Brexit compounded UK's shortage of doctors, says study

LONDON, United Kingdom - Brexit has compounded a shortage of doctors in Britain, with an estimated shortfall of 4,000 in major specialty areas from EU countries, a study published Sunday said.

It comes as the crisis-hit NHS state-funded health service struggles after years of underfinancing, with record waiting lists for some hospital care due to the Covid pandemic but also a lack of doctors and nurses.

The Nuffield Trust, an independent health think tank, focused on four fields of medicine -- anaesthesia, pediatrics, cardio-thoracic surgery and psychiatry -- where European doctors had been particularly relied upon before the UK left the European Union.

It found that in the four areas -- where recruitment was already challenging -- "the increase in EU and EFTA (European Free Trade Association) staff slowed down, falling below the projected increase".

If the trend seen before Brexit had continued, there should have been more than 41,000 doctors from the EU or EFTA (Norway, Switzerland, Iceland and Liechtenstein) registered in 2021, or at least 4,000 more than the figures showed.

"The campaign and result of the EU referendum is the obvious reason for a change in trend around 2015 and 2016," the study, commissioned by The Guardian newspaper, said.

It highlighted initial uncertainty over new rules for the movement of people, followed by tighter visa rules and "deteriorating work conditions" in the health system.

"The findings suggest that stagnation in the number of EU doctors in these specialities has exacerbated existing shortages in areas where the NHS has not been able to find enough qualified staff elsewhere," it added.

The Royal College of Nursing last week announced that its members would next month hold their first strike action in the union's 106-year history in England and Wales, citing pay, conditions -- and chronic staff shortages.

Agence France-Presse

Malaysian doctors stage walkout amid worsening COVID-19 outbreak

Hundreds of junior doctors at state-run Malaysian hospitals staged walkouts Monday demanding better conditions as the country faces its worst coronavirus outbreak yet. 

Dressed in black and holding signs with slogans including "equal pay, equal rights, equal opportunity" and "we are your future specialists", they protested at medical facilities nationwide. 

The doctors are on contracts for a set period and say their treatment is worse than that of permanent government staff, even as they have found themselves on the frontline of the fight against Covid-19.

They complain of a lack of job security, poor benefits and that very few are eventually offered permanent positions.

We want "equal rights, to be a permanent doctor," said a medic at a government hospital that treats virus patients outside Kuala Lumpur. 

"We would definitely not be here if we were treated fairly... we should be appreciated for what we do," the doctor, who spoke on condition of anonymity, told reporters.

The medic was among dozens who took part in the action at the hospital, which lasted around half an hour. 

Local media reported that several hundred participated across the country, but some doctors complained they were threatened by police and senior hospital staff in a bid to halt the protests.

Those involved said senior doctors took over their duties before they walked out, to ensure that patient care was not jeopardized. 

Malaysia is currently battling its most serious outbreak, driven by the highly contagious Delta variant. Officials have reported over one million cases and about 8,000 deaths.

There are over 23,000 doctors on these contracts in Malaysia -- about 45 percent of the total medical doctors in the public healthcare system, according to official estimates.

Last week, the government said it would extend junior doctors' contracts for up to four years in a bid to forestall the protests. 

But they stopped short of offering permanent jobs, and the organizers of Monday's walkout criticized the move as "short-sighted".

Agence France-Presse

Canada court rules doctors can help ill patients die

TORONTO — Canada's highest court unanimously struck down a ban on doctor-assisted suicide for mentally competent patients with terminal illnesses, declaring on Friday that "an individual's response to a grievous and irremediable medical condition is a matter critical to their dignity and autonomy."

The Supreme Court's decision reverses its own decision two decades ago and gives Parliament a year to draft new legislation that recognizes the right of consenting adults who are enduring intolerable suffering to seek medical help ending their lives. The current ban on doctor-assisted suicide stands until then.

The judgment said the ban infringes on the life, liberty and security of individuals under Canada's constitution. It had been illegal in Canada to counsel, aid or abet a suicide, an offense carrying a maximum prison sentence of 14 years

"The law allows people in this situation to request palliative sedation, refuse artificial nutrition and hydration, or request the removal of life-sustaining medical equipment, but denies the right to request a physician's assistance in dying," the ruling noted.

