Junior doctor posts may be scrapped in favour of nurse jobs as the Department of Health reorganises training for healthcare professionals
A briefing document by NHS Employers outlines Department of Health proposals to cut central funding given to hospitals to cover the base salaries of junior doctors.
At present 100 per cent of a first year junior doctor’s base salary (£23,000) is funded by the DH in recognition of the fact that they require almost constant supervision and training.
But under proposals circulated to teaching hospitals last week, only 80 per cent would be covered.
Funding to cover the salaries of junior doctors in their specialty training years would be drastically cut from 100 per cent for years three and four to 40 per cent and 25 per cent respectively. The changes mean hospital trusts would have to make up the rest of the salaries themselves.
The changes are being made to free up funding to better fund training places for nurses, midwives and all other healthcare professionals.
Discussions on the changes to the way clinical training is funded are being led by Medical Education England, which was set up after the 2007 debacle over junior doctor training posts when the new Medical Training Application Service was introduced.
A source close to Medical Education England said there were now concerns the proposals could “tip the balance” for some trusts, as they drop training posts for some specialties or dispense with junior doctors altogether.
Source: Nursing Times
A £15 set of electrodes could help doctors read a patient's mind during a general anaesthetic.
Not only will this ensure the patient is properly anaesthetised, but because doctors will be able to monitor the effect of the anaesthesia more accurately, this will reduce dosages, so patients will wake up less woozy, and cut the risk of overdose.
The pioneering device, known as cerebral function monitoring (CFM), means doctors can assess anaesthetic levels accurately first off - ensuring the patient remains asleep throughout the operation.
During the procedure, three silver electrodes are taped to the patient's forehead - these continually monitor brain function, relaying information back to the anaesthetic machine and a monitor. The new system helps the anaesthetist maintain regular brain signals, ensuring the anaesthetic is working effectively.
“This is incredibly exciting,” says Dr David Coates, consultant anaesthetist at Spire Hospital Bristol and Bristol Royal Infirmary, who has used CFM regularly and successfully.
“It allows constant finetuning of the amount of anaesthetic being delivered in a way we've never been able to do before.”
Source: Daily Mail
Reports from the department of anaesthesiology, Banaras Hindu University show there is an acute shortage of anaesthetists in India.
Dr Mathur, who is the general secretary of Indian Society of Anaesthesiologists (ISA), Varanasi Branch said that demand for fully trained and qualified anaesthesiologists in the country is ever increasing, he also emphasised the need for growing public awareness about recent advances in the field.
“One needs to understand that role of trained anaesthesiologists has diversified in recent years, and they are taking care of a number of super specialty health care services, especially the post-operative treatment of critical patients” he said. “Now, they offer services in various multi-speciality areas including neuro, paediatric and cardiac anaesthesia besides pain and palliative services to relieve pain of critically ill patients.”
However, his concern for shortage of trained anaesthesiologists in the region was also evident, as he indicated that the scarcity is leading to a situation, where critical cases are being handled by untrained staffs, inadequate to handle such emergency situation.
“These days anaesthesiolists are handling delicate health services like cardio-vascular and cardio-respiratory resuscitation and these services demand adequate training and pin point accuracy to read the situation. Similarly, other critical care services like ozone therapy also need training” Dr Mathur added.
Source: Times of India
Setting targets for NHS performance failed to win over the ‘hearts and minds’ of NHS staff, health secretary Andy Burnham has admitted.
Speaking to the Urban Institute think tank before a meeting with President Obama’s health taskforce, health secretary Andy Burnham said he understood why staff thought the drives signalled a lack of trust on the part of central Government.
But he also insisted that Labour had been right to introduce targets when it first came to power.
“Targets drove the system hard and were the right thing to do,” he said.
“Looking back now, I can see that the emphasis began to imply a lack of trust in staff at the frontline that became disempowering.”
Labour has been fiercely criticised for introducing what many view as an overwhelming number of targets, with patients groups suggesting the practice has caused less well-known issues to be ignored.
Mr Burnham said many of the targets would be scrapped over the coming months, but added that the 18-week operation guarantee would remain in place, as would the aim to see all patients entering A&E within four hours.
Source: Nursing Times
Swine flu may create a shortage of intensive-care unit beds for U.K. children, leaving medical professionals struggling to cope in the pandemic, according to a report in today’s Archives of Disease in Childhood.
Doctors at Cambridge University and Addenbrooke’s Hospital estimated that 3.8 percent of under-15s hospitalized with swine flu in the U.K. will require intensive care. If just 2 percent of children who contract the illness require hospitalization, almost all of the U.K.’s available 303 pediatric ICU beds in 25 centers will be occupied, according to the findings. If 1 percent is hospitalized, half of the existing capacity will be filled, the researchers said.
“It appears inevitable that pediatric ICUs will experience significant additional pressure this winter from admissions due to the pandemic,” the authors, led by Ari Ercole of the Cambridge University Department of Anaesthesia, wrote in the journal.
