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Medication with anticholinergic action is associated with potentially serious adverse effects in older people. We present an evaluation of a novel anticholinergic burden scale introduced into routine practice in older adult services in the South London and Maudsley (SLaM) NHS Foundation Trust. Our aim was to assess whether this tool improved the accurate identification of anticholinergic medication and guided safer prescribing in cognitively vulnerable older people.
The introduction of the anticholinergic effect on cognition (AEC) tool into clinical practice led to an increase in the identification and reporting to general practitioners of anticholinergic medication from 11 to 85% of cases (P = 0.0015).
Application of the AEC tool led to improved detection of anticholinergic medication and advice to primary care on when a medication review is necessary. This is an important step towards improving the safety of prescribing in this patient group.
Declaration of interest
SLaM NHS Foundation Trust owns both the app and IP for Medichec.
To examine data on referrals to an inner-city London memory service to explore any differences in referral rates, cognitive assessments and stages of dementia at presentation between ethnic groups.
African–Caribbean patients were well represented in the memory service. They were diagnosed with dementia on average 4.5 years younger than their White British counterparts and were more likely to be diagnosed with a vascular or mixed type dementia. However, scores on initial cognitive testing were significantly lower in the African–Caribbean group, possibly representing more advanced disease at presentation.
Initiatives to access Black and minority ethnic populations earlier in the course of their illness should be considered. Professionals need to consider the potential for cultural bias in memory testing and diagnosing dementia in these populations, and the importance of cultural competency in assessments.
To explore the experiences and attitudes of psychiatrists to a new electronic patient records system. A questionnaire was emailed to 115 psychiatrists across the South London & Maudsley National Health Service Foundation Trust.
The total response rate was 66% (senior house officers 75%, specialist registrars 57%, consultants 56%). Technical problems, difficulty with patient confidentiality, administrative burden and impact on clinical work were identified as concerns. However, psychiatrists recognised the potential benefits and the majority did not wish to return to using paper records.
Electronic patient records are rapidly being integrated into the daily practice of psychiatrists. More administrative assistance and specific training should be provided to support clinicians who use this system.
Studies have consistently shown a higher incidence of schizophrenia with onset in early adult life in African and Caribbean migrants to the UK.
To establish the incidence (first-contact rates) of very-late-onset (>60 years) schizophrenia-like psychosis (SLP) in south London and to test the hypothesis that this is higher among African— and Caribbean-born than indigenous elders.
We identified all new referrals of SLP to the Maudsley Hospital between 1995 and 2000. Demographic details, including age, ethnicity and electoral ward (address), were obtained from case notes. Incidence was estimated using 1997 census data to determine the denominator population for each ethnic group.
The incidence of SLP was significantly higher in African— and Caribbean-born than indigenous elders: 172.4 per 100 000 population (95% Cl=579–286.8) in African— and Caribbean-born males and 323.5 per 100 000 population (95% Cl 167.8–479.1) in African— and Caribbean-born females. Rates also were increased in elders from other immigrant groups, but the numbers involved were too small to reach accepted levels of significance.
Large-scale epidemiological studies are needed to determine both the incidence of and the coexistent risk factors for SLP among all elderly migrants, who may constitute a group with high service needs.
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