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Press releases Saturday 07 August 2004
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(1) Dispersing asylum seekers may increase HIV burden
(2) Denying NHS care to overseas visitors is unethical
(3) Deaths no higher in patients of new surgeons
(4) Tobacco firm launches mobile trailers to counter smoking bans
(1) Dispersing asylum seekers may increase HIV burden
(Dispersal of HIV positive asylum seekers: national survey of UK healthcare
providers)
http://bmj.com/cgi/content/full/329/7461/322
Doctors are concerned that the UK policy of dispersing asylum seekers may lead to increased HIV transmission, according to a paper in this week's BMJ.
More than 100,000 asylum seekers have so far been dispersed from London and southeast England to alternative locations around the United Kingdom in an attempt to spread the cost of care. Many are from regions with HIV/AIDS epidemics.
Fifty-six doctors working in genitourinary medicine clinics across England were surveyed about dispersal of HIV infected asylum seekers. Many believed that dispersal was disruptive, may compromise HIV care, and may lead to increased transmission.
Of particular concern was that dispersal is done at short notice or with no prior arrangement, and often without appropriate transfer of medical details. Only three centres had experienced appropriate transfer of care.
Before the decision to disperse, the National Asylum Support Service should seek specialist advice, say the authors.
This study is a reflection of doctors' opinions, however the serious concerns raised warrant further investigation if we are to ensure that dispersal is not to be detrimental to patients' health, they conclude.
Contact:
Simon Edwards, Consultant in Genitourinary Medicine, Camden Primary Care Trust, London, UK Email: Simon.Edwards@Camdenpct.nhs.uk
(2) Denying NHS care to overseas visitors is unethical
(Eligibility of overseas visitors and people of uncertain residential status
for NHS treatment)
http://bmj.com/cgi/content/full/329/7461/346
Current UK regulations for treatment of overseas visitors or people of uncertain residential status are unethical, argue researchers in this week's BMJ.
These regulations deny free treatment for HIV to illegal immigrants and failed asylum seekers. But the authors propose that treatment should be provided when it will prevent serious harm without undue cost.
They describe a case of a pregnant woman from Africa who is found to be HIV positive yet is denied treatment to prevent transmission of HIV to her unborn child. "The moral obligation to prevent transmission of HIV to the unborn child is sufficient grounds to treat", say the authors.
If use of NHS resources to treat people of uncertain residential status would compromise the care of UK residents, this would be a reason to restrict care, but current immigration patterns and controls do not suggest that there would be a huge burden on the health system, they write.
Concerns about creating incentives to visit or illegally immigrate for health care should be tackled by tighter policing of immigration, they add. "Immigration authorities, not doctors, should be enforcing the immigration policy."
Rather than tightening access to NHS services, we should relax the current unethical restrictions, and offer medical care to all those within our borders who require treatment before leaving the United Kingdom, they conclude.
Contacts:
Ruth Collier, Press Officer, University of Oxford, UK Email: press.office@admin.ox.ac.uk or Professor Julian Savulescu, Uehiro Chair in Practical Ethics, University of Oxford, UK Email: julian.savulescu@philosophy.ox.ac.uk
(3) Deaths no higher in patients of new surgeons
(Improving mortality of coronary surgery over first four years of
independent practice: retrospective examination of prospectively collected
data from 15 surgeons)
http://bmj.bmjjournals.com/cgi/reprint/bmj.38173.577697.55
Patients and hospitals should be reassured that being operated on by newly appointed heart surgeons carries a similar risk of death as being operated on by established surgeons, say researchers in a study available on bmj.com.
However, they did find a progressive fall in deaths in the first four years after appointment, suggesting that there is still a learning curve associated with moving from surgical training to independent practice.
The study involved over 18,000 patients undergoing coronary artery surgery for the first time between 1997 and 2003. Observed and predicted death rates for surgeons in the first four years after their consultant appointment were compared with figures for more established surgeons.
A total of 374 (2%) of patients undergoing surgery during the study died. Overall, death rates among patients of surgeons in the first four years after appointment were not significantly higher than those of more established consultants.
However, observed deaths did fall as surgeons became more experienced - from 2.2% in the first year to 1.2% in the fourth year. This result did not change after accounting for time and case mix. In contrast, predicted deaths increased in the four years after appointment, suggesting that surgeons are operating on patients with more complex illnesses.
This study suggests that patients and hospitals can be reassured that death is not higher in patients of newly appointed surgeons, say the authors.
However, plans to shorten the surgical training period, along with a reduction in training hours due to implementation of the European working time directive, may have implications on the experience of new consultants in the future, which may increase possible learning curve effects unless other modifying influences are introduced.
Planned publication of surgeon specific mortality and use of performance data in clinical excellence awards may well influence learning curves in future but may also encourage newly appointed surgeons to turn down higher risk cases, unless robust risk adjusted measures are used, they warn.
Contact:
Ben Bridgewater, Consultant Cardiac Surgeon, South Manchester University Hospital, Manchester, UK Email: ben.bridgewater@smuht.nwest.nhs.uk
(4) Tobacco firm launches mobile trailers to counter smoking bans
(Letter: Japan Tobacco Incorporated has found a new way of promoting tobacco
in motor sports)
http://bmj.com/cgi/content/full/329/7461/352
Tobacco sponsorship of motor sports is an efficient way to reach boys and young men, but now the world's third largest tobacco producer has found another way to promote smoking.
Japan Tobacco has launched two mobile trailers named 'SmoCar' so smokers can enjoy a smoke even when smoking is not allowed in public places, writes Professor Hiroshi Kawane in a letter to this week's BMJ.
'SmoCar 2' travelled to event locations throughout Japan last year, such as the classic-car race event in Gunma prefecture and the 37th Tokyo Motor Show. Japan Tobacco claims that these special trailers have been developed as part of the company's initiative for increased co-existence between smokers and non-smokers in public spaces.
Professor Kawane says: "I think secondhand smoke combined with exhaust fumes from 'SmoCar' has become a health hazard for non-smokers in the vicinity of the car."
Contact:
Professor Hiroshi Kawane, Japanese Red Cross Hiroshima College of Nursing,
Hatsukaichi City, Japan Email: kawane@jrchcn.ac.jp
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