The shortages may be more acute in some regions because the provision of ICU beds varies around the country, the researchers wrote. Hospitals in London, Yorkshire and the Humber and the Northeast are well equipped with pediatric ICU beds, while those in Wales, the southeast coast and east of England are not as well served, according to the report.
Source: Bloomburg News
In October NICE said the National Health Service would save 600 million pounds per year if certain guidance was adhered to, and highlighted the relevant documents within which the claimed savings lay.
In a statement on its website, the cost-effectiveness body said it was publishing a range of recommendations pulled from its guidance which would benefit the NHS in "challenging" financial times, if they were adhered to.
NICE said over its 10-year existence, it had made 150 recommendations which could save the NHS money, either in direct cash terms or by using resources more effectively elsewhere.
The highlighted guidance included measures that entailed both spending money now to save spending more in the future and cutting ineffective treatments. It includes several which have a potential effect on drug use.
Giving very brief details of its reasoning with references to the full guidance, NICE said in the case of hypertension, its update recommended greater use of drugs to control the condition.
"Following the revised recommendations will cost more in drugs, but this is far outweighed by the predicted number of cardiovascular events that will be avoided if hypertension is better controlled," it said.
NICE's leaders, Andrew Dillon and Mike Rawlins had previously come under pressure from members of parliament investigating NHS spending for not finding enough procedures that the health service could simply stop carrying out to save money.
Source: Binleys News
e-LfH’s e-Learning Anaesthesia project won gold for ‘best online or distance learning project’ at the e.learning age awards ceremony held in London in November.
The judges were ‘bowled over’ by this initiative, and were impressed by the way ‘it has been enthusiastically embraced by both trainees and exceeded its objectives’.
e-Learning Anaesthesia (e-LA) is an interactive online resource supporting training and professional development in the specialty of anaesthesia. Self-directed learning is encouraged and users can access the learning resources at a time and place that suits their individual needs.
Developed by the Royal College of Anaesthetists in partnership with DH e-Learning for Healthcare, it is available for free to anaesthetists practising in the NHS.
Ed Hammond and Andrew McIndoe, Clinical Leads for the e-LA project, said “We are delighted to have won this award which recognises the efforts, commitment and expertise of our authors, editors and development team who have worked together to produce a learning resource of outstanding quality for anaesthesia and the NHS.”
For more details visit
www.e-LA.org.uk, or email
e-LA@rcoa.ac.uk.
Servomex is offering the Paracube Micro oxygen sensor from Hummingbird Sensing Technology for use in critical-care medical applications.
Offering a full measurement range of 0-100 per cent O2, the Micro utilises Servomex's paramagnetic oxygen-cell technology.
With the non-consumable design meaning zero ongoing cost of ownership and the elimination of daily calibration, the Micro offers easy integration within critical care ventilators, anatomical anaesthesia, patient monitoring and other life-critical health-care applications.
The Micro measures 33.5 x 30 x 46.5mm, is supported by bespoke housing options and a choice of analogue or digital signal output and enables easy physical and system integration into a variety of host instruments.
As a consequence, the Micro can also be used in a variety of industrial applications, including area monitoring and general gas analysis.
Medical devices company Aircraft Medical has signed seven separate agreements with distributors in Asia as it looks to roll out its latest product.
The string of deals will allow the firm to distribute the McGrath Series 5, which it claims is the world’s first fully portable video laryngoscope.
Aircraft chief executive Matt Mcgrath said: “The signing of these distribution agreements for the McGrath Series 5 in the Asian Pacific region is affirmation of Aircraft’s commitment to expanding our anaesthesia and critical care product offering in key global markets.
“Aircraft has a growing network of dedicated distribution partners in the region, including Australasia and India. We look forward to recording strong sales in this territory in the near future.”
Issue: December 2009
Combination of pharmacological treatment and surgery
The research, published in the journal Pediatrics, follows on from studies showing hypnosis is an effective treatment for a range of conditions known as functional abdominal pain, which includes things like irritable bowel syndrome.
In this study, the children had 20 minute sessions of “guided imagery” - a technique which prompts the subject to imagine things which will reduce their discomfort.
One example is letting a special shiny object melt into their hand and then placing their hand on their belly, spreading warmth and light from the hand inside the tummy to make a protective barrier inside that prevents anything from irritating the belly.
The researchers, from the University of North Carolina and Duke University Medical Center, said a lack of therapists led them to the idea of using a CD to deliver the sessions.
Thirty children aged between six and 15 years took part in the study - half of whom used the CDs daily for eight weeks and the rest of whom got normal treatment. Among those who had used the CDs, 73.3% reported that their abdominal pain was reduced by half or more by the end of the treatment course compared with 26.7% in the standard care group.
In two-thirds of children the improvements were still apparent six months later.
It is not clear exactly how the technique works but studies have shown it is partly about reducing anxiety but there is also a direct effect on the pain response.
Some researchers think hypnosis-like techniques reduce “hypersensitivity” in conditions such as irritable bowel syndrome.
