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Objective: We evaluated whether memory recall following an extended (1 week) delay predicts cognitive and brain structural trajectories in older adults
Clinically normal older adults (52–92 years old) were followed longitudinally for up to 8 years after completing a memory paradigm at baseline [Story Recall Test (SRT)] that assessed delayed recall at 30 min and 1 week. Subsets of the cohort underwent neuroimaging (N = 134, mean age = 75) and neuropsychological testing (N = 178–207, mean ages = 74–76) at annual study visits occurring approximately 15–18 months apart. Mixed-effects regression models evaluated if baseline SRT performance predicted longitudinal changes in gray matter volumes and cognitive composite scores, controlling for demographics.
Worse SRT 1-week recall was associated with more precipitous rates of longitudinal decline in medial temporal lobe volumes (p = .037), episodic memory (p = .003), and executive functioning (p = .011), but not occipital lobe or total gray matter volumes (demonstrating neuroanatomical specificity; p > .58). By contrast, SRT 30-min recall was only associated with longitudinal decline in executive functioning (p = .044).
Memory paradigms that capture longer-term recall may be particularly sensitive to age-related medial temporal lobe changes and neurodegenerative disease trajectories. (JINS, 2020, xx, xx-xx)
Aberdeen students in the pre-NHS era received an introduction to general practice during attachments to the Woolmanhill public dispensary as part of their public health teaching. Between 1948 and the creation of the GPTU in 1967, there was no formal teaching in general practice, although many students fixed up short attachments to north-east general practices on their own initiative during vacations.
In 1967, with a grant from the Nuffield Provincial Hospitals Trust, the university decided to create the GPTU and advertised for a director at senior lecturer/reader level. Forty-four applications were received, the majority from senior north-east general practitioners without academic experience. Applicants from outside the area included several already in academic general practice positions. Ian Richardson was appointed from the local department of public health, bringing to the position substantial intellectual skills and a strong academic record in the field of community-based teaching and research.
His appointment heralded the start of a period of substantial and sustained achievement. An undergraduate programme dependent on significant good will from practices throughout the north-east of Scotland was developed, as was Aberdeen's vocational training scheme which, with twelve places each year, was the largest of its kind in the UK. With Ian Buchan, Ian Richardson carried out a major time-and-motion study of the general practice consultation, an idea later repeated for district nurses and health visitors.
The aims and constitution of the original AUTGP were drafted to promote the academic development of the discipline. The intention was that there should not be any significant element of ‘trade union’ activity, but the problems consequent on the totally insufficient funding of the early departments by their universities and medical schools surfaced regularly at the early executive committee meetings.
Across the NHS generally, the Department of Health was attempting to find a more explicit and more equitable formula for distributing its resources. This led in 1974 to the publication of the Resource Allocation Working Party (RAWP) Report, identifying historical differences between the total costs of running ‘teaching’ and ‘non-teaching’ hospitals. These differences were rationalised as being due to the ‘service costs of teaching’ (SIFT) and put back into the subsequent funding formula on a ‘per clinical student per year’ basis. From the outset these funds were payable only to hospitals. General-practice-based teaching was excluded, and so began our campaign for the provision of an analogous subsidy to meet the extra costs of supporting academic costs in the clinical setting of general practice. In 1974 the sum identified as needed to support hospital-based academic work was around £8,000 per student per year – a sum which had grown to nearly £40,000 per year (nearly £5 billion for the NHS nationally) by the time that first teaching practices (1990) and then departments of general practice (1992) won a share of NHS support funding.
The year 2008 marked the sixtieth anniversary of the founding of the NHS. The first academic department of general practice in the modern era also dated from the ‘due date’ for the start of the NHS on 1 July, when the University of Edinburgh established its ‘academic general practice’ in the former Mackenzie House Public Dispensary within its department of social medicine. By 2000, there were twenty-nine departments of general practice in the traditional medical schools of the UK (the department in Trinity College Dublin has traditionally been included in this grouping). The history of their evolution and development has been interesting but not always straightforward; often a source of frustration but eventually one of achievement and satisfaction. This essay tries to tease out some of the issues that have had to be faced up to on the journey.
