There are structural and functional modifications that occur to the neonatal heart immediately after birth. While a number of studies recently have assessed cardiac function in the newborn, there is a dearth of data on diastolic function in the neonatal period during transition and into infancy. The objective of this study is to assess diastolic function in a large cohort of infants to provide normative reference values and to assess the influence of predefined maternal and infant characteristics.

This is a single-centre observational study of babies born at 35 weeks of gestation and above, involving echocardiography in the first 2 DOL and longitudinal follow-up of these infants up to 18 months of age. The echocardiographic measurements to assess diastolic function used in this study include conventional echo measures, novel echo measures using tissue Doppler imaging and deformation measures using 2D speckle tracking echocardiography.

The protocol was approved by the Clinical Research Ethics Committee of the Cork Teaching Hospitals. The findings from this study will be disseminated in peer-reviewed journals and during scientific conferences.

NCT06200519.

Randomised controlled trials have aimed to assess the effectiveness of stereotactic ablative radiotherapy (SABR) with curative intent versus surgical resection for individuals diagnosed with early-stage non-small cell lung cancer (NSCLC) but have failed to recruit sufficient numbers of patients. Non-randomised studies for early-stage NSCLC have reported mixed outcomes following curative SABR versus surgical resection, but did not fully address confounding by indication. The Surgery Or RadioTherapy for early-stage cancer study (SORT) will assess the comparative effectiveness of SABR with curative intent versus surgical resection for NSCLC with a target trial emulation approach, as this can reduce biases in observational studies that aim to estimate the causal effect of interventions.

The SORT study will use the National Cancer Registry for individuals diagnosed with early-stage NSCLC in England during 2015–2020 (inclusive) who received SABR with curative intent or surgical resection. These data will be linked to Hospital Episode Statistics, National Radiotherapy Data Set and the Systemic Anti-Cancer Therapy dataset to obtain information on clinical and sociodemographic characteristics and the treatment received. This target trial emulation will define study population eligibility criteria and regimens for SABR with curative intent and surgical resection. We will reduce the risk of residual confounding with instrumental variable analyses that will exploit geographical variation across the National Health Service in England in the use of SABR with curative intent versus surgical resection for early-stage NSCLC. The primary outcome will be 3-year all-cause mortality after treatment initiation. Secondary outcomes will include 3-month, 6-month, 12-month and 24-month all-cause and lung-cancer mortality, time to death, numbers of hospitalisations, incremental costs and incremental cost-effectiveness.

Ethical approval was obtained from the London School of Hygiene and Tropical Medicine Research Ethics Committee (reference number 29 717–1). Results will be disseminated to clinicians, patients, policy-makers and researchers.

To examine the feasibility, safety and perceived patient response of a combined repetitive transcranial magnetic stimulation (rTMS) and quadriceps strengthening exercise intervention for knee osteoarthritis.

A two-arm, participant-blinded, therapist-blinded and assessor-blinded, randomised controlled trial with additional follow-up of pain and function at 3 months. Participants were randomised to receive active rTMS+exercise (AR+EX) or sham rTMS+exercise (SR+EX) twice weekly for 6 weeks while completing home exercises twice a week. Primary outcomes included recruitment rate, treatment attendance, dropouts, willingness to undergo therapy (11-point Numeric Rating Scale, ‘not at all willing’=0 and ‘very willing’=10), success of participant, therapist and outcome assessor blinding, adverse events and Global Perceived Effect Scale. Secondary outcomes were pain, function and measures of physiological mechanisms.

86 people were screened, 31 (36%) were randomised, 28 (90%) completed the treatments and 3 (10%) dropouts at 3-month follow-up. Both groups had high treatment attendance (98.4% and 100%). All participants scored at least 7 on the willingness to undergo therapy scale. Blinding was successful. No adverse events were reported. At the postintervention assessment, 80% in the AR+EX group and 75% in the SR+EX group reported an improvement on the Global Perceived Effect Scale. Both groups demonstrated within-group improvements in pain at the postintervention assessment but not at the 3-month follow-up. Function improved only in the AR+EX group at the postintervention assessment.

Combined rTMS and quadriceps strengthening exercise intervention for knee osteoarthritis is feasible, safe and well-received. A full-scale trial is justified to assess the clinical benefits of this novel treatment.

ACTRN12621001712897.

Explore what is known about the impact of changes made at a national level to UK postgraduate medical education during COVID-19.

A scoping review, following Arksey and O’Malley’s framework, reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist.

Ovid MEDLINE, Ovid Embase and ERIC were searched for peer-reviewed literature, and grey literature was searched via DuckDuckGo. The initial search was conducted on 17 January 2023 and updated on 5 June 2024. Forward citation tracking was performed.

English-language studies of any design examining national-level adaptations to postgraduate medical education (eg, curricula, examinations and Annual Review of Competency Panels (ARCPs)) within the UK during the COVID-19 pandemic. Studies were excluded, which focused solely on undergraduate education, international settings, grassroots-level changes (eg, to individual teaching sessions), or where full text was unobtainable.

Data were extracted using a piloted charting form and analysed thematically to identify recurring patterns across studies. Basic numerical data were collected to describe study characteristics.

Of 1067 records screened, 30 studies met inclusion criteria. Most were cross-sectional surveys, with a strong representation from surgical and craft specialties. Four themes were identified: (1) impact on career development (including concerns about career delays and shifts in aspirations); (2) impact on trainee progression (highlighting delays due to ARCP outcomes 10.1/10.2 and reduced procedure accreditation); (3) changes in teaching and learning (such as a shift to online learning and cancelled rotations) and (4) supervision and support (revealing mixed experiences, with reports of burnout and inadequate organisational guidance). The systemic impact was uneven across specialties and training stages.

National-level changes mitigated immediate educational disruptions but are beginning to reveal long-term consequences for career development, workforce planning and trainee well-being, highlighting the need for resilient and equitable future frameworks.