Results suggest the possibility of selective reporting of cut-off scores, and therefore, findings should be approached cautiously. Studies should report all cut-off scores, and all brief GDS versions should be compiled of standardised items. Copyright © 2016 John Wiley & Sons, Ltd.
Introduction: Depression in older adults is often under-diagnosed and consequently undertreated, despite association with higher rates of morbidity and mortality, increased healthcare utilisation and greater economic cost compared to younger populations. Better identification will be imperative in the future because of the estimated growth in the older adult population. Screening could improve identification; a well-known screening tool tis the Geriatric Depression Scale (GDS). Objective: To evaluate the diagnostic accuracy of the brief GDS-15 and ultra-brief versions in the detection of major depression. Method: Seven electronic databases and unpublished literature were searched, using predefined criteria, from 1982 to April 2014. Primary study quality was assessed using the QUADAS-2. Pooled diagnostic performance data was calculated using bivariate meta-analysis. Subgroup and sensitivity analyses were pre-planned. Heterogeneity was explored through meta-regression. Results: Of 6635 records identified 32 studies were included. Meta-analyses were possible for the GDS-1, GDS-4 and GDS-15. For the GDS-15, at the recommended cutoff score of 5, the diagnostic odds ratio was highest in a community setting and for older adults aged ≤69 years. A cutoff score of 4, however, provided better diagnostic accuracy. Diagnostic data was less favourable when depression prevalence was ≥10%. Better diagnostic properties were found in non-Western countries. Meta-regression revealed country and language were predictive of diagnostic accuracy. Conclusions: Further research is needed to explore diagnostic properties of ultra-brief GDS versions. GDS-15 findings suggest selective reporting of cutoff scores, which requires cautious interpretation and a need for greater methodological rigor in primary studies.
Purpose Psychiatric recruitment and retention are at an unprecedented low within the UK. The reasons for this shortfall may include public and professional stigma, recent NHS service developments and changes in undergraduate training. The purpose of this study is to explore medical student’s perceptions of the nature and magnitude of these factors on influencing whether or not they would choose a career in psychiatry. Design/methodology/approach This qualitative study was conducted with year four medical students at a single UK University with low levels of recruitment into psychiatry. Two focus groups were asked about their undergraduate experience within the speciality. Thematic analysis of the resulting transcripts enabled the identification of codes and over-arching themes, which formed the focus of this study. Findings Four key themes were identified during analysis and these included: the core subject matter (of psychiatry) viewed as being different; curriculum or course variables; interpersonal factors and; career factors. Placement enjoyment, positive role-modelling and enthusiasm were all important when considering psychiatry as a career. Therapeutic success, career flexibility and pay-banding were also powerful determinants. Practical implications These findings led to the initiation of an apprentice programme for undergraduates on psychiatric placement, designed to enhance the student experience of psychiatry and the perception of the speciality as a career. Originality/value While there are a number of possible solutions to current adverse national trends in psychiatric recruitment, increasing efforts to increase both the variety and quality of undergraduate placements and establishing a clearer sense of team identity is of vital importance if these patterns are to be reversed.
Introduction:Delirium is common but often under-diagnosed. Early detection and diagnosis are vital for better prognosis, placing emphasis on the quality of the admission clerking. NICE recommends using the Confusion Assessment Method (CAM) when assessing such patients. For a delirium diagnosis patients have to fulfill the CAM criteria.Aim:To establish if the CAM is a useful tool in clerking patients presenting with confusion.Objectives:Assess uptake of the CAMIdentify how many patients presenting with confusion fulfill diagnosis criteriaDetermine if the CAM results in a lower number of amended diagnosesDescribe associations between clinical findings and diagnosisEvaluate junior doctor knowledge about the CAMMethods:A prospective audit was performed to assess the quality of clerking in fifty patients presenting with “confusion’. The second phase involved a qualitative questionnaire to assess junior doctor knowledge of the CAM.Results:CAM was not used to make any diagnosis. Only 4% of clerkings fulfilled diagnosis criteria. Patients diagnosed with delirium, who then had their diagnosis amended, did not fulfill CAM criteria on admission. Junior doctor knowledge of delirium diagnosis was poor.Conclusions:The CAM is a useful and valuable tool, resulting in fewer unnecessary investigations and a reduced hospital stay. Junior doctor knowledge of it is inadequate explaining why it is not currently being used in practice. We recommend that the CAM should be included in the teaching curriculum. This study shows that further investigation of the aim, and its objective, is warranted and justified.
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