HEALTH EDUCATION CHIEFS CALL SUMMIT TO TACKLE DEVELOPING GP WORKFORCE CRISIS
From the FMS Global News Desk of Jeanne Hambleton PULSE TODAY 29 August 2014
Exclusive: Health education managers in the south west of England have arranged a crisis summit to tackle acute problems in the GP workforce, Pulse can reveal.
Health Education South West has written to primary care bodies about an urgent meeting in September, after admitting that despite its best efforts to recruit GP trainees it is ‘highly unlikely’ it will ‘find enough young doctors’ through its current recruitment drive.
It is hoped that the meeting will help identify workforce issues across primary care, and ‘establish a meaningful dialogue’ between organisations to tackle the issue, which has become ‘highly topical’ since the recent high-profile resignation of a practice in South Bristol, it said.
Pulse reported in July that St Martin’s Surgery in Knowles had been forced to hand their contracts back to NHS England as a result of the recruitment crisis that has engulfed general practice.
The Government has mandated Health Education England to recruit 3,250 GPs into training by 2015 – though this deadline has been pushed back to 2016 in light of worse than expected application rates.
In July HEE announced it was running an unprecedented third recruitment round for GP trainees after Pulse revealed that as many as 40% of training places were going unfilled in some parts of the country. And the South West is far from having the worst fill rates of the Health Education regions – it is currently seventh out of the 14 regions, with 6.5% of its available GP training places unfilled – compared to 37.5% in the East Midlands.
The letter sent out this month to CCGs, LMC chairs and CEOs, area teams and acute trust leads and signed by Health Education South West’s director of education and Quality, Derek Sprague, and Director of GP Education, Professor Bill Irish, states: ‘We would like to invite you to attend a meeting to discuss the current and developing local crisis in our primary care workforce, on the afternoon of Wednesday 24th September.’
Adding: ‘With the recent high profile resignation of a practice in South Bristol, this issue is of course highly topical locally and is likely to become more so in the months leading up to a general election.’
‘Whilst HESW has worked hard to progressively increase its recruitment of GP speciality trainees, it is increasingly clear that: It is highly unlikely that we will be able find enough young doctors to fill any further local expansions in training capacity.’
‘[and] A multi-agency approach is urgently needed to support and to reduce the loss of qualified GPs from the current workforce.’
It also calls for more primary care support staff, and wider involvement of social care to alleviate the burden on general practice.
An HEE spokesman said: ‘Health Education South West called a meeting with local NHS organisations to develop a better picture of the issues surrounding the GP workforce in their area to determine how best they can be addressed.’
‘The fill rate for GP training places for the South West is already above the national average but they are still working hard to further increase their recruitment of GP trainees.’
However Health Education England’s own figures show that this is the first time in five years that the South West has not filled at least 100% of GP training posts.
Comments from GP Partner
I agree. They are not looking at why young doctors are not attracted to GP. Neither are they looking at why newly qualified GPs are not wanting to commit to GP. Most want to do locums, go abroad, or work part time in GP and part time in some other part of medicine. Few see the role of the GP as part of a commitment to family medicine in the community as particularly attractive. Why is that? It has become impossible to do the job well, given the complexity and amount of stuff we are expected to do for our patients, in the paltry 10 minutes we are allocated. So we give patients more time, run late, get stressed – or stick to 10 minutes, rush our consultations, get stressed. Or give longer but fewer appointments which affects access and leads to complaints and stress. We need to move to 15-20 minutes per appointment and that would need double the number of GPs. It would make the job much more satisfying and attractive to young doctors, it would improve safety and quality of care for patients, and would be money well spent.
CHANGING THE EMOTIONAL ASSOCIATION OF MEMORIES
From the FMS Global News Desk of Jeanne Hambleton Embargoed: 27-Aug-2014 Citations Nature, August 28, 2014
Source Newsroom: Howard Hughes Medical Institute (HHMI)
Newswise — By manipulating neural circuits in the brain of mice, scientists have altered the emotional associations of specific memories. The research, led by Howard Hughes Medical Institute investigator Susumu Tonegawa at the Massachusetts Institute of Technology (MIT), reveals that the connections between the part of the brain that stores contextual information about an experience and the part of the brain that stores the emotional memory of that experience are malleable.
Altering those connections can transform a negative memory into a positive one, Tonegawa and his MIT colleagues report in the August 28, 2014, issue of the journal Nature.
