A Review of Screening Accuracy for Geriatric Depression in Primary Care

OBJECTIVE: To determine the accuracy of depression screening instruments for older adults in the primary care setting. METHODS: Systematic review: databases employed were MEDLINE (search dates 1966-2001), and the Cochrane database on depression, anxiety and neurosis. We also searched the second Guide to Clinical Preventive Services, the 1993 AHCPR Clinical Practice Guideline on Depression and recent systematic reviews. Hand-checking of bibliographies and extensive peer review were also used to identify potential articles. Our pre-defined search strategy targeted only studies of adults aged 65 or greater in primary care or community settings, including long-term care. Articles were included in this review if they reported original data and tested depression screening instruments against a criterion standard, yielding sensitivity and specificity. MAIN RESULTS: Seventeen articles met criteria and are included in this review, representing nine different screening instruments. The most commonly evaluated were the Geriatric Depression Scale, 30 and 15-item versions, the Center for Epidemiologic Studies-Depression scale, and the Self-Care D. There were minimal differences in the favorable performance of these three instruments, which had sensitivities ranging from 74-100% and specificities ranging from 53-98%. CONCLUSIONS: Accurate and feasible screening instruments are available for detecting late-life depression in primary care. More research is needed to determine the accuracy of depression screening instruments in demented individuals, and in those with subthreshold depressive disorders.Master of Public Healt

Practical Depression Screening in Residential Care/Assisted Living: Five Methods Compared With Gold Standard Diagnoses

To test the accuracy of five practical depression screening strategies in older adults residing in residential care/assisted living (RC/AL)

Glucose effects on long-term memory performance : duration and domain specificity.

Rational; Previous research has suggested that long term- verbal declarative memory is particularly sensitive to enhancement by glucose loading, however investigation of glucose effects on certain memory domains has hitherto been neglected. Therefore domain specificity of glucose effects merits further elucidation. Objectives; The aim of the present research was to provide a more comprehensive investigation of the possible effects of glucose administration on different aspects of memory by i) contrasting the effect of glucose administration on different memory domains (implicit/ explicit memory; verbal/ non-verbal memory, recognition/ familiarity processes), ii) investigating whether potential effects on memory domains differ depending on the dose of glucose administered (25g versus 60g), iii) exploring the duration of the glucose facilitation effect (assessment of memory performance 35 min and 1 week after encoding). Methods; a double blind, between- subjects design was used to test the effects of administration of 25 and 60g glucose on memory performance. Results; Implicit memory was improved following administration of 60g of glucose. Glucose supplementation failed to improve face recognition performance but significantly improved performance of word recall and recognition following administration of 60g of glucose. However, effects were not maintained one-week following encoding. Conclusions; Improved implicit memory performance following glucose administration has not been reported before. Furthermore the current data tentatively suggest that level of processing may determine the required glucose dosage to demonstrate memory improvement and that higher dosages may be able to exert effects on memory pertaining to both hippocampal and non-hippocampal brain regions

Magnetic and thermal properties of 4f-3d ladder-type molecular compounds

We report on the low-temperature magnetic susceptibilities and specific heats of the isostructural spin-ladder molecular complexes L$_{2}$[M(opba)]_{3\cdot xDMSO$\cdot y$H$_{2}$O, hereafter abbreviated with L$_{2}$M$_{3}$ (where L = La, Gd, Tb, Dy, Ho and M = Cu, Zn). The results show that the Cu containing complexes (with the exception of La$_{2}$Cu$_{3}$) undergo long range magnetic order at temperatures below 2 K, and that for Gd$_{2}$Cu$_{3}$ this ordering is ferromagnetic, whereas for Tb$_{2}$Cu$_{3}$ and Dy$_{2}$Cu$_{3}$ it is probably antiferromagnetic. The susceptibilities and specific heats of Tb$_{2}$Cu$_{3}$ and Dy$_{2}$Cu$_{3}$ above $T_{C}$ have been explained by means of a model taking into account nearest as well as next-nearest neighbor magnetic interactions. We show that the intraladder L--Cu interaction is the predominant one and that it is ferromagnetic for L = Gd, Tb and Dy. For the cases of Tb, Dy and Ho containing complexes, strong crystal field effects on the magnetic and thermal properties have to be taken into account. The magnetic coupling between the (ferromagnetic) ladders is found to be very weak and is probably of dipolar origin.Comment: 13 pages, 15 figures, submitted to Phys. Rev.

