Creating a sport and exercise medicine undergraduate syllabus: a delphi study.

BACKGROUND: Sport and Exercise Medicine (SEM) is a growing speciality in the United Kingdom (UK). This growth has not been replicated in SEM teaching at an undergraduate level and SEM-related topics in schools of medicine in the UK are under-represented. As SEM continues to develop as a specialty it is important to consider how it is embedded at all levels of training. The aim of this project was to establish a consensus on SEM-related skills and knowledge relevant for undergraduate medical students in the UK, ultimately creating a curriculum of learning objectives (LOs). METHODS: A modified Delphi survey was utilised to seek consensus on LOs suitable for incorporation into UK medical school curricula. An expert panel with adequate knowledge in the field was recruited. The initial curriculum was created by the research team using already established postgraduate SEM curricula. All learning objectives were sent to the expert panel for opinions in phases. Levels of agreement and comments made by the expert panel were reviewed after each phase until a consensus on each learning objective was made. RESULTS: The expert panel was made up of 45 individuals, with 35 also completing phase 2 (78% retention rate). The initial curriculum contained 58 learning objectives separated into 9 themes. In phase 1 31% (18/58) were accepted outright, 48% (28/58) were altered and 19% (11/58) were rejected. Two additional learning objectives were added. Of the 49 LOs included in phase 2, 98% (48/49) were accepted. The final curriculum was made up of 9 sub-themes and 48 LOs. CONCLUSION: Sport and Exercise Medicine is a broad ranging and rapidly growing speciality. It is important to establish SEM education in all levels of medical education, including undergraduate level. This is the first published version of a Delphi SEM curriculum for undergraduate medical teaching.

Inflammation and cardiovascular status impact midazolam pharmacokinetics in critically ill children: An observational, prospective, controlled study.

Altered physiology caused by critical illness may change midazolam pharmacokinetics and thereby result in adverse reactions and outcomes in this vulnerable patient population. This study set out to determine which critical illness-related factors impact midazolam pharmacokinetics in children using population modeling. This was an observational, prospective, controlled study of children receiving IV midazolam as part of routine care. Children recruited into the study were either critically-ill receiving continuous infusions of midazolam or otherwise well, admitted for elective day-case surgery (control) who received a single IV bolus dose of midazolam. The primary outcome was to determine the population pharmacokinetics and identify covariates that influence midazolam disposition during critical illness. Thirty-five patients were recruited into the critically ill arm of the study, and 54 children into the control arm. Blood samples for assessing midazolam and 1-OH-midazolam concentrations were collected opportunistically (critically ill arm) and in pre-set time windows (control arm). Pharmacokinetic modeling demonstrated a significant change in midazolam clearance with acute inflammation (measured using C-Reactive Protein), cardio-vascular status, and weight. Simulations predict that elevated C-Reactive Protein and compromised cardiovascular function in critically ill children result in midazolam concentrations up to 10-fold higher than in healthy children. The extremely high concentrations of midazolam observed in some critically-ill children indicate that the current therapeutic dosing regimen for midazolam can lead to over-dosing. Clinicians should be aware of this risk and intensify monitoring for oversedation in such patients.

Conservative management of fifth metacarpal head fracture in a professional cricketer: A case study and literature review.

This is a unique presentation of common injury in a young professional athlete. The sensitivity of typical acute clinical signs in athletes is not known. Adequate splinting and early graded mobilization are key for successful rehabilitation, which was shorter than reported in the literature.

Regenerative Response of Degenerate Human Nucleus Pulposus Cells to GDF6 Stimulation.

Growth differentiation factor (GDF) family members have been implicated in the development and maintenance of healthy nucleus pulposus (NP) tissue, making them promising therapeutic candidates for treatment of intervertebral disc (IVD) degeneration and associated back pain. GDF6 has been shown to promote discogenic differentiation of mesenchymal stem cells, but its effect on NP cells remains largely unknown. Our aim was to investigate GDF6 signalling in adult human NP cells derived from degenerate tissue and determine the signal transduction pathways critical for GDF6-mediated phenotypic changes and tissue homeostatic mechanisms. This study demonstrates maintained expression of GDF6 receptors in human NP and annulus fibrosus (AF) cells across a range of degeneration grades at gene and protein level. We observed an anabolic response in NP cells treated with recombinant GDF6 (increased expression of matrix and NP-phenotypic markers; increased glycosaminoglycan production; no change in catabolic enzyme expression), and identified the signalling pathways involved in these responses (SMAD1/5/8 and ERK1/2 phosphorylation, validated by blocking studies). These findings suggest that GDF6 promotes a healthy disc tissue phenotype in degenerate NP cells through SMAD-dependent and -independent (ERK1/2) mechanisms, which is important for development of GDF6 therapeutic strategies for treatment of degenerate discs.

Should sports and exercise medicine be taught in the Swiss undergraduate medical curricula? A survey among 1764 Swiss medical students.

