Medical students’ experiences of health inequalities and inclusion health education

Background Inclusion health groups experience a significantly larger burden of morbidity and mortality than the general public. Despite this, undergraduate medical education is often limited in its approach to inclusion health curricula, leaving students disengaged and lacking understanding. Methods We conducted two research studies to explore medical students’ experiences of inclusion health education. All participants were studying medicine at the University of Leeds at the time of data collection. We gathered experiences of both compulsory and elective inclusion health education via semi-structured interviews. Interview responses were audio-recorded, transcribed and analysed thematically. Findings We identified several key findings across the two studies. Firstly, medical students felt unprepared to work with inclusion health groups. Further to this, medical students have a preference for interactive teaching and learning in inclusion health education. Finally, encountering inclusion health groups by chance (on placement) or choice (optional initiatives) present different opportunities. Discussion and Conclusion Our research suggests that simply being exposed to inclusion health groups through lectures and on placement is not considered sufficient by medical students, and in fact can lead to the perpetuation of misinformation and stigma. Participants perceived that optional initiatives or ‘choice encounters’ had profoundly positive impacts on attitudes and interest, particularly when there were opportunities to learn directly from individuals with lived experience of exclusion. We suggest that a flipped classroom approach to inclusion health education along with integrated experiential learning would provide medical students with comprehensive and patient-focused learning opportunities

Growth hormone prescribing and initial BMI SDS: Increased biochemical adverse effects and costs in obese children without additional gain in height

BACKGROUND: Recombinant human growth hormone (rhGH) treatment in children is usually prescribed using actual body weight. This may result in inappropriately high doses in obese children. METHODS: Retrospective audit of all paediatric patients treated with rhGH 2010-14 at a tertiary paediatric hospital in the UK. Change in height SDS and IGF-I SDS during the first year of treatment was stratified by initial BMI SDS in a mixed cohort, and a subgroup of GH deficient (GHD) patients. Alternative doses for those BMI SDS ≥2.0 (Obese) were calculated using BSA, IBW and LBW. RESULTS: 354 patients (133 female) received rhGH, including 213 (60.2%) with GHD. Obesity was present in 40 patients (11.3%) of the unselected cohort, and 32 (15.0%) of the GHD cohort. For GHD patients, gain in height SDS was directly related to BMI SDS, except in obese patients (p<0.05). For both the entire cohort, and GHD patients only, IGF-1 SDS was significantly higher in obese patients (p<0.0001 for both groups). Cross sectional data identified 265 children receiving rhGH, 81 (30.5%) with a BMI-SDS ≥1.75. Alternate prescribing strategies for rhGH prescribing in obese patients suggest a saving of 27% - 38% annually. CONCLUSIONS: Gain in IGF-I SDS is greater in obese children, and is likely to be related to relatively higher doses of rhGH. Additional gain in height was not achieved at the higher doses administered to obese children. Alternative dosing strategies in the obese patient population should be examined in rigorous clinical trials

Technological enhancements in the teaching and learning of reflective and creative practice in dance

This is an electronic version of an article published in Huxley, M., Doughty, S., Francksen, K. and Leach, M. (2008) Technological enhancements in the teaching and learning of reflective and creative practice in dance. Research in Dance Education. 9 (1), pp.129-146.A team of researchers at De Montfort University’s Centre for Excellence in Performance Arts has explored uses of technology in dance education. The wider context of dance and technology pedagogy includes research into dance, technologies, learning and teaching and the relationships between teaching and research. The paper addresses all of these themes. Three pedagogic research projects are reported on. They address dance and technology in terms of: (i) teaching the Alexander Technique for dancers, (ii) improvisation, (iii) interactive practice using the software environment Isadora. Two main themes are highlighted: (1) use of technology as a means of enabling reflection, and (2) technology as a means of both engaging in the creative process and as a creative tool. It is argued that student-centred autonomous learning in dance can be significantly enhanced by an informed application of technologies

Cardiac dose from tangential breast cancer radiotherapy in the year 2006.

PURPOSE: To quantify the radiation doses received by the heart and coronary arteries from contemporary tangential breast or chest wall radiotherapy. METHODS AND MATERIALS: Fifty consecutive patients with left-sided breast cancer and 5 consecutive patients with right-sided breast cancer treated at a large United Kingdom radiotherapy center during the year 2006 were selected. All patients were irradiated with 6- or 8-MV tangential beams to the breast or chest wall. For each dose plan, dose-volume histograms for the heart and left anterior descending (LAD) coronary artery were calculated. For 5 of the left-sided and all 5 right-sided patients, dose-volume histograms for the right and circumflex coronary arteries were also calculated. Detailed spatial assessment of dose to the LAD coronary artery was performed for 3 left-sided patients. RESULTS: For the 50 patients given left-sided irradiation, the average mean (SD) dose was 2.3 (0.7) Gy to the heart and 7.6 (4.5) Gy to the LAD coronary artery, with the distal LAD receiving the highest doses. The right and circumflex coronary arteries received approximately 2 Gy mean dose. Part of the heart received &gt;20 Gy in 22 left-sided patients (44%). For the 5 patients given right-sided irradiation, average mean doses to all cardiac structures were in the range 1.2 to 2 Gy. CONCLUSIONS: Heart dose from left-tangential radiotherapy has decreased considerably over the past 40 years, but part of the heart still receives &gt;20 Gy for approximately half of left-sided patients. Cardiac dose for right-sided patients was generally from scattered irradiation alone