Enhancing Quality in Psychiatry with Psychiatrists (EQUIPP)—Results from a Pilot Study

To pilot a pharmacist-led, patient centered medication management program

Protocol for a non-randomised feasibility study testing a primary care intervention to promote engagement in an online health community for adults with troublesome asthma

Introduction: In the UK, approximately 4.3 million adults have asthma, with one-third experiencing poor asthma control, affecting their quality of life, and increasing their healthcare use. Interventions promoting emotional/behavioural self-management can improve asthma control and reduce comorbidities and mortality. Integration of online peer support into primary care services to foster self-management is a novel strategy. We aim to co-design and evaluate an intervention for primary care clinicians to promote engagement with an asthma online health community (OHC). Our protocol describes a ‘survey leading to a trial’ design as part of a mixed-methods, non-randomised feasibility study to test the feasibility and acceptability of the intervention. Methods and analysis: Adults on the asthma registers of six London general practices (~3000 patients) will be invited to an online survey, via text messages. The survey will collect data on attitudes towards seeking online peer support, asthma control, anxiety, depression, quality of life, information on the network of people providing support with asthma and demographics. Regression analyses of the survey data will identify correlates/predictors of attitudes/receptiveness towards online peer support. Patients with troublesome asthma, who (in the survey) expressed interest in online peer support, will be invited to receive the intervention, aiming to reach a recruitment target of 50 patients. Intervention will involve a one-off, face-to-face consultation with a practice clinician to introduce online peer support, sign patients up to an established asthma OHC, and encourage OHC engagement. Outcome measures will be collected at baseline and 3 months post intervention and analysed with primary care and OHC engagement data. Recruitment, intervention uptake, retention, collection of outcomes, and OHC engagement will be assessed. Interviews with clinicians and patients will explore experiences of the intervention. Ethics and dissemination: Ethical approval was obtained from a National Health Service Research Ethics Committee (reference: 22/NE/0182). Written consent will be obtained before intervention receipt and interview participation. Findings will be shared via dissemination to general practices, conference presentations and peer-reviewed publications. Trial registration number: NCT05829265

Non-randomised feasibility study testing a primary care intervention to promote engagement in an online health community for adults with troublesome asthma: protocol

Introduction: In the UK, approximately 4.3 million adults have asthma, with one-third experiencing poor asthma control, affecting their quality of life, and increasing their healthcare use. Interventions promoting emotional/behavioural self-management can improve asthma control and reduce comorbidities and mortality. Integration of online peer support into primary care services to foster self-management is a novel strategy. We aim to co-design and evaluate an intervention for primary care clinicians to promote engagement with an asthma online health community (OHC). Our protocol describes a ‘survey leading to a trial’ design as part of a mixed-methods, non-randomised feasibility study to test the feasibility and acceptability of the intervention. Methods and analysis: Adults on the asthma registers of six London general practices (~3000 patients) will be invited to an online survey, via text messages. The survey will collect data on attitudes towards seeking online peer support, asthma control, anxiety, depression, quality of life, information on the network of people providing support with asthma and demographics. Regression analyses of the survey data will identify correlates/predictors of attitudes/receptiveness towards online peer support. Patients with troublesome asthma, who (in the survey) expressed interest in online peer support, will be invited to receive the intervention, aiming to reach a recruitment target of 50 patients. Intervention will involve a one-off, face-to-face consultation with a practice clinician to introduce online peer support, sign patients up to an established asthma OHC, and encourage OHC engagement. Outcome measures will be collected at baseline and 3 months post intervention and analysed with primary care and OHC engagement data. Recruitment, intervention uptake, retention, collection of outcomes, and OHC engagement will be assessed. Interviews with clinicians and patients will explore experiences of the intervention. Ethics and dissemination: Ethical approval was obtained from a National Health Service Research Ethics Committee (reference: 22/NE/0182). Written consent will be obtained before intervention receipt and interview participation. Findings will be shared via dissemination to general practices, conference presentations and peer-reviewed publications. Trial registration number: NCT05829265

