BGS Scotland

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BGS Scotland

BGS Scotland is the professional organisation of doctors who specialise in the medicine of old age in Scotland. The branch has 280 or so members and is affiliated to the main British Geriatrics Society in London (BGS).

We welcome suggestions and input from members of BGS Scotland or from representatives of organisations sharing the interests of the Society. Contact the Web Editor, Dr Allan MacDonald of Belford Hospital.

Doing research as a trainee in Geriatric Medicine

Part 1: The benefits of doing research, and finding a project

Alasdair MacLullich, Lecturer, University of Edinburgh
Miles Witham, Lecturer, University of Dundee

The process of moving from clinical work to enter the less structured world of research can be confusing and a little daunting. To address this we are producing a series of articles on ‘Doing research as a trainee in Geriatric Medicine’. In this first part we discuss the reasons for doing research, and then give some suggestions on finding a suitable project.

Why do research?

Benefits to Society
Research, whether basic or applied, is the most important means of adding to our knowledge of ageing, disease and the individual. Consequently, if you do good quality research you will have a real influence on clinical practice – even if this influence seems several steps down the line. Additionally, as a research-trained clinician, you have the opportunity to make sure that ongoing research is useful and relevant to the care of older people.

In Memoriam – Brian Chapman

Former Consultant Geriatrician and Acute Physician, Royal Infirmary, Edinburgh (b 28th January 1956; q Edinburgh 1981; FRCPE) died from metastatic renal cancer on 9th February 2012.

Brian Chapman died peacefully at home on Thursday 9th February after a long battle against renal cancer.

Born in Edinburgh, he attended Daniel Stewart’s School where he was Dux, and then entered Medical School at the University of Edinburgh. There he met his wife Dorothy and they spent a memorable student elective in South Africa, narrowly avoiding being charged by an elephant. They became engaged on their return and he qualified BSc (2.1 in Biochemistry) and MB ChB in 1981.

After house jobs, he was appointed to a senior house officer rotation in Edinburgh and initially explored a career in Respiratory Medicine. However, after diagnosing an elderly patient attending a Respiratory Clinic with Parkinson’s Disease, he came to the attention of Roger Smith, a Senior Lecturer in Geriatric Medicine who persuaded him to apply for a post in the specialty. Brian’s subsequent contribution has been immense.

After training posts at the City and Longmore Hospitals in Edinburgh, Brian became the first Consultant Physician in Geriatric and Acute Medicine at the Royal Infirmary of Edinburgh in 1989. At that time, Geriatric Medicine was regarded with deep suspicion by many of those in other specialties.  However Brian quickly gained the respect of his specialty colleagues due to his superb clinical skills both within the specialty and on Acute Receiving.  He became the Clinical Director of Medicine of the Elderly services in 1996 and under his leadership, the specialty became the largest in the hospital, and he also set up an Acute Stroke service. That he achieved this without alienating the other specialties is a tribute to his outstanding negotiating skills and the respect in which he was held. He worked tirelessly on endless committees and working groups to put the case for services for older people at a national and local level and contributed enormously to the expansion of Geriatric services across Edinburgh. He inspired many trainees to join the specialty along the way, and was a mentor to many consultant colleagues. His advice was always consistent, considered and invariably sound. Colleagues in all specialties sought out his clinical opinion and frequently asked him to care for their older relatives. He gave his time freely to patients, their families and colleagues in need.

He also found time to contribute as Chair of the Symposium Committee of the Royal College of Physicians of Edinburgh, was a regular Host Examiner in the PACES exam and latterly Assistant Registrar of the College. He was a recent Secretary and Treasurer of the Scottish Branch of the British Geriatrics Society, and was awarded the President’s Medal by the British Geriatrics Society in 2010. He also worked as Principal Medical Officer at Scottish Widows.