Assisted suicide is legal in Switzerland, Germany, Albania, Colombia, Japan and in the U.S. states of Washington, Oregon, Vermont, New Mexico and Montana. Euthanasia is currently legal in the Netherlands, Belgium and Luxembourg.

Friday's decision reverses a Canadian Supreme Court ruling in 1993. At the time, the justices were primarily concerned that vulnerable people could not be properly protected under physician-assisted suicide.

"For seriously and incurably ill Canadians, the brave people who worked side by side with us for so many years on this case — this decision will mean everything to them," said a visibly overjoyed Grace Pastine, the litigation director for the British Columbia Civil Liberties Association.

The pressure will now be on Parliament to act in an election year, as the court says no exemptions may be granted for those seeking to end their lives during the 12-month suspension of the judgment.

Friday's decision was spurred by the families of two now-dead British Columbia women, supported by Pastine's organization.

Gloria Taylor was diagnosed with Lou Gehrig's disease, a degenerative neurological illness. Kay Carter was diagnosed with a degenerative spinal cord condition. At age 89, Carter travelled to Switzerland, where assisted suicide is allowed.

Taylor had won a constitutional exemption at a lower court for a medically assisted death in 2012, but that decision was overturned in subsequent appeals. She died of an infection later the same year.

It has been more than 20 years since the case of another patient with Lou Gehrig's disease, Sue Rodriguez, gripped Canada as she fought for the right to assisted suicide. She lost her appeal but took her own life with the help of an anonymous doctor in 1994, at the age of 44.

source: philstar.com

Some US hospitals weigh withholding care to Ebola patients

CHICAGO/NEW YORK - The Ebola crisis is forcing the American healthcare system to consider the previously unthinkable: withholding some medical interventions because they are too dangerous to doctors and nurses and unlikely to help a patient.

US hospitals have over the years come under criticism for undertaking measures that prolong dying rather than improve patients' quality of life.

But the care of the first Ebola patient diagnosed in the United States, who received dialysis and intubation and infected two nurses caring for him, is spurring hospitals and medical associations to develop the first guidelines for what can reasonably be done and what should be withheld.

Officials from at least three hospital systems interviewed by Reuters said they were considering whether to withhold individual procedures or leave it up to individual doctors to determine whether an intervention would be performed.

Ethics experts say they are also fielding more calls from doctors asking what their professional obligations are to patients if healthcare workers could be at risk.

US health officials meanwhile are trying to establish a network of about 20 hospitals nationwide that would be fully equipped to handle all aspects of Ebola care.

Their concern is that poorly trained or poorly equipped hospitals that perform invasive procedures will expose staff to bodily fluids of a patient when they are most infectious. The US Centers for Disease Control and Prevention is working with kidney specialists on clinical guidelines for delivering dialysis to Ebola patients. The recommendations could come as early as this week.  

The possibility of withholding care represents a departure from the "do everything" philosophy in most American hospitals and a return to a view that held sway a century ago, when doctors were at greater risk of becoming infected by treating dying patients.

"This is another example of how this 21st century viral threat has pulled us back into the 19th century," said medical historian Dr. Howard Markel of the University of Michigan.  

Some ethicists and physicians take issue with the shift.

Because the world has almost no experience treating Ebola patients in state-of-the-art facilities rather than the rudimentary ones in Africa, there are no reliable data on when someone truly is beyond help, whether dialysis can make the difference between life and death, or even whether cardiopulmonary resuscitation (CPR) can be done safely with proper protective equipment and protocols.

Such procedures "may have diminishing effectiveness as the severity of the disease increases, but we simply have no data on that," said Dr. G. Kevin Donovan, director of the bioethics center at Georgetown University.

Donovan said he had received inquiries from fellow physicians about whether hospitals should draw up lists of procedures that would not be performed on an Ebola patient. "To have a blanket refusal to offer these procedures is not ethically acceptable,” he said he told the doctors.

New guidelines

Nevertheless, discussions about adopting policies to withhold care in Ebola cases are under way at places like Geisinger Health System, which operates hospitals in Pennsylvania, and Intermountain Healthcare, which runs facilities in Utah, according to their spokesmen.

