Vitamin A deficiency is a major health risk for infants and children in low- and middle-income countries. This scoping review identified, quantified, and mapped research for use in updating nutrient requirements and upper limits for vitamin A in children aged 0 to 48 months, using health-based or modelling-based approaches. Structured searches were run on Medline, EMBASE, and Cochrane Central, from inception to 19 March 2021. Titles and abstracts were assessed independently in duplicate, as were 20% of full texts. Included studies were tabulated by question, methodology and date, with the most relevant data extracted and assessed for risk of bias. We found that the most recent health-based systematic reviews and trials assessed the effects of supplementation, though some addressed the effects of staple food fortification, complementary foods, biofortified maize or cassava, and fortified drinks, on health outcomes. Recent isotopic tracer studies and modelling approaches may help quantify the effects of bio-fortification, fortification, and food-based approaches for increasing vitamin A depots. A systematic review and several trials identified adverse events associated with higher vitamin A intakes, which should be useful for setting upper limits. We have generated and provide a database of relevant research. Full systematic reviews, based on this scoping review, are needed to answer specific questions to set vitamin A requirements and upper limits.

Background The social distancing requirements of the COVID-19 pandemic have resulted in an inability to deliver traditional, face-to-face Mock OSCEs; a means of clinical skill learning that has been shown to be beneficial to students. This study investigated the ability of an Online Mock OSCE to replace the in-person format and assessed whether similar benefits could be obtained by this method of delivery. Methods A student-run Online Mock OSCE was designed and rolled out to Year 2 undergraduate medical students; a questionnaire was then distributed to 43 students who consented to be involved in the research. Both quantitative and qualitative data were collected, with interpretation carried out via paired sample t-tests and supplementary thematic analysis. Results Comparison of pre-and-post-OSCE scores demonstrated a significant decrease in anxiety both towards summative OSCEs with similar stations and with different stations. Student confidence levels and self-reported retention of clinical skills showed statistically significant increases as a result of the Online Mock OSCE. Students had a strongly positive opinion of the process; analysis of written responses identified the provision of useful feedback on clinical skills, allowance of recognition of knowledge gaps, and enablement of increased familiarity with the assessment process as common justifications for this. Conclusions The Online Mock OSCE represents an excellent alternative to face-to-face delivery; it is well-received by students and offers a number of benefits, including decreased anxiety levels, increased confidence and improved self-reported retention of clinical skills, alongside logistical advantages of the online process. This study gives evidence for its continuing adaptation and inclusion within the medical curriculum even as in-person practice becomes feasible once more, such are the extensive assets it offers, and the potential for the method to be utilised within blended learning.

A man in his late 40s with no significant medical history presented with 2 weeks of lethargy, nausea and dizziness, alongside worsening headaches. Initial assessment revealed severe hyponatraemia and secondary hypothyroidism; urgent MRI pituitary was requested with a clinical suspicion of pituitary apoplexy. This demonstrated a likely cystic pituitary adenoma, with further testing revealing pituitary gland suppression, leading to a diagnosis of chronic secondary hypopituitarism. Initiating hormone replacement allowed substantial reported improvements in this patient’s quality of life.A review of the patient’s work-up revealed areas in which best practice was not followed. Cortisol measurements and paired urinary and serum osmolalities were initially not sent, nor results appropriately chased. A subsequent literature review identified that conformation with national and local guidelines on hyponatraemia management is poor. This patient’s case, when combined with the literature review, provides evidence to support methods to increase educational awareness of an appropriate work-up of hyponatraemia among clinicians.

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