He was devoted to his family and enjoyed travelling the world with them on holiday. He enjoyed many sports but was a rugby fanatic, managing to land the job of ‘Crowd Doctor’ at the Scotland rugby international games at Murrayfield.  He was very active within his Church, contributing as Session Clerk for a long period. Latterly he developed an interest in contemporary Scottish art.

In 2006, he was diagnosed with renal cancer. He accepted this with equanimity and was remarkable for the open and dignified way in which he dealt with the many adversities that subsequently befell him.  He drew great comfort from his faith. He continued working despite considerable pain and fatigue until he was forced to take early retirement in 2010. It is a tribute to him that so many colleagues continued to visit and share current issues – his advice continued to be relevant and considered. This advice continues to guide others charged with developing future Medicine of the Elderly services in Edinburgh.

He is survived by Dorothy, and his children Fiona, Andrew (both Foundation Doctors) and Gavin (a medical student). He was immensely proud of their achievements. He will be greatly missed by his colleagues throughout Scotland.

 

Annual Report of BGS Scotland – 2011/12

The Scottish Council has met formally on 3 occasions over the last year – with an increasing proportion of BGS Scotland’s business being done by e-mail.  

Meetings – The past 12 months have seen 3 successful BGS Scotland meetings.  A special one day meeting on “Community Geriatrics” took place at the Royal College of Physicians and Surgeons of Glasgow in June 2011.   This event masterminded by Dr Brendan Martin was highly successful with thought-provoking challenges identified for our speciality.  The Autumn meeting held at the Royal College in Edinburgh had almost 100 delegates and included a high quality CPD session on orthogeriatrics.  Today’s Spring Meeting in Fife continues the flavour of high quality Scottish meetings – with specific CPD focus on delirium and cognition. As the NHS in the 4 nations continues to diverge it is crucial that our speciality maintains its regular Scottish meetings to highlight service developments and promote networking of new ideas.  The trend to incorporating a high quality CPD session on a specific topic within the meetings is a welcome development.

Health Service Initiatives – BGS Scotland has continued to engage, to a degree, with “Reshaping Care for Older People”.  This government policy has multiple strands and we have representation on several of the more relevant ones – including their stakeholder group, care home group and the polypharmacy group.  The overall strategy is liked to “Change Fund” developments – designed to try to shift care from secondary to primary care.  The “Change Fund” finances have had a patchy impact for the speciality – with new consultant posts or sessions funded by some areas – but little or no impact in other regions.  The “Reshaping Care for Older People” meetings appear to have diminished in the last year – perhaps effected by the Scottish elections and subsequent review of policies by the new government has been disappointing.  The other important initiative in the last year has been “Improving Care for Older People in hospital”.  This was triggered by several adverse reports of care in 2011.  The Cabinet Secretary ordered a programme of visits to acute hospitals to reassure the public that elder care in all departments of our hospitals is at the required standard.  The visits started in November 2011 and are ongoing.  The visitors are focussing on direct “hands on” care – with specific interest in capacity, cognition, delirium, medicines management, and falls assessment.  BGS Scotland had representation on the Stakeholder Reference Group and is taking up a seat on the longer term Stakeholder Review Group.  The latter group is intended to review the results of the visits and recommend areas for improvement.

Training – Geriatric Medicine’s establishment remains unchanged after last years review by Scottish Government – with up to 85 trainees permitted across the country.  The speciality continues to attract high calibre doctors from core medicine with 31 applicants for the 13 ST3 post this year.  Overall trainee satisfaction as judged by the GMC survey remains high.  The Scottish Trainee meeting was held in Perth and was deemed to be very successful.  Trainees continue to gain consultant posts relatively easily on gaining their CCT – although there continue to be concerns over a “bulge” of trainees in the next couple of years.  Both junior representatives on Scottish Council demitted office during the last year (Dr Claire Steel and Dr Jo Ford) – our thanks for all their efforts and good wishes for their future career.  The 2 new representatives on Council are Dr Sarah Alder and Dr Zoe Muir.  In order to protect the training establishment, it is crucial that BGS Scotland maintain an accurate database of our consultant establishment, existing vacancies, and future developments.  Please respond to the periodic requests for information in this area.