Dr Nancy Kass, a bioethicist at Johns Hopkins Bloomberg School of Public Health, said healthcare workers should not hesitate to perform a medically necessary procedure so long as they have robust personal protective gear.

So far, only two US hospitals have used kidney dialysis: Texas Health Presbyterian Dallas, which treated Liberian patient Thomas Duncan and where two nurses became infected, and Emory University Hospital in Atlanta, which has treated four Ebola patients at its biocontainment unit without any healthcare workers becoming infected.

Although it is not yet clear how the Dallas nurses became infected, health officials have questioned both the lack of adequate training in the use of protective gear and the decision to perform invasive procedures.

The American Society of Nephrology and CDC are now working on new dialysis guidelines for Ebola patients, whose kidneys often fail. In some cases, dialysis can help a patient get through the worst of the illness until their own immune system can fend off the virus.

Nephrologist Dr. Harold Franch said the new guidelines will consider both whether the procedure is medically necessary and whether the hospital can do it safely.

"Most academic medical centers and many good private tertiary care hospitals will be able to do this," he said. Yet he thinks many hospitals may not offer the service, since “it takes a lot of money and time to train people.”

Treat, or flee? 


Throughout the history of medicine some doctors have declined to treat infectious patients or fled epidemics, said Michigan's Markel. Greek physician and philosopher Galen fled Rome during the bubonic plague 1,800 years ago, doctors deserted European cities stricken by the Black Death of the Middle Ages, and some health workers refused to treat HIV/AIDS patients in the 1980s.

"The idea that a doctor would stick to his post to the last during an epidemic, that's not part of the Hippocratic Oath," Markel said. "If you feel your life is at risk you don't have to stay and provide care."

At University of Chicago Medicine, questions of taking last-ditch measures were discussed early in the hospital's Ebola planning, said Dr. Emily Landon, a bioethicist and epidemiologist.

Decisions about offering services such as dialysis or inserting a breathing tube are made in advance by the hospital's care team in consultation with patients. But if a doctor on the team feels in the moment that she cannot provide the service, another may step in and do the procedure.

Landon views dialysis as a "no brainer" for Ebola patients, and believes the risks are fairly low to the well-trained nursing staff who have volunteered for the hospital's isolation ward.

But putting in a breathing tube and putting them on a ventilator is more controversial.

"We have very little experience with that except for Mr Duncan, who didn't do well," she said. The hospital plans to consult with patients before the need arises and plans to insert a breathing tube at the earliest sign that it might be needed.

CPR, which is performed when a patient's breathing or heart stops, also poses risks. It can involve chest compressions, inserting breathing tubes and other invasive procedures.

If a patient goes into cardiac or respiratory arrest, a team would have to don protective gear. Rushing could leave them without proper protection, but a delay could make the procedure ineffective.

That represents too great a risk for caregivers for what could be "a futile act," said Dr. Joseph Fins, chief of medical ethics at Weill Cornell Medical College in New York City.

source: interaksyon.com

Eye doctors warn of damage from lasers

NEW YORK - Powerful lasers that are easily purchased online pose a serious danger to vision, according to a new report.

Doctors from the Duke University Medical Center in Durham, North Carolina, report on the case of a nine-year-old boy who showed up at their hospital after being blinded by an adult playing with a handheld laser.

"Until he came in, no one had realized there was an actual injury and we saw the bleeding," Dr. Cynthia Toth, one of the authors of the new report, told Reuters Health.

The high-power laser had passed through the boy's eye lenses and burst the blood vessels in the back of his eyes.

"This was a larger device that was sold as some toy, but it's a dangerous weapon," Toth said. "You can start a fire with the power that was coming out of that one."

Toth is a professor of ophthalmology and biomedical engineering at Duke. She also has a long history of studying and working with lasers.

The high-power laser was made from a component of a dismantled home theater projector and purchased online.

A laser, according to the US Food and Drug Administration (FDA), is a "powerful, targeted beam of electromagnetic radiation that is used in many products, from music players and printers to eye-surgery tools."

The FDA regulates lasers, as it does other radiation-emitting electronic products, and separates them into classes and subclasses.

