Methods to improve recruitment to randomised controlled trials : Cochrane systematic review and meta-analysis

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Post-Pandemic Cities: An Urban Lexicon of Accelerations/Decelerations

COVID-19 has stimulated renewed societal and academic debate about the future of cities and urban life. Future visons have veered from the ‘death of the city’ to visual renderings and limited experiments with 15-minute neighbourhoods. Within this context, we as a diverse group of urban scholars sought to examine the emergent ‘post’-COVID city through the production of an urban lexicon that investigates its socio-material contours. The urban lexicon makes three contributions. First, to explore how the pandemic has accelerated certain processes and agendas while at the same time, other processes, priorities and sites have been decelerated and put on hold. Second, to utilise this framing to examine the impacts of the pandemic on how cities are governed, on how urban geographies are managed and lived, and with how care emerged as a vital urban resource. Third, to tease out what might be temporary intensifications and what may become configurational in a variety of urban domains, including governance, platforming, density, crowds, technosolutionism, dwelling, respatialisation, reconcentration, care, improvisation, and atmosphere. The urban lexicon proposes a vocabulary for delineating, describing, and understanding some of the key aspects of the emergent post-pandemic city

Episodic memory function is associated with multiple measures of white matter integrity in cognitive aging

Previous neuroimaging research indicates that white matter injury and integrity, measured respectively by white matter hyperintensities (WMH) and fractional anisotropy (FA) obtained from diffusion tensor imaging (DTI), differ with aging and cerebrovascular disease (CVD) and are associated with episodic memory deficits in cognitively normal older adults. However, knowledge about tract-specific relationships between WMH, FA, and episodic memory in aging remains limited. We hypothesized that white matter connections between frontal cortex and subcortical structures as well as connections between frontal and temporo-parietal cortex would be most affected. In the current study, we examined relationships between WMH, FA and episodic memory in 15 young adults, 13 elders with minimal WMH and 15 elders with extensive WMH, using an episodic recognition memory test for object-color associations. Voxel-based statistics were used to identify voxel clusters where white matter measures were specifically associated with variations in episodic memory performance, and white matter tracts intersecting these clusters were analyzed to examine white matter-memory relationships. White matter injury and integrity measures were significantly associated with episodic memory in extensive regions of white matter, located predominantly in frontal, parietal, and subcortical regions. Template based tractography indicated that white matter injury, as measured by WMH, in the uncinate and inferior longitudinal fasciculi were significantly negatively associated with episodic memory performance. Other tracts such as thalamo-frontal projections, superior longitudinal fasciculus, and dorsal cingulum bundle demonstrated strong negative associations as well. The results suggest that white matter injury to multiple pathways, including connections of frontal and temporal cortex and frontal-subcortical white matter tracts, plays a critical role in memory differences seen in older individuals

Trends in primary care antidepressant prescribing 1995-2007:a longitudinal population database analysis

BACKGROUND: Antidepressant prescribing is increasing worldwide, prompting policy interventions and targets to halt the rise. AIM: To examine time trends in GP antidepressant prescribing using patient-level data. DESIGN AND SETTING: Longitudinal population database of all community pharmacy dispensed prescriptions for all 325 000 residents of theTayside region of Scotland. METHOD: In each of 3 study years (1995/1996, 2000/2001 and 2006/2007), the volume of antidepressants prescribed was calculated, and numbers of patients prescribed antidepressants in each year, mean treatment duration, and mean dose per patient in that year examined using descriptive statistics. RESULTS: Total drug volume increased threefold between 1995/1996 and 2006/2007, largely driven by increases in selective serotonin reuptake inhibitor (SSRI) prescribing, and laterally also in ‘other’ antidepressant prescribing. Tricyclic prescribing is static, but low-dose amitriptyline increasingly dominates this drug class. Increased drug volume was initially driven by increasing patient numbers (from 8.0% of the population prescribed at least once in 1995/1996 to 11.9% in 2000/2001) and increased treatment duration (from 170 days in the measurement year to 200). Latterly, drug volume increases are increasingly attributable to longer duration of treatment and higher mean daily dose. CONCLUSION: The large rise in antidepressant volumes is caused by a complex mixture of more patients being prescribed SSRI and ‘other’ antidepressants, the use of higher doses, and longer durations of treatment, with the balance changing overtime. Tricyclic prescribing is now largely low dose, and probably for conditions otherthan depression. Interventions to improve the quality of antidepressant prescribing need to be more subtle than blanket targets to reduce the total volume of antidepressants prescribed

Potential implications of genomic medicine in general practice

• Genomic research can link specific molecular genetic information with specific diseases. • Implications of genomic medicine in general practice include developments in screening and diagnosis, predicting disease prognosis, and optimising preventive and therapeutic care. • As users or co-producers of genomic information, or as collaborators in genomic research, general practitioners can help realise the potential of advances in genomic research.</p

Improving System Integration: The Art and Science of Engaging Small Community Practices in Health System Innovation

This paper focuses on successful engagement strategies in recruiting and retaining primary care physicians (PCPs) in a quality improvement project, as perceived by family physicians in small practices. Sustained physician engagement is critical for quality improvement (QI) aiming to enhance health system integration. Although there is ample literature on engaging physicians in hospital or team-based practice, few reports describe factors influencing engagement of community-based providers practicing with limited administrative support. The PCPs we describe participated in SCOPE: Seamless Care Optimizing the Patient Experience, a QI project designed to support their care of complex patients and reduce both emergency department (ED) visits and inpatient admissions. SCOPE outcome measures will inform subsequent papers. All the 30 participating PCPs completed surveys assessing perceptions regarding the importance of specific engagement strategies. Project team acknowledgement that primary care is challenging and new access to patient resources were the most important factors in generating initial interest in SCOPE. The opportunity to improve patient care via integration with other providers was most important in their commitment to participate, and a positive experience with project personnel was most important in their continued engagement. Our experience suggests that such providers respond well to personalized, repeated, and targeted engagement strategies.Peer Reviewe