) 13 careers videos & infographics were created for 10 specialties. The (Study) questionnaire showed changes across 3 of Kirkpatrick’s levels. Level 1 (Response) students found resources helpful & accessible. Level 2 (Learning) students reported increased understanding of careers. Level 3 (Transfer) students planned using checklists and made career comparisons by specialty. Level 4 (Results) students’ career choices were not demonstrated but there were tentative proxy measures such as copying and modelling career routes and choices. (Act) involved rolling out and regularly updating resources. CONCLUSION: This PDSA model enabled development of resources by students mapped to students’ needs. We demonstrated changes in relation to students’ response, learning and transfer, with tentative suggestions of impact on career choice

Does undertaking an intercalated BSc influence first clinical year exam results at a London medical school?

Background: Intercalated BScs (iBScs) are an optional part of the medical school curriculum in many Universities. Does undertaking an iBSc influence subsequent student performance? Previous studies addressing this question have been flawed by iBSc students being highly selected. This study looks at data from medical students where there is a compulsory iBSc for non-graduates. Our aim was to see whether there was any difference in performance between students who took an iBSc before or after their third year (first clinical year) exams.Methods: A multivariable analysis was performed to compare the third year results of students at one London medical school who had or had not completed their iBSc by the start of this year (n = 276). A general linear model was applied to adjust for differences between the two groups in terms of potential confounders (age, sex, nationality and baseline performance).Results: The results of third year summative exams for 276 students were analysed (184 students with an iBSc and 92 without). Unadjusted analysis showed students who took an iBSc before their third year achieved significantly higher end of year marks than those who did not with a mean score difference of 4.4 (0.9 to 7.9 95% CI, p = 0.01). (overall mean score 238.4 "completed iBSc" students versus 234.0 "not completed", range 145.2 - 272.3 out of 300). There was however a significant difference between the two groups in their prior second year exam marks with those choosing to intercalate before their third year having higher marks. Adjusting for this, the difference in overall exam scores was no longer significant with a mean score difference of 1.4 (-4.9 to +7.7 95% CI, p = 0.66). (overall mean score 238.0 "completed iBSc" students versus 236.5 "not completed").Conclusions: Once possible confounders are controlled for (age, sex, previous academic performance) undertaking an iBSc does not influence third year exam results. One explanation for this confounding in unadjusted results is that students who do better in their second year exams are more likely to take an iBSc before their third year

A systematic review of the physical activity assessment tools used in primary care

Background: Primary care is an ideal setting for physical activity interventions to prevent and manage common long-term conditions. To identify those who can benefit from such interventions and to deliver tailored support, primary care professionals (e.g. general practitioners, practice nurses, physiotherapists, healthcare assistants) need reliable and valid tools to assess physical activity. However, there is uncertainty about the best performing tool. Objective: To identify the tools used in the literature to assess the physical activity in primary care and describe their psychometric properties. Method: A systematic review of published and unpublished literature was undertaken up to 1st December 2016). Papers detailing physical activity measures, tools or approaches used in primary care consultations were included. A synthesis of the frequency and context of their use, and their psychometric properties, was undertaken. Studies were appraised using the Downs and Black critical appraisal tool and the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) initiative checklist. Results: Fourteen papers reported 10 physical activity assessment tools. The General Practice Physical Activity Questionnaire (GPPAQ) was most frequently reported. None of the assessment tools identified showed high reliability and validity. Intra-rater reliability ranged from Kappa: 0.53 (Brief Physical Activity Assessment Tool (BPAAT)) to 0.67 (GPPAQ). Criterion validity ranged from Pearson’s Rho: 0.26 (GPPAQ) to 0.52 (Physical Activity Vital Sign). Concurrent validity ranged from Kappa: 0.24 (GPPAQ) to 0.64 (BPAAT). Conclusion: The evidence base about physical activity assessment in primary care is insufficient to inform current practice

‘They say’: medical students’ perceptions of General Practice, experiences informing these perceptions, and their impact on career intention—a qualitative study among medical students in England

Objectives The number of UK graduates choosing General Practice training remains significantly lower than the current numbers required to meet the demands of the service. This work aims to explore medical students’ perceptions of General Practice, experiences which lead to the development of these perceptions, and the ultimate impact of these on career intention. Design This mixed-methods, qualitative study used focus groups, semistructured interviews, longitudinal audio diary data and debrief interviews to explore and capture the experiences and perceptions of students in their first and penultimate years of university. Setting Three English medical schools. Participants Twenty students were recruited to focus groups from first and fourth/fifth year of study. All students in these years of study were invited to attend. Six students were recruited into the longitudinal diary study to further explore their experiences. Results This work identified that external factors, internal driving force and the ‘they say’ phenomenon were all influential on the development of perceptions and ultimately career intention. External factors may be split into human or non-human influences, for example, aspirational/inspirational seniors, family, peers (human), placements and ‘the push’ of GP promotion (non-human). Driving force refers to internal factors, to which the student compares their experiences in an ongoing process of reflection, to understand if they feel General Practice is a career they wish to pursue. The ‘they say’ phenomenon refers to a passive and pervasive perception, without a known source, whereby usually negative perceptions circulate around the undergraduate community. Conclusion Future strategies to recruit graduates to General Practice need to consider factors at an undergraduate level. Positive placement experiences should be maximised, while avoiding overtly ‘pushing’ GP onto students

Enforcing walking speed and step-length affects joint kinematics and kinetics in male and female healthy adults.

Individuals increase walking speed by increasing their step-length, increasing their step-frequency, or both. During basic training military recruits are introduced to marching "in-step", and thus the requirement to walk at fixed speeds and step-lengths. The extent to which individuals are required to under- or over-stride will vary depending on their stature, and the stature of others in their section. The incidence of stress fractures in female recruits undergoing basic training is higher than that for their male counterparts. Therefore, the purpose of this study was to determine how joint kinematics and kinetics are affected by walking speed, step-length, and sex. Thirty-seven (19 female) aerobically active non-injured individuals volunteered for this study. Synchronised three-dimensional kinematic and kinetic data were collected while participants walked overground at prescribed speeds. Audio and visual cues were used to control step-lengths. Linear mixed models were run to analyse the effects of speed, step-length condition, and sex on peak joint moments. The findings of this study showed that, in general, walking faster and over-striding predominantly increased peak joint moments, suggesting that over-striding is more likely to negatively affect injury risk than under-striding. This is especially important for individuals unaccustomed to over-striding as the cumulative effect of increased joint moments may affect a muscles capability to withstand the increased external forces associated with walking faster and with longer step-lengths, which could then lead to an increased risk of developing an injury. [Abstract copyright: Copyright © 2023. Published by Elsevier B.V.