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Press releases Saturday 13 January 2007

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(1) Should Muslims have faith based health services?
(2) Poor ward care is harming patients
(3) UK government is failing sex workers
(4) Offenders unlikely to seek help when experiencing mental distress
(5) Clear guidelines on oral chemotherapy needed

(1) Should Muslims have faith based health services?
(Head to Head: Should Muslims have faith based health services?)
http://www.bmj.com/cgi/content/full/334/7584/74

At a time when many government and public bodies are recognising the importance of engaging with faith communities, in this week±s BMJ two experts consider the case for faith based health services for Muslims.

Muslims have the poorest overall health services in Britain, says Professor Aziz Sheikh from the University of Edinburgh and their needs ± in the short term at least ± should be met by faith specific healthcare initiatives.

Professor Sheikh says that there is a lack of reliable data, but that the limited information available shows that Muslims are about twice as likely to self-report poor health and disability as the general population. He argues that a better picture of the health profile and experiences of British Muslims must be developed.

The first step to facilitate this is the recording of religious affiliation, not just ethnic background at primary and secondary care levels. He believes that whilst these data are collected, there are several faith services which should be introduced which could help improve the health of the Muslim population. These include the availability of male circumcision on the NHS, better access to prayer and ablution facilities in hospitals and more information on the derivation of drugs so that Muslims can avoid alcohol and porcine-derived pharmaceuticals.

"Change is unlikely to occur without adequate ... representation of faith communities in positions of influence ± be they government bodies, research charities, or NHS trusts" Professor Sheikh says. He concludes that the long-term goal must be "to mainstream the understanding of the importance of religious identity."

But Professor Aneez Esmail from Manchester University argues that whilst it is "reasonable [that] we try to plan and configure our services to take account of needs that may have their roots in particular beliefs ... we cannot meet everyone±s demands for special services based on their religious identity: it would not be practical." He goes on to argue that some faith groups might support practices which may be morally and ethically unacceptable to the majority ± for example female circumcision and the refusal to accept blood transfusions in life saving situations.

Professor Esmail believes that going down the path of providing special services for defined groups risks stigmatisation and stereotyping. He concludes that "in an ideal world doctors±would ask about a patient±s beliefs not so that they can be categorised but because it might be important for the patient in their illness."

Contacts:
Aziz Sheikh, Professor of Primary Care Research and Development, Division of Community Health Sciences, University of Edinburgh, UK
Email: Aziz.shikh@ed.ac.uk

Aneez Esmail, Professor of Primary Care, School of Primary Care, University of Manchester, UK
Email: Aneez.esmail@manchester.ac.uk

(2) Poor ward care is harming patients
(Personal View: What±s wrong with the wards?)
http://www.bmj.com/cgi/content/full/334/7584/97

Poor ward care is harming patients, warns a senior doctor in this week±s BMJ.

Recent figures show that three of the four commonest causes of delayed discharge are associated with inadequate care on the ward: pressure sores, healthcare acquired infections, and medication errors.

This crisis is the result of lack of trained staff, lack of continuity of care, and poor leadership, and it is directly harming patients, argues consultant anaesthetist, Katherine Teale.

Common complaints include never seeing a nurse except when drugs are being handed out, days going by without any contact with senior medical staff, having to virtually beg for help moving up the bed or getting to the toilet, and repeated requests for pain relief.

It±s these experiences, and not the skilful surgery, that patients remember and tell their friends about. And it±s these that make patients, especially elderly patients, dread being in hospital, she says.

It±s easy to blame the nurses, but we doctors have to take our share of the responsibility, she adds. If the senior medical staff are rarely on the ward seeing what goes on, if they don±t act as role models for their trainees, and don±t make themselves available to support the nursing team then patient care suffers.

Ward care is just as important as complex surgery ± and can be just as difficult ± but unfortunately it is not so glamorous, nor is it appreciated by peers. This is tragic, not only for the patients but also for the future of the hospital.

"It±s madness to spend thousands of pounds on fancy surgery if the patients are then allowed to develop avoidable complications," she concludes.

Contact:
Katherine Teale, Consultant Anaesthetist, Manchester, UK
Email: Kathy@willoughby.demon.co.uk

(3) UK government is failing sex workers
(Protection of sex workers)
http://www.bmj.com/cgi/content/full/334/7584/52

The UK government is failing sex workers by continuing to promote discriminatory laws and practices, argue experts in this week±s BMJ.

Professor Michael Goodyear and Dr Linda Cusick call on the prime minister to protect women by decriminalising all aspects of sex work now.

Sex workers around the world continue to be murdered, write Professor Goodyear of Dalhousie University, Canada and Dr Cusick of the University of Paisley, Scotland. The five young women killed in Suffolk last month raised questions about our collective duty to protect such women and how best to achieve it.