UK Perspective – Everybody should be aware of the substantial changes to the UK governance structure of the British Geriatric Society – as suggested by President Elect, Prof Paul Knight.  The Chair of Scottish Council remains part of the new Trustee Board.  The new Executive Board, where much of the regular business will be done, has no formal regional representation.  Most positions on the Executive Board will be appointed using a UK recruitment process based on merit.  The Trustee Board is responsible for overseeing the Executive Board. Scotland will have a strong position in the near future, when Prof Knight takes on the Presidency.

Finances – Finances remain healthy with autumn and spring meetings continuing to generate a profit.  However, engaging the pharmaceutical industry is becoming more challenging.  The costs of Council meetings have fallen due to their reduced frequency.

Congratulation – This year has seen a very large number of new consultant appointments – these included Claire McKay (Hairmyres), Laura Peacock (Hairmyres), Alison Craig (Monklands), Sarah Coutts (Edinburgh Royal), Susan Shenkin (Liberton), Rachael Murphy (Edinburgh Royal), Claire Copeland (Crosshouse), Elizabeth Kean (Fife), Marie Williams (Fife), James Shaw (Tayside), Deepa Sumukadas (Tayside) and Dirk Habicht (Perth).

We awarded several prizes over the year.  Dr Louise Burton won the Kate Johnston Prize.  Mr Jim Zhong won the prize for the Ferguson Anderson essay.  Dr Andrew Breckinbridge won the EBM prize and Dr Eilidh Hill won the Taylor Brown prize.

Acknowledgements – I am now finishing my 2 year period as Chair of BGS Scotland and I would like to acknowledge the assistance of every one on the Scottish Council over this period.  The Officer Bearers – Dr Sandip Ghosh, Dr Brendan Martin and Dr Stuart Johnston have worked diligently to support and enhance the aims of the Society.  I wish Dr Martin and Dr Johnston well for the next 2 years.

 

Spring BGS (Scotland) Meeting

The spring scientific meeting of the Scottish British Geriatrics Society was held in April in the Queensferry Hotel in Fife. The views across the Firth of Forth provided a beautiful background to what proved to be an educational and inspiring event.

The meeting commenced with an evening symposium entitled ‘An Inspector Calls’, with Ros Moore (Chief Nursing Officer), Hugh Masters (Policy Lead for Older People) and Donald Lyons (Chief Executive of the Mental Welfare Commission) providing an insight into current and future initiatives to improve healthcare services for older people in Scotland. This included an overview of current programmes including ‘Re-shaping Care for Older People’, Health Improvement Scotland’s ‘Standards of Care for Dementia in Scotland’ and forthcoming inspections focussing particularly on nutrition, falls, pressure care and assessment of capacity. This provoked a lively debate regarding how these initiatives can best be met given the current challenges of limited available resources.

The following day, the first session focussed on delirium starting with an excellent talk from visiting Dutch Professor Sophia de Rooij to share her ongoing studies into the pathophysiology of delirium. Areas of research include use of bedside wrist worn sensors to measure patients’ movements (with disruption of normal circadian patterns), use of diagnostic rating scales and increased serum biomarkers such as IL6 and 8. An intriguing area of interest is in the role of melatonin in both delirium treatment and prevention. This was followed by an outline of Dr. Andrew Teodorczuk’s qualititative research into delirium education. His vivid patient video describing the experience of delirium is available for all to use on the internet as an educational tool, and his work has resulted in delirium becoming a local Trust priority in his area. To conclude this session, two audits were then presented, the first from an FY1 outlining how implementation of a standardised treatment plan has improved their completion of AWI, the second looking at whether elderly patients would like copies of their clinical letters (in line with DOH good practice guidelines). The majority of surveyed patients were in favour, although this provoked much division of opinion amongst the audience.