Older adults' beliefs about physician-estimated life expectancy: a cross-sectional survey

BACKGROUND: Estimates of life expectancy assist physicians and patients in medical decision-making. The time-delayed benefits for many medical treatments make an older adult's life expectancy estimate particularly important for physicians. The purpose of this study is to assess older adults' beliefs about physician-estimated life expectancy. METHODS: We performed a mixed qualitative-quantitative cross-sectional study in which 116 healthy adults aged 70+ were recruited from two local retirement communities. We interviewed them regarding their beliefs about physician-estimated life expectancy in the context of a larger study on cancer screening beliefs. Semi-structured interviews of 80 minutes average duration were performed in private locations convenient to participants. Demographic characteristics as well as cancer screening beliefs and beliefs about life expectancy were measured. Two independent researchers reviewed the open-ended responses and recorded the most common themes. The research team resolved disagreements by consensus. RESULTS: This article reports the life-expectancy results portion of the larger study. The study group (n = 116) was comprised of healthy, well-educated older adults, with almost a third over 85 years old, and none meeting criteria for dementia. Sixty-four percent (n = 73) felt that their physicians could not correctly estimate their life expectancy. Sixty-six percent (n = 75) wanted their physicians to talk with them about their life expectancy. The themes that emerged from our study indicate that discussions of life expectancy could help older adults plan for the future, maintain open communication with their physicians, and provide them knowledge about their medical conditions. CONCLUSION: The majority of the healthy older adults in this study were open to discussions about life expectancy in the context of discussing cancer screening tests, despite awareness that their physicians' estimates could be inaccurate. Since about a third of participants perceived these discussions as not useful or even harmful, physicians should first ascertain patients' preferences before discussing their life expectancies

Older adults' attitudes about continuing cancer screening later in life: a pilot study interviewing residents of two continuing care communities

BACKGROUND: Individualized decision making has been recommended for cancer screening decisions in older adults. Because older adults' preferences are central to individualized decisions, we assessed older adults' perspectives about continuing cancer screening later in life. METHODS: Face to face interviews with 116 residents age 70 or over from two long-term care retirement communities. Interview content included questions about whether participants had discussed cancer screening with their physicians since turning age 70, their attitudes about information important for individualized decisions, and their attitudes about continuing cancer screening later in life. RESULTS: Forty-nine percent of participants reported that they had an opportunity to discuss cancer screening with their physician since turning age 70; 89% would have preferred to have had these discussions. Sixty-two percent believed their own life expectancy was not important for decision making, and 48% preferred not to discuss life expectancy. Attitudes about continuing cancer screening were favorable. Most participants reported that they would continue screening throughout their lives and 43% would consider getting screened even if their doctors recommended against it. Only 13% thought that they would not live long enough to benefit from cancer screening tests. Factors important to consider stopping include: age, deteriorating or poor health, concerns about the effectiveness of the tests, and doctors recommendations. CONCLUSION: This select group of older adults held positive attitudes about continuing cancer screening later in life, and many may have had unrealistic expectations. Individualized decision making could help clarify how life expectancy affects the potential survival benefits of cancer screening. Future research is needed to determine whether educating older adults about the importance of longevity in screening decisions would be acceptable, affect older adults' attitudes about screening, or change their screening behavior

Academic language socialisation in high school writing conferences

This study examines multilingual high school writers’ individual talk with their teachers in two advanced English language development classes to observe how such talk shapes linguistically diverse adolescents’ writing. Addressing adolescent writers’ language socialization through microethnographic discourse analysis, the author argues that teachers’ oral responses during writing conferences can either scaffold or deter students’ socialization into valued ways of using academic language for school writing. She suggests what forms of oral response provide scaffolding and what forms might limit multilingual adolescent learners’ academic literacy. Constructive interactions engaged students in dialogue about their writing, and students included content or phrasing from the interaction in their texts. Unhelpful interactions failed to foster students’ language development in observable ways. Although teachers attempted to scaffold ideas and language, they often did not guide students’ discovery of appropriate forms or points. These interactions represent restrictive academic language socialization: while some students did create academic texts, they learned little about academic language use