Governments and health and social services have a duty of care without discrimination, yet they argue that UK government policies discriminate against the most disadvantaged.

Criminalisation of prostitution limits access to health and social care and contravenes United Nations± guidelines on human rights. "Only by moving prostitution out of the criminal justice system and focusing on public health and social care can we provide optimum support and help break the cycle of violence," they say.

The status quo in the UK is unacceptable moral cowardice, they add. The prime minister has opposed reform and stalled demands for the protection of women; he must show leadership and restore human rights by decriminalising all aspects of sex work now.

They believe that the deaths of Gemma Adams, Tania Nicol, Anneli Alderton, Paula Clennell, and Annette Nicholls were almost inevitable. "They deserved better, but we failed them. We will honour them best by now doing the right thing."

Contact:
Michael Goodyear, Assistant Professor, Department of Medicine and Women±s Centre, Dalhousie University, Canada
Email: mgoodyear@dal.ca

(4) Offenders unlikely to seek help when experiencing mental distress
(Understanding help seeking behaviours among offenders: lessons from a qualitative interview study)
http://www.bmj.com/onlinefirst_date.dtl

Offenders± lack of trust in medical professionals means many may not seek help when they are experiencing mental distress, says a new BMJ study.

Men who have been incarcerated have significantly higher rates of mental illness and suicide and under-utilise mental health services compared to the general population. Previous research suggests that a positive prior encounter with a health professional may predict the likelihood of seeking help in the future.

Researchers from Exeter undertook a qualitative study, involving face to face in-depth interviews with 35 male offenders, a quarter of whom had been identified as at risk of self-harm. Nineteen of the participants were then interviewed after their release.

All were asked whether they had ever been formally diagnosed with a mental health problem and whether or not they felt they had a mental health problem (regardless of diagnosis). Several reported a formal mental health diagnosis, while many said that they personally felt they may have a mental health problem. Of the 35 interviewed, the majority (21) said that they would not consider attending a GP on account of mental health problems. Of those who were followed-up none had contacted a medical professional in the time between release and follow-up interview.

The researchers found that three factors which appeared to influence whether or not the participants would seek medical help. These were a chaotic upbringing, a fear of diagnosis and distrust of the system. Overall, lack of trust emerged as the most prominent factor. Many of the participants did not feel that health professionals genuinely cared about them or had the ability to help with mental health problems. Others were reluctant to seek helped because they feared a formal diagnosis of mental illness. Some of these individuals feared the stigma that such a diagnosis would bring, while others feared that a diagnosis would mean having to confront the problem.

The authors point out that most health professionals are not trained to manage those who have been involved in the criminal justice system and recommend that training is developed for medical staff. They conclude that "like most people, the participants±wanted to feel listened to±and treated as individuals by their GPs± By ensuring that a positive precedent is set±GPs may be able to encourage future help-seeking."

Contact:
John Campbell, Professor of General Practice and Primary Care, Peninsula Medical School, Exeter, UK
Email: John.campbell@pms.ac.uk

(5) Clear guidelines on oral chemotherapy needed
(Oral chemotherapy safety practices at US cancer centres: questionnaire survey)
http://www.bmj.com/onlinefirst_date.dtl

Current practices around the use of oral chemotherapy in US cancer centres need to be improved, say doctors in a study on bmj.com.

Common malignancies can be treated with oral chemotherapy ± a treatment which is increasingly used across the USA and internationally.

Researchers from Boston set out to analyse the guidelines and practices used by comprehensive cancer centres for the provision of oral chemotherapy. Forty-two centres took part in the study. Variations in practice emerged in the prescribing methods, consent requests and the coordination and monitoring of treatment. They found that few of the safeguards which are routinely used for infusion chemotherapy were adopted for oral chemotherapy treatment.

Most of the 42 organisations which took part in the study had no required elements for prescribing oral chemotherapy and few requested patients± written consent for off protocol prescribing. Only one in three organisations required a clinician to note the body surface area or calculation of dose on the prescription, and only one in four required the patients± diagnosis or protocol.

Nearly a quarter of the centres had no formal process for monitoring patients± adherence. In the past year respondents at 10 centres reported at least one serious adverse drug event related to oral chemotherapy and respondents at 13 centres reported a ±serious near miss±.

The authors conclude that ±prescribing, monitoring and coordination, pharmacy practices and education of patients for oral chemotherapy vary substantially. Despite clinicians± concerns about oral chemotherapies, there is no apparent consensus among oncology professionals about safe practices for these drugs. The oncology community must define safe medication practices appropriate for oral chemotherapy, develop practice guidelines and accelerate their adoption."

Contact:
Saul N Weingart, Vice President for patient safety, Centre for Patient Safety, Dana-Farber Cancer Institute, Boston, USA
Tel: via William Schaller, Dana-Farber Press Office: +617 632-5357

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