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Press releases Saturday 4 November 2006

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(1) IRAQI PEOPLE LIKELY TO SUFFER PSYCHOLOGICAL DAMAGE

(2) HEART CATHETERS DO NOT BENEFIT PATIENTS

(3) NEEDS OF FAMILIES WITH DISABLED CHILDREN REMAIN LARGELY UNMET

(4) DOCTORS WORKING OVERSEAS FACE HAVING LICENSES REMOVED

(1) IRAQI PEOPLE LIKELY TO SUFFER PSYCHOLOGICAL DAMAGE

(Letter: Psychological implications of Iraqi invasion)
http://bmj.com/cgi/content/full/333/7575/971

Exposure to violence is putting the people of Iraq at risk of serious psychological damage, says a doctor in this week’s BMJ.

Previous studies have suggested that the risk of developing post-traumatic stress disorder following a traumatic event ranges from 7.5% to 72%, with the risk being highest in those exposed to sustained combat trauma.

With an excess of over 500,000 violent deaths, there will no doubt have been many more people exposed to grave violence. It therefore seems likely that the nation of Iraq may suffer a double blow, firstly by losing a sizeable proportion of its working population and secondly by the significant consequences of people suffering post-traumatic stress disorder, writes Dr Michael Reschen of the John Radcliffe Hospital, Oxford.

This may also be compounded by cultural barriers which prevent people from seeking psychological help, he adds.

The mainstay of the coalition's medical effort has been understandably directed at assisting with basic medical help and treating injured civilians in Iraqi or coalition hospitals. The medical literature provides ample examples of rebuilding psychiatric facilities in a post-war era, most notably the experiences of doctors in Croatia following the invasion by coalition forces.

“We must learn the lessons of history and expedite the psychiatric help for Iraqi civilians,” he concludes.

Contact:

Michael Reschen, Senior House Officer, John Radcliffe Hospital, Oxford, UK
Email: mreschen@doctors.org.uk

(2) HEART CATHETERS DO NOT BENEFIT PATIENTS

(Editorial: Pulmonary artery catheters)
http://bmj.com/cgi/content/full/333/7575/930

Doctors should probably stop using pulmonary artery catheters because they do not benefit patients, say doctors from Australia in this week’s BMJ.

The pulmonary artery catheter was invented in 1968. It enabled bedside monitoring in critically ill patients by measuring heart output and capillary pressure in the lungs and became widely used in intensive care units.

But reports of serious complications soon appeared and arguments for and against its use have continued ever since.

The most recent evaluation, commissioned by the NHS Health Technology Assessment (HTA) programme, found that pulmonary artery catheters do not benefit patients and concluded that withdrawing them from UK intensive care units would be cost effective.

Another recent trial in patients with acute lung injury confirmed these findings, while an analysis of 13 trials reported no overall effect of using these devices on mortality or length of hospital stay.

So what should clinicians do with all this information?

Given that the use of pulmonary artery catheters increases the risk of important complications, continued use of these devices is difficult to defend, say the authors.

The onus is now on the proponents of the pulmonary artery catheter and related devices to limit their use to clinical trials and to show that protocols based on such devices do benefit patients, they conclude.

Contact:

Simon Finfer, Associate Professor and Senior Staff Specialist in intensive care, Royal North Shore Hospital and Northern Clinical School, University of Sydney, NSW, Australia
Email: sfinfer@george.org.au

(3) NEEDS OF FAMILIES WITH DISABLED CHILDREN REMAIN LARGELY UNMET

(Editorial: Families with disabled children)
http://bmj.com/cgi/content/full/333/7575/928

The social and economic needs of families with a disabled child are high, but remain largely unmet, argue researchers in this week’s BMJ.

More disabled children and young people live in the UK than ever before (about 770,000 according to criteria defined in the Disability Discrimination Act) and the number of children with the most severe or complex needs is also increasing, write social policy experts from the University of York.

More than half of families with disabled children live in poverty, yet the costs associated with bringing up a disabled child are estimated to be three times those of bringing up a non-disabled child.

The child’s care needs also affect parents’ ability to work. State benefits are the sole source of income for 90% of lone parent families with a disabled child, but current benefits do not meet the additional outgoings associated with having a disabled child.

Parents with disabled children also have higher levels of stress and lower levels of wellbeing than parents with non-disabled children. Many parents report that they want but do not receive help to deal with the sources of stress.

Most families also report problems with housing, equipment, and a shortfall in services that provide short term breaks from caring.

How can primary care trusts respond to these issues, ask the authors?

They can ensure that workers are aware of the needs of disabled children and their families. They can make sure that families are offered a key worker, that families’ needs are assessed, and that appropriate interventions are available in their local area.

Primary care trusts can also promote strong multiagency working and commissioning of services for disabled children. They can also ensure that the needs of disabled children and their families are central to the agendas of children’s trusts and that housing and leisure agencies are included in plans to meet these needs, they conclude.

Contacts:

Tricia Sloper, Assistant Director, or Bryony Beresford, Senior Research Fellow, Social Policy Research Unit, University of York, UK
Email: ps26@york.ac.uk; bab3@york.ac.uk

(4) DOCTORS WORKING OVERSEAS FACE HAVING LICENSES REMOVED

(Personal View - Appraising UK doctors working overseas: open letter to the chief medical officer)
http://bmj.com/cgi/content/full/333/7575/977

UK doctors working for charities overseas are being removed from the lists of approved practitioners in the UK because they are unable to attend face to face appraisal, warns a GP in this week’s BMJ.

This means that they cannot work as soon as they return to the UK.

Overseas working gives doctors valuable experience that benefits the NHS when they return, writes Alex Duncan, a GP from West Sussex, currently working in Afganistan. But the need for appraisal and regulation may make a stint of working overseas too difficult for doctors to contemplate.

This would be a shame, as it would deprive parts of the developing world of badly needed expertise and the NHS of valuable experience on the doctors’ return.

“We need a body that regulates doctors like me,” he says.

He calls on England’s Chief Medical Officer to set up a body that would regulate doctors who undertake a contract for more than a year’s work with a recognised charity or medical organisation and who have a clear intention to return to work in the NHS.

This body should ensure that doctors are fit to practise in the UK at the time they depart for work overseas and at any time they return to the UK.

“At the moment it’s all a bit of a fudge,” says Duncan. “Those who are supposed to regulate me know little about my work and have no idea about the difficulties of my working conditions.”

A regulatory authority for doctors working overseas would have the experience to know what is going on and to spot problems that primary care and hospital trusts might miss. The system would also provide greater transparency for doctors getting back into UK practice, he writes.

All this would benefit the doctors concerned, be helpful to potential employers and - most importantly - protect the public by ensuring that returning doctors are fit to practise.

Contact:

Alex Duncan, Project Leader, ORA International Wakhan community health training programme, Badakhshan, Afganistan
Email: alexandeleanor@uuplus.com

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