“There is some evidence from pyschotherapy that positive memory can suppress memories of negative experience,” Tonegawa says, referring to treatments that reduce clinical depression by helping patients recall positive memories.
“We have shown how the emotional valence of memories can be switched on the cellular level.”
The episodes and events that we experience become intimately associated with emotion as they are stored as memories in the brain. Recalling a favorite vacation may summon pleasure for years to come, whereas the fear that accompanies a memory of assault might cause a victim to never return to the scene of the crime. Tonegawa explains that the contextual information about these events – where and when they happened – is recorded in the brain’s hippocampus, whereas the emotional component of the memory is stored separately, in a brain region called the amygdala.
“The amygdala can store information with either a positive or negative valence, and associate it with a memory,” Tonegawa explains.
Last year, Tonegawa and his colleagues reported that by artificially activating the small set of cells that stored a specific memory in a mouse, they could create a new, false memory.
In that study, the team made the cells that stored a memory of a safe environment sensitive to light, so that they could be manipulated by the researchers. Switching on those cells while subjecting the animal to a mild shock in a new environment caused the mouse to fear the original environment, even though it had had no unpleasant experiences there.
In those experiments, the scientists had caused the mice to associate a neutral setting with fear. Now Tonegawa and his colleagues wanted to see if he could alter a memory that was already associated with emotion. Once an animal had developed fear of a place, could the memory of that place be made pleasurable instead?
To find out, the scientists began by placing male mice in a chamber that delivered a mild shock. As the mouse formed of memory of this dangerous place, Tonegawa’s team used a method it had previously developed to introduce a light-sensitive protein into the cells that stored the information.
By linking the production of the light-sensitive protein to the activation of a gene that is switched on as memories are encoded, they targeted light-sensitivity to the cells that stored the newly formed memory.
The mice were removed from the chamber and a few days later, the scientists artificially reactivated the memory by shining a light into the cells holding the memory of the original place. The animals responded by stopping their explorations and freezing in place, indicating they were afraid.
Now the scientists wanted to see if they could overwrite the fear and give the mice positive associations to the chamber, despite their negative experience there. So they placed the mice in a new environment, where instead of a shock they had the opportunity to interact with female mice.
As they did so, the researchers activated their fear memory-storing neurons with light. The scientists activated only one subset of memory-storing neurons at a time – either those in the context-storing hippocampus or those in the emotion-storing amygdala. They then tested the emotional association of the memory of the original chamber by giving mice the opportunity to move away from an environment in which the memory was artificially triggered.
Reactivating the amygdala component of the memory while the male mice had the pleasurable experience of interacting with females failed to change the fear response driven by those amygdala neurons. Consequently, mice retained their fear.
When the researchers reactivated the memory-storing cells in the hippocampus while the mice interacted with females, however, the memory cells in the hippocampus acquired a new emotional association. Now the mice sought out environments that triggered the memory.
“So the animal acquired a pleasure memory,” Tonegawa says. “But what happened to the original fear memory? Is it still there or is it gone?”
When they put the animals back in the original chamber, where they had experienced the unpleasant shock, the animals showed less fear and more exploratory and reward-seeking behaviors.
“The original fear memory is significantly changed,” Tonegawa concludes.
The researchers had similar results in experiments where they switched the emotion of a memory in the opposite direction – allowing mice to first develop a pleasurable memory of the chamber, then artificially activating the memory-storing cells in the hippocampus while the animals experienced a shock. In those mice, the pleasurable response linked to the hippocampal memory cells was replaced with a fear response.
The experiments indicate that the cells that store the contextual components of a memory form impermanent or malleable connections to the emotional components of that memory. Tonegawa explains that while a single set of neurons in the hippocampus stores the contextual information about a memory, there are two distinct sets of neurons in the amygdala to which they can connect: one set responsible for positive memory, the other responsible for negative memory.
Circuits connect the hippocampal cells to each of the two populations of cells in the amygdala.
“There is a competition between these circuits that dictates the overall emotional value and [positive or negative] direction of a memory,” Tonegawa says.
In an accompanying News & Views article in Nature, Tomonori Takeuchi and Richard G.M. Morris of the University of Edinburgh, state, “What is so intriguing about this study is that the memory representations associated with a place are dissected into their network components and, rather than re-exposing the animals to the training situation to achieve a change, light is used to selectively reactivate the representation of the ‘where’ component of a memory and then change its ‘what’ association.”