Within the UK
Following the birth of the NHS in 1948, the highly critical Collings Report of 1950 led to the foundation in 1952 of the College of General Practitioners, one of whose first aims was to see established a department of general practice in every UK medical school. The Edinburgh department became independent in 1956 and its chair followed in 1963. Between 1970 and 1972 three other chairs were established in Scotland. Manchester (1972) led the way in England, but it took until 1995 for all schools to follow. From 1971 onwards regional (postgraduate) advisers were appointed in all UK regions, mostly with connections to medical schools through postgraduate Deans. In Exeter, a postgraduate chair was established in 1986.
The first collective record of the evolution of general medical practice as an academic discipline over half a century. This anthology captures the stories of the early struggles to set up university departments between visionary supporters and traditionalist blockers as well as the steadily increasing successes aided by a dedicated funding system. The accounts are written where possible by the people involved in the early developments of their subject. These tales are of vision, commitment and resilience and are interesting both in their own right and for the more general lessons they tell us about the processes of creating institutional change within a modern democracy.* Demonstrates the radical shifts in the shape of medical education in the last two decades* Provides vivid personal accounts from early academic leaders* Includes comment on contemporary medical and educational developments.
Imagine a country whose medical schools do not systematically teach students within the clinical discipline that most of them would work in. Imagine such a country also failing to conduct research into the clinical and organisational problems faced by patients and the doctors working in that discipline. Although it seems unthinkable now, the UK was such a country when the NHS began. This book describes and analyses how the pioneers of academic general practice in the UK and the Republic of Ireland overcame the challenges and obstacles to achieving their vision of ensuring that all undergraduates in every medical school experience excellent education in a research-rich environment.
The editors have compiled chapters from departments across the country, telling the highly variable story about how each made progress within their own context. Support from postgraduate departments, the RCGP, departments of public health and parts of the NHS all played their part. The appendices describe the new medical schools; the crucial SIFT/ACT developments; an integrating perspective; and the transition from AUTGP to AUDGP to SAPC. For many readers the main interest will lie in the story of their own institution but others will see common themes and insights that will help them understand how support for progress can be marshalled within and across organisations to overcome today's challenges.
During the second half of the eighteenth century, Andrew Duncan – then professor of medicine in the University of Edinburgh – proposed and constructed a public dispensary to provide care to the sick poor in the Old Town of Edinburgh and to instruct medical students. From 1890 attendance at one of several public dispensary practices became a compulsory part of the Edinburgh undergraduate curriculum.
As in many UK medical schools, the development of the academic department owed much to the foresight and opportunism of senior academic public health/social medicine physicians. In Edinburgh, Professor Frank Crew recognised that the closure of the public dispensaries at the start of the NHS in 1948 would be an important loss to the education of medical students. In 1947, Richard Scott, then a lecturer in Crew's department and with pre-war experience in general practice, embarked on a project to explore the medical and social needs of families in sickness and in health, and together they sought to establish a ‘laboratory in the community’ to provide teaching to medical students and for long-term studies of illness within families.
So, on the first day of the NHS in July 1948, Richard Scott together with a medical assistant, an almoner, a nurse and a dentist set up an NHS practice within the Royal Public Dispensary in West Richmond Street. By 1951 some thirty medical students each year were being provided with a three-month course of clinical instruction, and in 1952 the Rockefeller Foundation offered financial support to aid the development of general practice as an academic discipline.
In July 2007, the Heads of Departments group of SAPC invited those of their retired predecessors and founder members of AUTGP they could trace to join them for their annual get-together in an Indian restaurant in South Kensington. Anxious to repay their hospitality and recognising that many of our stories of the early struggles and setbacks along the road to where we were now had never been properly recorded and were in danger of being lost, our cluster of veterans agreed to write about the early developments of our respective departments. Four years on, this book is the result.