The next session on Geriatric medicine and cognition began with an overview of vascular cognitive impairment and its relation to small vessel disease (SVD). With data from the PROGRESS trial, perhaps in patients with clinical evidence of SVD (including cognitive impairment), there is benefit in treating vascular risk factors although the aims of treatment are unclear. This was followed by an excellent overview of the ‘Cholinergic Effect of Medication’, outlining how a higher score on the Anti-cholinergic Cognitive Burden (ACB) scale relates to an increased risk of cognitive impairment and mortality. Current evidence suggests that prolonged use of drugs with significant anti-cholinergic burden (beyond sixty days) is more likely to have a lasting impact on cognitive function. There is an update of the ACB drug scale in progress.

The afternoon session started with a series of talks on the oldest old. The first presentation looked at multi-morbidity, expansion of this population group and the survivor effect. This led to excellent discussion about geriatric medicine being very little to do with age and everything to do with frailty and comorbidity. There was an interesting discussion about the risk of even geriatricians exhibiting paternalism toward the oldest old. There was then an excellent trainee presentation from the Northern Deanery looking at their oldest old and indeed a very clear case study highlighting the survivor effect and high functionality at extreme old age with limited comorbidity.

Dr Martin Wilson from Inverness entertained us all with a clear, precise and astute talk on pragmatic prescribing in the elderly. Given that an estimated 25% of older adult acute hospital admissions are felt due to adverse drug events topics such as this can never be covered enough.

The penultimate talk from Dr. A Breckinbridge, winner of the best presentation at the trainee Evidence Based Medicine day in Glasgow, outlining the evidence behind treatment of HIV infection in patients aged over 65. This is of increasing relevance as it is estimated that by 2015, half of those with HIV will be over the age of 50.

The day was concluded with a talk from Michael Matheson, the MSP Minister for Public Health, outlining the Public Health strategy plans for increasing longevity. Following on from the publication in June 2011 of the Standards of Care for Dementia in Scotland, a consultation document will be coming out in May 2012 addressing integration of health and social care. Looking to the future, he outlined a government proposal that from 2013, all those post diagnosis of dementia will receive at least a year of formal support – further details will surely follow.

With many thanks to Professor Reynish and colleagues from Fife for organising a very enjoyable and successful BGS Spring meeting.

Jane Rimer

Trainees Update

 

The annual Evidenced Based Medicine day has recently taken place at the RCPSG.  This year a cash prize as well as the chance to present at the BGS meeting in Fife was up for grabs.  Competition was tight with 8 trainees presenting topics from cost effectiveness of Dabigatran for stroke prevention in AF to the use of “early warning scores” in the elderly.  The prize was won by Dr Andrew Breckenridge, ST5 in the West of Scotland, for “What is the evidence for the treatment of HIV infection in patients aged over 65?”  A number of presenters converted their reviews to posters for the recent BGS meeting in Fife.  The EBM day is held annually in Glasgow in the Spring and the prize will continue to be sponsored by BGS Scotland.

Our annual trainees meeting will be held on the 14th September 2012 in the Queens Hotel, Perth.  The programme is now complete so please keep a note of the date.  We will be looking to elect a new trainee representative at this meeting – please get in touch if you would like to consider standing for this.

Please be aware of the Start-up Grants offered the Scottish BGS branch to support research in Geriatric Medicine. They are intended to provide immediate financial assistance to support new (sometimes a pilot project) research that may not yet be developed sufficiently to warrant support from other sources. Grants up to the value of £2000 will be supported.  The application process is described on our website under the Trainees/Research section.  Jo Ford has now gone on maternity leave before moving to a Consultant post in Norwich.  Many thanks for all her hard work over the last 2 years.  She will hopefully return for the trainees meeting in September.

