Press releases Monday 1 June to Friday 5 June 2009
Please remember to credit the BMJ
as source when publicising an article and to tell your readers that they can
read its full text on the journal's website (http://www.bmj.com).
(1) Men and women doctors trained in Britain follow similar career paths
(2) Lager, wine, and trampolines do not mix, warn doctors
(3) Questions over stroke policy as information request denied
(4) MP speaks out over libel threat to scientific debate
(5) Study reveals "unacceptable delays" in stroke prevention surgery
(6) Government focus on acute stroke may compromise other areas of stroke care
(1)Men and women doctors trained in Britain follow similar career paths
(Research: Retention in the British National Health Service of medical graduates trained in Britain: cohort studies)
http://www.bmj.com/cgi/doi/10.1136/bmj.b1977
(Research: Career progression and destinations, comparing men and women in the NHS: postal questionnaire surveys)
http://www.bmj.com/cgi/doi/10.1136/bmj.b1735
(Editorial: The future of female doctors)
http://www.bmj.com/cgi/doi/10.1136/bmj.b2223
The vast majority of medical graduates trained in Britain work in the NHS for many years, refuting claims that doctors are increasingly leaving the NHS because they are disenchanted with it, according to a study published on bmj.com today.
A second study also published today shows that direct discrimination is no longer a barrier to the career progression of women doctors in the NHS.
The findings are based on regular surveys of doctors who qualified from UK medical schools over the last 30 years.
In the first study, 32,013 graduates were tracked at regular intervals up to 25 years after qualification. Of these, 94% were from family homes in Britain and 6% were from family homes overseas.
88% of graduates with family homes in Britain were working in the NHS two years after qualification. Subsequent years showed a gradual, small decline: 86% at five and 10 years, 85% at 15, 82% at 20, and 81% at 25 years. Most of the doctors who moved outside the NHS remained in medical practice, either in Britain outside the NHS or in other countries.
Among those with family homes overseas, 76% were working in the NHS two years after graduation and two thirds were still in the NHS 10 years after qualifying.
The percentage of women medical graduates who worked in the NHS was almost the same as that of men, refuting claims that women are much less likely than men to practise. However, a much higher percentage of women than men worked part time, a factor that needs to be fully considered in workforce planning, say the authors.
In the second study, 7,012 doctors who qualified from UK medical schools in 1977, 1988 and 1993 responded to a survey about career progression.
The results show that, although a smaller proportion of women than men progressed to senior posts, and men progressed more quickly than women to these posts, the career paths of women who had always worked full-time were very similar to those of men.
Part-time men and part-time women also had broadly similar trajectories which were slower than those of full-time doctors.
There was no evidence that having children disadvantaged the career progress of women who had always worked full-time, both in terms of the proportion who reached senior posts and the speed with which they reached them.
But there were important differences between men and women, and between full-time and part-time women, in their specialty destinations.
The authors say that, although these data indicate that there is no systematic direct discrimination against women in the NHS, indirect discrimination may remain and might include factors like working conditions that conflict with family life and lack of suitable role models in some specialties.
There can be no doubt that there were real barriers to women in medicine in the past, they add. However, with women now comprising 60% of medical school intake, it is now important to ensure that women wishing to work part-time do not encounter barriers to career progression, such as inflexible career structures, they conclude.
These findings are reiterated in a report published by the Royal College of Physicians this week. Entitled Women and medicine: the future, it states that "the main challenge ahead is no longer barriers to entry or delays to the career progression of women ...." Instead, it sees the new challenge as being "to ensure that the increasing proportion of women is effectively, economically, and fairly incorporated into the workforce for the benefit of patients." The report is discussed in more detail in an accompanying editorial.
Contact:
Michael Goldacre, Professor of Public Health, Department of Public Health, University of Oxford, UK
Email: michael.goldacre@dphpc.ox.ac.uk
As temperatures rise, doctors warn that more children are likely to attend hospital with trampoline related injuries - especially after bouncing with adults.
In a letter to this week's BMJ, Dr Andrew Bogacz and colleagues at Ninewells Hospital and Medical School in Dundee analysed 50 cases presenting to their accident and emergency department over six weeks and compared them with the safety guidelines of the Royal Society for the Prevention of Accidents (RoSPA).
They found that the most important factor associated with trampoline injury is having many users on a trampoline at one time, with the lightest person five times more likely to be injured.
The severity of the injury also increases with the mismatch between child and adult weights, they explain. For example, a child of 20 kg can experience a force equivalent to a 3.5 m fall when bouncing with an adult of 80 kg.
Adult supervision is also crucial in preventing trampoline injuries, they add - "to ensure safety guidelines are followed, exuberance is controlled, and help is provided with setting up and dismounting from the trampoline."