Class 3a lasers include those typically used for pointing during presentations. Their power is capped at 5 milliwatts (mW) on the visible light spectrum under federal regulation. Class 4 lasers are the type used in industrial or medical settings and are an immediate hazard.

The laser used on the boy in the new report falls into class 4, according to the researchers. It produced 1,250 mW of power.

The boy's vision eventually recovered after two months, Toth and her colleagues report in JAMA Ophthalmology.

But other people are not so fortunate, Toth said.

Within the past few months, other reports of eye injuries by lasers were published in other journals, Toth said. In one case, a laser burned a hole through the back of a person's eye.

"I do think that higher power lasers are more available than they were in the past," she said. "For that reason, I wouldn't be surprised if there was an increase in the number of injuries."

"The amount of damage correlates to the strength of the laser," Dr. Stacy Pineles, assistant professor of ophthalmology and a retinal specialist at the Stein Eye Institute at the University of California, Los Angeles, told Reuters Health in an email.

"Shorter wavelength lasers that are now available to consumers as described in this article are more easily absorbed by the retina and therefore can cause severe and sometimes permanent vision loss," Pineles, who was not involved in the new report, said.

People who work with lasers should wear protective goggles, she said. "Different types of lasers require specific goggles for maximum protection."

Toth said it's also important that people don't let children play with lasers of any type.

"Even a so-called safe level can also be dangerous," she said, adding that people who think they are injured should see a doctor.

source: interaksyon.com

Cuban doctors battle to control cholera outbreak

Manzanillo, Cuba (CNN) -- At first the Cuban doctors thought they were dealing with an outbreak of food poisoning.

The patients that arrived for treatment in mid-June at hospitals in Manzanillo had all gone to the same birthday party held at a house in the hilly countryside on the perimeter of the eastern Cuban city.

The sick had eaten shrimp at the party and doctors thought that meal might be the cause for the patients' heavy vomiting and diarrhea.

Then more people began walking into hospitals with similar symptoms.

But they had not attended the party.

"They started coming in a few at a time," said Julio Cesar Fonseca Rivero, the director of the Celia Sanchez Manduley Hospital, the largest in the region. "The first day five came, and then eight. That's not normal, that five people would come with the same symptoms. The most critical days were when there were 30 to 32 patients who arrived in a single day."

A sudden spike in cases of diarrhea is not unusual for Manzanillo's hospitals that treat the surrounding rural communities. There residents often live without indoor plumbing and in the summer months endure the scorching heat and heavy rains.

Illness kills three in eastern Cuba

This summer had already been particularly hot with heavy rains that caused outhouses to flood into several drinking wells.

Still, doctors suspected they were dealing with something they hadn't seen before.

"We became alarmed with the number of cases arriving. We usually see one or two cases of diarrhea each day," said Dr. Oyantis Matos Zamora, who oversees a clinic on the edge of the city that attends to rural residents.

The symptoms some patients exhibited -- the rapid onset of watery diarrhea and dehydration — had also not been seen in generations.

"The way that the outbreak developed and the appearance of other similar cases in the region, we realized this was a problem of a different magnitude," said Dr. Manuel Santin Peña, Cuba's national director of epidemiology.

The "problem" was cholera.

Cuba's last cholera outbreak occurred over a century ago. Although eradicated in many countries, the disease, according to the World Health Organization, still infects between 3 million and 5 million people each year, killing between 100,000 and 120,000.

In Manzanillo the outbreak has taken on a name of its own. There it's simply referred to by residents as "el evento."

So far "el evento" has taken three lives and infected at least 110 people, said Santin. He said doctors were waiting on test results for tens of other possible cases but said so far fewer than 30% percent of suspected cases had been shown to be cholera.

He denied reports that the Cuban government has underreported the death toll or that the outbreak is spreading to other provinces.

He said a handful of suspected cases had been identified elsewhere in the country. But he said those cases had come from the same region where the original outbreak took place and are believed to have been infected there.

"We can categorically say that there is no other outbreak in any other province," Santin told CNN, outside the entrance to the Celia Sanchez Manduley Hospital, where three more people had arrived suffering from severe diarrhea.

Cuban health officials allowed a CNN crew to be the first media to film in the hospital and speak with doctors there about the ongoing effort to control the cholera outbreak.