Zoe Muir zoe.muir@nhs.net and Sarah Alder sarah.alder@nhs.net

 

2012 Ferguson Anderson Prize in Geriatric Medicine

2012 Ferguson Anderson Prize in Geriatric Medicine

Three essay prizes (£300, £200, and £100) are open to medical students studying at Scottish Universities.  Many students are now involved in special study modules or elective projects relating to the elderly.

These may provide the basis for a submission. The essay can cover any topic relating to ageing or care of older people and must not exceed 2500 words, excluding references. For 2012 we will welcome essays written either by individuals or representing the work from two or more students. The prizes would still be allocated per winning essay

 

Closing date for entries: 31st December

Entries and submissions to:

Dr Stuart Johnston
Perth Royal Infirmary
Perth PH1 1NX

 

 

Trainees Update

As many of you will be aware the 2012 Speciality Certificate Examination (SCE) will be held on Wednesday 21 March.  The subsequent exam date for 2013 has also been confirmed – Wednesday 6 March 2013.

We thought it would be helpful to include below the findings and comments from the SCE 2011 Trainees’ Survey compiled by Thomas Jackson, former Chair of the BGS Trainees’ Council.  This was conducted after the SCE in 2011.

As last year we surveyed trainees who had taken the SCE (38 responses, 4 of whom failed).

It appears that the majority taking the exam were ST5 (55%), with 31% being ST4.  54% found it harder than expected, which is an improvement on last year, with 38% saying it was of an expected standard.

We asked people to rate what resources they used to help prepare for the exam.  Unfortunately local trainers were rated as poor by 25%, average by 34% and not used by 29%.  The RCP website and the Dundee university questions were well rated, as was the Oxford Handbook of Geriatric Medicine.  Those that used the Mulley and Rai training guide (only 40%) found it helpful.  Again, those who attended the Southampton weekend (approx 50%) found both the lectures and Mike’s session helpful.

A lot of people also recommended  ‘Essential Geriatrics’ by Woodford, and ‘Rapid review’ by Vassallo and Allen, which were not in the original survey.

The topics people felt less prepared for were ethical questions (more complex than a BOF answer), biogerontology and walking aids/physiotherapy.  There was again a general feel that some questions were a bit too much like MRCP2 medicine.  I will ensure the full comments go to Dr Vassallo.

In conclusion I think the important points are (and clearly this is from a small survey, and ‘official’ details may inform us better)

Local trainers may well need more training with regard the SCE

A review of the textbooks people use would be welcome – are they at the right level?

We need to continue ensuring that trainees realise that the exam is hard and what to expect.

The trainees weekend should be encouraged and continue

Should the majority of people taking the exam be ST4 and 5? Or should we be encouraging ST5 and ST6’’

We are delighted to welcome Zoe Muir, ST6 in the West of Scotland, currently based in Glasgow Royal Infirmary, who joins Sarah Alder and myself as Trainee Reps. In May Jo will be going on maternity leave so will be less involved over the summer months.

The presentations from our Scottish Trainees’ Meeting in September 2011 are now on the website.

We will be hosting our meeting again in Perth on Friday 14 September 2012.  We are currently making up the programme and if you have any subjects you would like to be covered do send us an email.   Please keep this date in your diary.

Contacts:  Joanna FordSarah Alder, and Zoe Muir

Ferguson Anderson Prize – 2011

The Ferguson Anderson Prize is awarded annually, and offers 3 prizes of £300, £200 and £100 to medical students studying at Scottish Universities for an essay covering any topic relating to ageing or care of older people. The essay must not exceed 2500 words, excluding references.

Prize winners this year were 1. Jim Zhong 2.Laura Hughes and 3 Carys Morrison.

Jim’s winning essay was entitled ‘The difficulties of care in Alzheimer’s Disease: a student’s perspective’. Congratulations to him and to everyone who entered last year. For 2012 we are changing the entry qualifications slightly. BGS Council is aware that a lot of students do work together in groups during their training period, so for 2012 we will accept a group entry as well as pieces of work from individuals. Please see our website for more details.