Finally, they point out that children have been hurt while being supervised or bouncing with adults who have been drinking at a summer garden party. "Adults, please note that lager, wine, and trampolines do not mix," they conclude.
Contact:
Andrew Bogacz, Speciality Registrar, Ninewells Hospital, Dundee
Via Shona Singers, Head of Communications, NHS Tayside
Email: s.singers@nhs.net
(3) Questions over stroke policy as information request denied
(Letter: Timely access to information)
http://www.bmj.com/cgi/doi/10.1136/bmj.b2194
MPs may have been "kept in the dark" about the full content of a review criticising a National Audit Office report on stroke care, claims a senior doctor in a letter to this week's BMJ.
If so, this calls into question MP's recommendations about stroke services, he says.
In 2008, Nigel Dudley, a consultant in stroke medicine at St James's University Hospital in Leeds, used the Freedom of Information to ask the House of Commons whether, and, if so, when, the National Audit Office provided the Committee of Public Accounts with a full copy of this report.
The report outlined targets for reducing death, disability and recurrent stroke, along with estimated cost savings, and its recommendations led to the publication of the National Stroke Strategy in 2007.
His request was refused on the grounds of parliamentary privilege.
But the author argues that, if MPs had been kept in the dark about the full content of the report, can the public have trust and confidence in MP's recommendations about stroke services and priority of funding and developments?
This is important, he explains, as data show that much of the benefit of the National Stroke Strategy comes from early supported discharge and community rehabilitation rather than from acute imaging and thrombolysis (giving anti-clotting drugs as soon as possible after a stroke).
The public and health policy researchers have a right to access information in a timely manner, he says. Currently just £5.5 million is spent on the Information Commissioner's work with the Freedom of Information Act, comparing unfavourably with the sums spent by MPs on their own expenses.
He suggests that MPs should look at the relative spending priorities and increase the Information Commissioner's funding as a matter of priority.
Contact:
Nigel Dudley, consultant in elderly/stroke medicine, St James's University Hospital, Leeds, UK
Email: nigel.dudley@leedsth.nhs.uk
The MP Evan Harris is among a group of leading academics, publishers, journalists, performers, clinicians, and scientists backing science writer Simon Singh in his application to appeal against a libel judgment in the High Court today.
In an editorial published on bmj.com, he warns that this judgment - if upheld - would have "major implications for the ability of scientists, researchers, and other commentators freely to engage in robust criticism of scientific, and indeed purportedly scientific, work."
On 19 April 2008, Singh wrote an article in the Guardian newspaper criticising claims made by chiropractors about the efficacy of spinal manipulation in dealing with childhood conditions such as asthma, colic, and ear infections, among others.
He suggested there was "not a jot" of evidence to support such interventions for these ailments, and complained that the British Chiropractic Association "happily promotes bogus treatments." The British Chiropractic Association has sued for libel.
In a pretrial hearing on 7 May 2009, Mr Justice Eady upheld the assertion of the British Chiropractic Association that the words meant that it knowingly promoted a treatment that they knew to be a sham. The judge also decided that the words represented a statement of verifiable fact, and that Singh therefore could not benefit from a "fair comment" defence.
Singh has stated that, under the judge's interpretation, it would be difficult for him to win the case.
What Singh's case reinforces, writes Harris, is the increasing recognition that the libel laws in England and Wales give major advantages to the plaintiff.
It is also remarkable that the plaintiffs in this case are representatives of healthcare practitioners, who could, one would expect, make their case in peer reviewed scientific literature as well as through the usual letters columns of whatever newspaper they believe has treated them unfairly, he says.
In the field of health care, the consumer is particularly vulnerable to false promises of cure or symptomatic relief, and all practitioners - especially those in the private sector - need to be able to justify their claims in a transparent and scientific way, he concludes. If that debate is chilled, then the medical profession, patients' interests, and scientific discourse are severely undermined.
Contact:
Evan Harris, MP, Oxford West and Abingdon, House of Commons, London, UK
Email: harrise@parliament.uk
UK health services are currently focusing on immediate clot-busting treatment in the first 72 hours after a stroke. But two BMJ online articles argue that other important elements of care are being neglected: preventive surgery and - once a stroke has occured - treatment with aspirin and admission to a specialist unit.
(5) Study reveals "unacceptable delays" in stroke prevention surgeryOnly one in five UK patients have surgery to reduce their risk of stroke within the two week target time set by the National Institute for Health and Clinical Excellence (NICE), finds a study published on bmj.com today.
The authors call for major improvements in services to enable early surgery to prevent strokes in high risk patients.