OBJECTIVES: The global lack of sports and exercise medicine (SEM) teaching at medical schools contrasts with evidence that physical activity (PA) plays a major role in preventing and treating non-communicable diseases (NCDs). The aims of this study were to (a) examine whether Swiss medical students are expected to acquire SEM-related skills and knowledge, (b) systematically reviewed SEM teaching in the Swiss undergraduate medical curricula, (c) assess if Swiss medical students are aware of SEM and (d) whether they would like SEM to be included in their curricula. METHODS: Two authors independently screened the 'Principal Relevant Objectives and Framework for Integrative Learning and Education in Switzerland' (PROFILES) for SEM-related learning objectives and reviewed the curricula. 7708 Swiss medical students were invited to participate in an online survey. RESULTS: 32 SEM-related learning objectives were identified in PROFILES with 20 of them linked to PA. Four of eight Swiss medical schools display limited mandatory SEM teachings. 1764 students participated in the survey (482.0% of the necessary sample size, 22.9% of all Swiss medical students). One in two students knew that SEM includes preventing and treating NCDs. Almost 95% of the participants would like SEM to be included in the curricula. CONCLUSION: Despite its inclusion in PROFILES and comprehensive evidence that SEM should be taught at medical schools, this is scarcely the case in Switzerland. Swiss medical students have limited understanding of SEM, but are keen to have it included in the curricula. This study highlights the need for more comprehensive SEM teaching at Swiss medical schools.

Quality of Life and Life Satisfaction in Former Athletes: A Systematic Review and Meta-Analysis.

BACKGROUND: Sport participation has many physical and psychosocial benefits, but there is also an inherent risk of injury, subsequent osteoarthritis and psychological challenges that can negatively impact quality of life (QOL). Considering the multifaceted impacts of sport participation on QOL across the lifespan, there is a need to consolidate and present the evidence on QOL in former sport participants. OBJECTIVE: To evaluate QOL and life satisfaction in former sport participants, and determine what factors are associated with QOL and life satisfaction in this population. METHODS: Eight electronic databases were systematically searched in July 2018 to retrieve all articles that evaluated QOL or life satisfaction in former sport participants. Two authors independently screened titles/abstracts and full texts, extracted data, and appraised methodological quality using a modified Downs and Black Checklist. Random-effects meta-analysis estimated pooled mean and 95% confidence intervals (Cis) for Mental Component Scores (MCS) and Physical Component Scores (PCS) derived from the SF-12, SF-36, VR-12 and VR-36 measures. MCS and PCS were pooled for all former sport participants, as well as professional- and collegiate-athlete subgroups. Data that were inappropriate for meta-analysis (i.e. EQ-5D, PROMIS and life-satisfaction outcomes) were collated and reported descriptively. RESULTS: Seventeen articles evaluated QOL or life satisfaction in a total of 6692 former athletes [eight studies (n = 4255) former professional athletes; six studies (n = 1946) former collegiate athletes; two studies (n = 491) included both] with a mean age ranging from 21 to 66 years. Most studies were cross-sectional (15 of 17 articles) and 12 studies had a moderate risk of bias (n = 1 high-risk, n = 4 low-risk). Unpublished data were provided for five studies. Meta-analysis of seven studies resulted in a pooled PCS mean (95% CI) of 50.0 (46.6-53.3) [former professional athletes from two studies: 46.7 (42.1-51.2), former collegiate athletes from five studies: 51.2 (48.4-53.9)] and a pooled MCS of 51.4 (50.5-52.2) [former professional athletes: 52.7 (51.3-54.2), former collegiate athletes: 50.9 (50.0-51.8)]. Factors associated with worse QOL or life satisfaction in former athletes included involuntary retirement from sport (three studies), collision/high-contact sport compared with low/no-contact sport (three studies), three or more concussions compared with no/fewer concussions (two studies), increased body mass index (BMI) (worse PCS, three studies), and osteoarthritis or musculoskeletal issues (worse PCS and MCS, three studies; worse PCS but not MCS, two studies). CONCLUSIONS: Former athletes had similar PCS and better MCS, compared to general-population norms. Former athletes with impaired PCS reported better MCS than population norms, highlighting the need to use an instrument that differentiates between physical and mental components of QOL in former sport participants. Factors associated with worse QOL that may explain between-study variation include involuntary retirement, collision/high contact sports, concussion, BMI and osteoarthritis. PROSPERO: CRD42018104319.

Embedding sports and exercise medicine into the medical curriculum; a call for inclusion.

The UK is currently facing an inactivity crises, with 1 in 5 children currently meeting physical activity guidelines (Health Survey for England, Children's Health, 2016). To combat this growing problem there has been increased interest in promoting exercise and healthy lifestyle advise to patients as a method for improving public health. In line with this, the specialty of Sports and Exercise Medicine (SEM) has been gaining momentum and is now a recognised specialty with a higher specialist training programme. This postgraduate speciality aims to produce doctors who are experts in exercise and musculoskeletal medicine. Increasing numbers of NHS departments are employing SEM doctors to better manage musculoskeletal (MSK) issues and prescribe exercise (Morrissey et. al, Muscles Ligaments Tendons J 3:190-195, 2013). In keeping with this increased opportunity for SEM in postgraduate training, we believe that we should not forget that SEM should not be exclusive to postgraduates and there is increasing interest and need for teaching to medical students (Cullen et al, Br J Sports Med 34:244-245, 2000). This article provides an overview to students and clinicians into the current state of undergraduate SEM education in the UK, and highlights the importance of incorporating SEM into the medical curricula.