Creating a leaflet about dementia case finding

To create a leaflet for GPs about the “case finding” of people in the DES “facilitating timely diagnosis and support for people with dementia,” within 4 weeks using email to link a newly formed group. Questions we asked were: How reliable is the GPCog screening tool? What is the natural history of Mild Cognitive Impairment (MCI)? What are patient benefits of early therapy? A literature review and email discussion ensued. The main findings were: Positive predictive value of GPCog is 71% so an abnormal score does not indicate definite dementia Not every memory loss is dementia; not every dementia is Alzheimer’s Pathological features of Alzheimer’s may be present in normally ageing brains A review of attendees at a memory clinic: >50% had not got dementia or MCI. 27% had “benign memory complaints” Patients with MCI - 20% develop dementia at 5 years. Rates of conversion of MCI to dementia vary between 11-33% at 2 years 42% of patients with MCI have remitting symptoms, with normal cognition at 1.5 and 3 years There is no current benefit of early therapy with cholinesterase inhibitors in MCI at 1, 2 or 3 year

Poster RCGP conference 2015:Postoperative micronutrient replacement for patients after bariatric surgery

In Sept 2014 the British Obesity and Metabolic Surgery Society (BOMSS) produced guidance on postoperative micronutrient replacement for patients after bariatric surgery. We conducted a retrospective study to see if we conformed to this guidance. Patients post bariatric surgery are getting suboptimal care in micronutrient supplementation and monitoring, resulting in anaemia, often 3-4 years post procedure. This group is likely to increase in numbers in line with weight loss protocol

A study to enhance medical students' professional decision-making, using teaching interventions on common medications

Aim To create sustained improvements in medical students' critical thinking skills through short teaching interventions in pharmacology. Method The ability to make professional decisions was assessed by providing year-4 medical students at a UK medical school with a novel medical scenario (antenatal pertussis vaccination). Forty-seven students in the 2012 cohort acted as a pretest group, answering a questionnaire on this novel scenario. To improve professional decision-making skills, 48 students from the 2013 cohort were introduced to three commonly used medications, through tutor-led 40-min teaching interventions, among six small groups using a structured presentation of evidence-based medicine and ethical considerations. Student members then volunteered to peer-teach on a further three medications. After a gap of 8 weeks, this cohort (post-test group) was assessed for professional decision-making skills using the pretest questionnaire, and differences in the 2-year groups analysed. Results Students enjoyed presenting on medications to their peers but had difficulty interpreting studies and discussing ethical dimensions; this was improved by contextualising information via patient scenarios. After 8 weeks, most students did not show enhanced clinical curiosity, a desire to understand evidence, or ethical questioning when presented with a novel medical scenario compared to the previous year group who had not had the intervention. Students expressed a high degree of trust in guidelines and expert tutors and felt that responsibility for their own actions lay with these bodies. Conclusion Short teaching interventions in pharmacology did not lead to sustained improvements in their critical thinking skills in enhancing professional practice. It appears that students require earlier and more frequent exposure to these skills in their medical training

Quantitative analysis of medical students’ and physicians’ knowledge of degenerative cervical myelopathy

Objectives: We have previously identified a delay in general practitioner (GP) referrals for patients with degenerative cervical myelopathy (DCM). The aim of this study was to evaluate whether an education gap existed for DCM along the GP training pathway by quantitatively assessing training in, and knowledge of, this condition. Design: Gap analysis: comparison of DCM to other conditions. Comparators selected on the basis of similar presentation/epidemiology (multiple sclerosis), an important spinal emergency (cauda equina syndrome) and a common disease (diabetes mellitus). Subjects: Medical students, foundation doctors and GP trainees. Primary and secondary outcome measures: (1) Assessment of training: quantitative comparison of references to DCM in curricula (undergraduate/postgraduate) and commonly used textbooks (Oxford Handbook Series), to other conditions using modal ranks. (2) Assessment of knowledge: using standardised questions placed in an online question-bank (Passmedicine). Results were presented relative to the question-bank mean (+/−). Results: DCM had the lowest modal rank of references to the condition in curricula analysis and second lowest modal rank in textbook analysis. In knowledge analysis questions were attempted 127 457 times. Performance for DCM questions in themes of presentation (+6.1%), workup (+0.1%) and management (+1.8%) were all greater than the question-bank mean and within one SD. For students and junior trainees, there was a serial decrease in performance from presentation and workup (−0.7% to +10.4% relative to question-bank mean) and management (−0.6% to −3.9% relative to question-bank mean). Conclusions: Although infrequently cited in curricula and learning resources, knowledge relating to DCM was above average. However, knowledge relating to its management was relatively poor

Tailored educational intervention for primary care to improve the management of dementia: the EVIDEM-ED cluster randomized controlled trial

Early diagnosis of dementia is important because this allows those with dementia and their families to engage support and plan ahead. However, dementia remains underdetected and suboptimally managed in general practice. Our objective was to test the effect of a workplace-based tailored educational intervention developed for general practice on the clinical management of people with dementia