Predictably, our writers did not want to be constrained by any particular format, although we originally signed up to a target length of around 1,000 words. At the end of two years we had six essays in; twenty-five to come! A number of founder heads were no longer with us, or no longer able to contribute, so we set about finding deputies. The original London schools proved a particular challenge, having been so complicated by later mergers and their earliest roots often hard to trace. Some of our most compelling essays have been written in the first person, but most are in the third person. Some were well over our target length; in some we identified important gaps; and some were referenced although most were not. Most problematically, some were concluded (naturally on the retirement of the author) in the late 1970s or early 1980s before other stories had started.
General practitioner activity is increasingly under pressure to monitor its performance. The involvement of service users in the development and assessment of services is said to be a key feature of this process. This article reports on the acceptability among general practitioners of a patient-completed post-consultation measure of outcome (the Patient Enablement Instrument; PEI), and its use in conjunction with two further indicators of quality, namely time spent in consultation and patients reporting knowing the doctor well. The survey was conducted using focus groups and the administration of a postal questionnaire among a group of general practices that had participated and received feedback from a large quantitative study testing these measures. The focus group study provided useful insights into general practitioners' perceptions of patient assessment of their performance and their concerns surrounding the measurement of general practice activity. The general practitioners' perceptions of the measures under the study were enmeshed within these concerns overall. The PEI was seen as being generally acceptable as a measure of patient assessment of care, and the methods of data collection were acceptable for routine use in general practice. General practitioners who performed better in terms of their feedback scores generally approved more of the proposed measures. However, these general practitioners were not comfortable with the concept of assessment of the clinical interaction by patients, and were anxious to link such assessment explicitly with clinical (disease-related) outcome. Doctors who performed ‘better’ were no more likely than those who performed less well to advocate more use of patient assessment, or to believe that patient assessment of consultations is a reliable quality indicator. These concerns need to be addressed if patients' assessments of their care are to be taken seriously.
The index and period of an element a of a finite semigroup are the smallest values of m ≥ 1 and r ≥ 1 such that am+r = am. An element with index m and period 1 is called an m-potent element. For an element α of a finite full transformation semigroup with index m and period r, a unique factorisation α = σβ such that Shift(σ) ∩ Shift(β) = ∅ is obtained, where σ is a permutation of order r and β is an m-potent. Some applications of this factorisation are given.
Little is known about the presentation and management of seasonal affective disorder (SAD) in primary care.
To determine the use of health care services by people suffering from SAD.
Following a screening of patients consulting in primary care, 123 were identified as suffering from SAD. Each was age— and gender-matched with two primary care consulters with minimal seasonal morbidity yielding 246 non-seasonal controls. From primary care records, health care usage over a 5-year period was established.
Patients with SAD consulted in primary care significantly more often than controls and presented with a wider variety of symptoms. They received more prescriptions, under went more investigations and had more referrals to secondary care.
Patients with SAD are heavy users of health care services. This may reflect the condition itself, its comorbidity or factors related to the personality or help-seeking behaviour of sufferers.
Studies of light therapy have not been conducted previously in primary care.
To evaluate light therapy in primary care.
Fifty-seven participants with seasonal affective disorder were randomly allocated to 4 weeks of bright white or dim red light. Baseline expectations for treatment were assessed. Outcome was assessed with the Structured Interview Guide for the Hamilton Depression Scale, Seasonal Affective Disorder Version.
Both groups showed decreases in symptom scores of more than 40%. There were no differences in proportions of responders in either group, regardless of the remission criteria applied, with around 60% (74% white light, 57% red light) meeting broad criteria for response and 31% (30% white light, 33% red light) meeting strict criteria. There were no differences in treatment expectations.
Primary care patients with seasonal affective disorder improve after light therapy, but bright white light is not associated with greater improvements.