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(1) Dispersing asylum seekers may increase HIV burden
(1) Dispersing asylum seekers may increase HIV burden
(Dispersal of HIV positive asylum seekers: national survey of UK healthcare
providers) 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{at}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) 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{at}admin.ox.ac.uk
or Professor Julian Savulescu, Uehiro Chair in Practical Ethics, University of
Oxford, UK Email: julian.savulescu{at}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) 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{at}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) 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{at}jrchcn.ac.jp
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(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
http://bmj.com/cgi/content/full/329/7461/322
http://bmj.com/cgi/content/full/329/7461/346
http://bmj.bmjjournals.com/cgi/reprint/bmj.38173.577697.55
http://bmj.com/cgi/content/full/329/7461/352
(contact: pressoffice{at}bma.org.uk)
Student BMJ
Asylum seekers' care
UK medical students have published unreleased government plans to restrict failed asylum seekers' access to medical care