Every year in the UK, about 120,000 people have a transient ischaemic attack (TIA) or minor stroke and up to 30% die within a month. Stroke is also the single largest cause of severe disability in adults and costs the economy £7bn a year.
Studies show that a surgical procedure known as carotid endarterectomy reduces the risk of stroke in patients with stenosis (a narrowed or blocked carotid artery) and symptoms of having had a minor stroke, but it is unclear how many patients have had symptoms and how long they have to wait for surgery.
So a team of researchers, led by Professor Alison Halliday at St George's University of London, assessed the timeliness of carotid endarterectomy services in the UK.
They surveyed 240 surgeons from 102 hospital trusts across the UK about all carotid endarterectomies they performed between December 2005 and December 2007.
Of 5,513 patients who underwent surgery, 83% had a history of transient ischaemic attack or stroke, but only 20% had their operation within two weeks of onset of symptoms and 30% waited more than 12 weeks. The average delay from referral to surgery was 40 days.
Twenty-nine patients (0.5%) died while in hospital, while 48 patients (1%) died 30 days after surgery, mainly from strokes.
These findings show unacceptable delays between symptom and operation in the UK, say the authors. Such delays are associated with a high risk of disabling or fatal stroke before surgery, and the benefit of surgery consequently falls rapidly with increasing delay.
Major improvements in services are necessary to enable early surgery in appropriate patients in order to prevent strokes, they conclude.
Contact:
Alison Halliday, Professor of Vascular Surgical Studies, St George's, University of London, UK
Email: alisonhalliday@aol.com
The focus on acute stroke in the UK government’s national stroke strategy may distract attention and resources from other important elements of stroke care, warn experts in a paper published on bmj.com today.
In 2005, the National Audit Office (NAO) report on stroke services outlined improvements for reducing death, disability and recurrent stroke, along with costs. Its recommendations led to the publication of the national stroke strategy in 2007.
But it has been suggested that the NAO report overemphasised the benefits and cost savings to be gained from intravenous thrombolysis (giving anti-clotting drugs within three hours of an acute stroke) and underestimated the gains from comprehensive care in a stroke unit.
Now senior doctors at the University of Edinburgh warn that the report’s strong focus on hyperacute stroke care (the first 72 hours), and on greatly increasing the proportion of patients being given intravenous thrombolysis, could mean that the many other effective components of a comprehensive stroke service might not receive as much attention.
They examined the current performance of stroke services in England, Wales and Northern Ireland against three proven interventions for acute stroke: organised stroke unit care, early administration of aspirin, and intravenous thrombolysis.
According to the 2008 national sentinel stroke audit, 68% of patients admitted to hospital with an acute stroke spent more than half of their admission on a specialist stroke unit, 85% of eligible patients received early aspirin, and 1.4% of eligible patients received intravenous thrombolysis.
Based on these figures, the authors estimate that, at present, in a notional UK population of one million people, intravenous thrombolysis is preventing two patients from having a poor outcome (death or disability) each year, while stroke unit care and aspirin are preventing 37 and 24 poor outcomes respectively.
More optimistically, if 5% of all stroke patients could be treated with intravenous thrombolysis within three hours (a greater than fivefold increase in what is currently being achieved UK-wide, and an improvement even on the highest rates in the UK), then 11 would avoid a poor outcome, while increased rates of stroke unit admission and early aspirin administration would lead to 59 and 29 patients avoiding a poor outcome respectively.
These calculations clearly show that the numbers of patients benefiting at current or realistic target levels are far larger for stroke units and aspirin than for intravenous thrombolysis, and they remain higher even at optimistic target levels, say the authors.
Achieving a higher rate of thrombolysis will also require radical changes to local systems. But they warn "we must be careful that the emphasis on developing hyperacute stroke care, mainly to allow delivery of thrombolysis to the small proportion who may benefit, does not distract attention and resources from the other proved interventions."
They conclude: "Although it is important to give intravenous thrombolysis in an appropriate setting to as many eligible patients as possible, it is crucial that this should not be at the expense of any of the other parts of a comprehensive stroke service. All elements of effective stroke care must be properly joined up, and funded, from hyperacute care to long term community support."
Contact:
Dr Cathie Sudlow, Clinical Senior Lecturer and Honarary Consultant Neurologist, Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, Scotland
Email: cathie.sudlow@ed.ac.uk
For more information please contact:
Emma Dickinson
Tel: +44 (0)20 7383 6529
Email: edickinson@bmj.com
Press Office telephone : 020 7383 6254 (Weekdays : 0900hrs - 1800hrs)
British Medical Association
BMA House, Tavistock Square, London WC1H 9JP
and from:
the EurekAlert website, run by the
American Association for the Advancement of Science (http://www.eurekalert.org)
[[$FOOTER]]