Study leader Dr Miranda van Tilburg said it was especially exciting that the children were able to use the technique on their own.
Such self-administered treatment is, of course, very inexpensive and can be used in addition to other treatments, which potentially opens the door for easily enhancing treatment outcomes for a lot of children suffering from frequent stomach aches.
“Children are very good at using their imagination - when you use this in adults you have to overcome a barrier first.”
Professor David Candy, a consultant paediatric gastroenterologist at Western Sussex Hospitals, said his team had tried hypnosis in a small group of children with severe abdominal pain problems and had 100% success rate.
He added they are now keen to try the guided imagery technique to see if they can replicate the US findings.
There is really a dearth of information on how to manage children with abdominal pain and it’s a very common problem which keeps children out of school.”
Source: BBC News
Pan-European clinical trials led by Cork University Hospital assesses whether lumbar puncture skills can be accurately assessed on computers, at zero risk to patients
SensAble Technologies, Inc., announced that its customer, the Cork University Hospital, is leading clinical trials in two European hospitals using a haptically-enabled computer simulation system for testing physician competency in administering spinal anaesthesia. SensAble is a manufacturer of haptic devices and toolkits, and its PHANTOM® force-feedback haptic devices and programming technologies were used to develop this simulator. The clinical trials at Cork University Hospital in Ireland and the University of Pecs in Hungary explore whether virtual reality simulations can accurately assess high-risk clinical skills without the need for physicians to practice on patients.
With spinal procedures potentially causing irreversible injury to patients, and an adverse affect rate of up to 30 percent - from spinal headaches to cardiac arrest, neurological impact and even death1 - they present a compelling case for the role of computer-based simulators to train physicians on procedures that require a delicate sense of touch. The trials are the culmination of a two-year project, Medical Competency Assessment Procedure (MedCAP), financially supported by the European Commission through the Lifelong Learning Programme, Leonardo da Vinci sub programme. If successful, MedCAP’s creators envision future teaching and testing applications in other specialties.
“Placing a fine needle very close to the spinal cord requires the operator to feel very small changes in resistance as the needle tip passes through each anatomical structure. Traditionally this has been learned by practising on patients under supervision. Clearly that is not ideal. Furthermore, in today’s clinical setting, medical trainees have fewer opportunities to practice,” said Prof. George Shorten, director of the anaesthesia department at Cork University Hospital. “We can’t assume that practitioners can perform high-risk procedures just because they have been licensed for a certain number of years, or because they answered questions correctly on an exam. Touch-enabled computer simulators allow a variety of clinical cases to be presented, and provide objective and quantifiable metrics which together describe physician competence. These learning opportunities pose zero risk to patients while physicians demonstrate competency.”
Led by the Cork University Hospital, the MedCAP team developed a virtual reality computer-based simulator with which anesthetists hold a SensAble haptic device – like a high-precision Nintendo Wii – as 3D computer screens direct them to perform a lumbar puncture procedure. The haptic device literally pushes back on the user’s hand so they feel surface tension as the spinal needle meets the skin; a “pop” as it punctures the skin; and the different viscosities of tissue, ligaments, cerebrospinal fluid and dura mater, the tough outer layer of the meninges surrounding the spinal cord. Should trainees puncture too far and enter the other meninges or the spinal cord itself - or puncture only into the skin - they feel different sensations and receive immediate alarms and on-screen error messages.
In the clinical trials, groups of skilled anaesthetists and residents-in-training must perform a lumbar puncture on six virtual patients who present at different ages and complications, and answer a battery of clinical care questions. The simulator is blind to the user’s experience level, merely recording and scoring them on nearly 200 competencies and calculating a score that suggests the user is either a knowledgeable practitioner, or a trainee. Users receive detailed feedback on their performance, so that they can practise any areas of weakness until they achieve competency. Once clinical trials are completed this fall, results are expected to show that the practicing anaesthetists score better than residents-in-training - suggesting the simulator is a valid competency assessment tool.
“It’s not enough to train specialists with the traditional ‘do one, see one, teach one’ approach to learning by apprenticeship on patients,” said Erik Lovquist, researcher at the University of Limerick’s Interactive Design Center, who was technical lead of the collaboratively developed haptically enabled simulator. “The MedCAP-system offers the potential to assess competence of those performing other high stakes medical procedures in a valid and reliable way”.
The MedCAP partnership includes the Interaction Design Centre, University of Limerick, Ireland and the University Graz, Austria as well as the clinical centers in Cork and Pecs. Its approach is based on the competence-based knowledge space theory, developed by Dietrich Albert and the team at the University of Graz.
“With today’s haptic devices and toolkits it’s possible to create computer-based systems that mimic and quantify even the most subconscious aspects of human touch,” said Dr. David Chen, chief technology officer of SensAble Technologies. “The MedCAP project showcases the invaluable role that haptically-enabled simulators can play in medical certification, beyond its already – demonstrated role in training – and the sophistication that SensAble’s haptics technology allows.”
Source: Reuters
The website is www.medap.eu