Tonegawa emphasizes that their success in switching the emotion of a memory in mice does not translate to an immediate therapy for patients. There is no existing technology to manipulate neurons in people as they did in their mouse experiments. However, he says, the findings suggest that neural circuits connecting the hippocampus and the amygdala might be targeted for the development of new drugs to treat mental illness.
CEDARS-SINAI HEART INSTITUTE OPENS FIRST-OF-ITS-KIND RESEARCH STEM CELL CLINIC FOR CARDIAC PATIENTS
Physicians to Devise Comprehensive Treatment Strategies, Evaluate Patients for Inclusion in Ongoing Stem Cell Clinical Trials
From the FMS Global News Desk of Jeanne Hambleton 12-Aug-2014
Source : Cedars-Sinai Medical Center
Newswise — LOS ANGELES – Regenerative medicine experts at the Cedars-Sinai Heart Institute have opened a new clinic to evaluate heart and vascular disease patients for participation in stem cell medical studies.
Led by Eduardo Marbán, MD, PhD, director of the Cedars-Sinai Heart Institute, and Timothy Henry, MD, director of the Heart Institute’s Cardiology Division, the doctors and researchers at the Cedars-Sinai Heart Institute Regenerative Medicine Clinic use a scientific approach to assess the possible benefits of stem cells to repair damaged or diseased cardiovascular tissues. The clinic is believed to be the first at a major U.S. academic medical center dedicated to matching patients with appropriate stem cell clinical trials, whether those research interventions are available at the medical center or at other institutions.
The Heart Institute Regenerative Medicine Clinic offers consultative services for patients with heart and vascular disease who may qualify for investigative stem cell therapy. The goal is to provide research options to patients who remain symptomatic on their current management regimen, or for patients with stable heart disease who are concerned about disease progression.
“Over the past decade, medical experts have predicted that in the future, stem cell therapies would transform heart disease treatment and save lives,” said Shlomo Melmed, MD, dean of the Cedars-Sinai faculty and the Helene A. and Philip E. Hixon Distinguished Chair in Investigative Medicine.
“At Cedars-Sinai, we have a track record of successfully directing cardiac stem cell studies as well as transferring innovations from the laboratory to the patient bedside.”
In 2009, Marbán and his team completed the world’s first procedure in which a patient’s own heart tissue was used to grow specialized heart stem cells. The specialized cells were then injected back into the patient’s heart in an effort to repair and re-grow healthy muscle in a heart that had been injured by a heart attack.
Results, published in The Lancet in 2012, showed that one year after receiving the stem cell treatment, heart attack patients demonstrated a significant reduction in the size of the scar left on the heart muscle after a heart attack.
Henry has served as principal investigator of multiple large, multicenter trials in acute coronary syndromes, myocardial infarction and angiogenesis, including several ongoing cardiovascular stem cell trials. He also is principal investigator for one of seven NIH Clinical Cardiovascular Stem Cell Centers.
“Our goal is to help make stem cells a regular treatment option for heart disease,” Henry said. “Right now, many patients with advanced heart disease have limited treatment options. Stem cells offer not only hope but a real chance of a game-changing treatment.”
As part of each patient’s assessment in the Heart Regenerative Medicine Clinic, physicians will evaluate patients interested in participating in stem cell clinical trials at Cedars-Sinai and, for patients willing to travel at other medical institutions across the nation. For patients willing to travel to participate in research, Cedars-Sinai physicians will work closely with investigators at other centers to expedite referrals and seamlessly transfer all relevant medical records.
“Patients who have battled heart failure, heart attacks and severe hypertension for years might not be aware of new options that could improve their health and quality of life,” Marbán said.
“Not every patient will find a suitable stem cell clinical trial, but we are focused on finding each patient the most advanced treatment for their disease.”
To make an appointment for a preliminary evaluation, patients should call toll free 855-STEM-WORK (855-783-6967) or 310-423-1231.
About the Cedars-Sinai Heart Institute
The Cedars-Sinai Heart Institute is internationally recognized for outstanding heart care built on decades of innovation and leading-edge research. From cardiac imaging and advanced diagnostics to surgical repair of complex heart problems to the training of the heart specialists of tomorrow and research that is deepening medical knowledge and practice, the Cedars-Sinai Heart Institute is known around the world for excellence and innovations.
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