To combat the outbreak, the local government has closed 12 contaminated wells around Manzanillo, Santin said. Clean water is being trucked in for residents until a different source of water can be found.

At the entrances to hospitals and government buildings in the city stand buckets for people to wash their hands and soles of their shoes with chlorine bleach.

Kiosks throughout Manzanillo that sell milkshakes, iced drinks or other foods that come into contact with water have been shuttered.

A temporary ban has also been issued for fishing and bathing in waters off the coast that may be contaminated.

While in the rest of the country little has been said in the official press about the cholera, in Granma province, the site of the outbreak, residents are now shown a nightly program on how to prevent infection.

Santin told CNN those efforts appear to be working and that doctors are seeing a decline in the rate of infection. The perception that the outbreak was increasing, he said, came from the seven to 10 days it takes for Cuba's labs to return results of tests on the infected.

"The number of cases is dropping," he said. "That doesn't make us confident so much as make us work to intensify all our preventive measures so that in the next few weeks we can stop the outbreak."

Maria Rosa Rodriguez has seen up close what cholera can do.

The Manzanillo schoolteacher was hospitalized for a week with cholera and only recently was allowed return home to finish her recovery. She winced as she recounted the agony that the infection caused her.

"You're very nervous because we had never seen this before here," Rodriguez said. "You're feeling bad with diarrhea, vomiting and you lose weight very quickly. You think the worst."

source: CNN

Anna Nicole Smith Doc's License YANKED ... for 90 Days

One of Anna Nicole Smith's doctors is losing her medical license -- temporarily -- over her conviction for writing prescriptions for Anna under false names.

According to court documents, Dr. Khristine Eroshevich and the The Medical Board of California reached a settlement ... in which the doc admitted to her conviction of a crime in the Anna Nicole case -- and making false statements in a psychiatric report, unrelated to Anna Nicole.

As a result the Board is suspending Eroshevich's medical license for 90 days and putting her on probation for 5 years.

A jury convicted Eroshevich of a felony in October 2010 -- but in 2011 a judge knocked it down to a misdemeanor ... and she was sentenced to one year probation.

As part of her Medical Board discipline, Eroshevich will also have to undergo a psychiatric evaluation and take an ethics course.

source: http://www.tmz.com/2012/04/02/anna-nicole-smith-doctor-khristine-erosovich-medical-license-suspended/#.T3ql5tn64zA

Aspirin may inhibit spread of cancer

SYDNEY —Aspirin and other household drugs may inhibit the spread of cancer because they help shut down the chemical “highways” which feed tumors, Australian researchers say.

Scientists at Melbourne’s Peter MacCallum Cancer Centre said they have made a biological breakthrough helping explain how lymphatic vessels—key to the transmission of tumors throughout the body—respond to cancer.

“We’ve shown that molecules like the aspirin… could effectively work by reducing the dilation of these major vessels and thereby reducing the capacity of tumors to spread to distant sites,” researcher Steven Stacker said.

Doctors have long suspected that non-steroidal anti-inflammatory drugs such as aspirin may help inhibit the spread of cancer but they have been unable to pinpoint exactly how this is done.

By studying cells in lymphatic vessels, the researchers found that a particular gene changed its expression in cancers which spread, but not when the cancer did not spread.

The results published in Cancer Cell journal reveal that the gene is a link between a tumor’s growth and the cellular pathway which can cause inflammation and dilation of vessels throughout the body.

Once these lymphatic vessels widen, the capacity for them to act as “supply lines” to tumors and become more effective conduits for the cancer to spread is increased.

But aspirin acts to shut down the dilation of the vessels.

“So it seems like we have found a pivotal junction point in a biochemical sense between all these different contributors,” Stacker said.

The discovery could lead to new and improved drugs which could help contain many solid tumors, including breast and prostate cancer, as well as potentially provide an “early warning system” before a tumor begins to spread.

Last year, a study published in medical journal The Lancet found that rates of cancer of the colon, prostate, lung, brain and throat were all reduced by daily aspirin use.

Many doctors recommend regular use of aspirin to lower the risk of heart attack, clot-related strokes and other blood flow problems. A downside of extended daily use is the risk of stomach problems.

source: japantoday.com