Methodological problems in dementia research in primary care: a case study of a randomized controlled trial

The emerging UK national research network in neurodegenerative diseases and dementias aims to promote large-scale community-based studies of therapeutic interventions, based in primary care. However, trials in primary care settings can be problematic, a common difficulty being the recruitment of a large enough sample. The article discusses recruitment issues in a multi-centre randomized controlled trial of differing educational approaches to improving dementia care in general practice. Sample size calculations based on community studies of prevalence may be misleading in intervention trials which may recruit practices with atypical demography. Recruitment rates for practitioners in this study were lower than expected. Professionals excluded themselves from the study mainly due to pressures of time and staff shortages, and we detected both ambivalent attitudes to primary care research and a perception that research into dementia care was not a high priority. Evaluation of the quality of care may be perceived as criticism of clinical practice, at a time when general practice is undergoing major administrative and contractual changes. Variations in Research Ethics Committee conditions for approval led to different methods of recruitment of patients and carers into the study, a factor which may have contributed to disparate levels of recruitment across study sites. Patient and carer levels of recruitment were lower than expected and were affected partly by carers' time pressures and other family commitments, but largely by problems in identifying patients and carers in the practices. The development of research potential in primary care is at an early stage and studies reliant on patient recruitment in general practice must allow for multiple obstacles to enrollment. This is particularly relevant for studies of dementia care, where the prevalence of dementia in a demographically average population is low and the incidence very low, compared with other disabilities. Professionals may give dementia low priority in allocating practice time for research projects, and strategies to address this problem are needed

Mapping post-diagnostic dementia care in England: an e-survey

Purpose: Post-diagnostic dementia care is often fragmented in the United Kingdom, with great variation in provision. Recent policies suggest moving towards better community-based care for dementia; however, little is known on how this care is delivered. This study aimed to map the post-diagnostic dementia support provided in England a decade after the introduction of a National Dementia Strategy. Design/methodology/approach: A mixed-methods e-survey (open Nov 2018–Mar 2019) of dementia commissioners in England recruited through mailing lists of relevant organisations was conducted. The authors descriptively summarised quantitative data and carried out thematic analysis of open-ended survey responses. Findings: 52 completed responses were received, which covered 82 commissioning bodies, with representation from each region in England. Respondents reported great variation in the types of services provided. Information, caregiver assessments and dementia navigation were commonly reported and usually delivered by the voluntary sector or local authorities. Integrated pathways of care were seen as important to avoid overlap or gaps in service coverage. Despite an increasingly diverse population, few areas reported providing dementia health services specifically for BME populations. Over half of providers planned to change services further within five years. Practical implications: There is a need for greater availability of and consistency in services in post-diagnostic dementia care across England. Originality/value: Post-diagnostic dementia care remains fragmented and provided by a wide range of providers in England

Cost-effectiveness of topical pharmacological, oral pharmacological, physical and combined treatments for acne vulgaris

Background. Acne vulgaris is a common skin condition that may cause psychoso-cial distress. There is evidence that topical treatment combinations, chemical peels and photochemical therapy (combined blue/red light) are effective for mild-to-moderate acne, while topical treatment combinations, oral antibiotics combined with topical treatments, oral isotretinoin and photodynamic therapy are most effective for moderate-to-severe acne. Effective treatments have varying costs. The National Institute for Health and Care Excellence (NICE) in England considers cost-effectiveness when producing national clinical, public health and social care guidance.Aim: To assess the cost-effectiveness of treatments for mild-to-moderate and moderate-to-severe acne to inform relevant NICE guidance.Methods: A decision–analytical model compared costs and quality-adjusted life-years (QALYs) of effective topical pharmacological, oral pharmacological, physical and combined treatments for mild-to-moderate and moderate-to-severe acne, from the perspective of the National Health Service in England. Effectiveness data were derived from a network meta-analysis. Other model input parameters were based on published sources, supplemented by expert opinion.Results: All of the assessed treatments were more cost-effective than treatment with placebo (general practitioner visits without active treatment). For mild-to-moderate acne, topical treatment combinations and photochemical therapy (com-bined blue/red light) were most cost-effective. For moderate-to-severe acne, topical treatment combinations, oral antibiotics combined with topical treatments, and oral isotretinoin were the most cost-effective. Results showed uncertainty, as reflected in the wide confidence intervals around mean treatment rankings.Conclusion: A range of treatments are cost-effective for the management of acne. Well-conducted studies are needed to examine the long-term clinical efficacy and cost-effectiveness of the full range of acne treatments

Unusual psychiatric syndromes part 1

This is a series of 49 unusual psychiatric syndromes produced by students at Liverpool and Lancaster schools of medicine, coordinated and helped by Dr Jane Wilcock a community clinical tutor for Liverpool and Mr Nick Mullin as CPN and medical educator at Lancaste