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  1. WHO warning as attacks on health workers increase

    There were almost 600 reported attacks on healthcare facilities and workers in 19 countries in just two years, the World Health Organisation has reported.

    And trying to meet the needs of people in emergency situations is not only “increasingly challenging”, the needs are “unprecedented”, the organisation warns.

    In its first report on attacks on health care in emergencies, WHO says that in 2015, an estimated 125 million people affected by emergencies needed assistance – the biggest number on record.

    Between January 2014 and December 2015, there were 594 reported attacks on health care that resulted in 959 deaths and 1,561 injuries in 19 countries where they were operating in emergency situations.

    More than half of the attacks were against healthcare facilities, while one quarter was against healthcare workers. Sixty-two per cent of the attacks were reported to have intentionally targeted health care.

    The report says limitations of the available information highlighted the importance for more and better data collection. The report’s authors also called for standard definitions and classifications to be introduced that will enable comparisons to be made of information from multiple sources.

    Health care is consistently identified by emergency-affected populations as among their top priorities for humanitarian assistance and addressing health needs during emergencies not only saves lives, it can improve longer-term health outcomes and strengthen global health security, says the report.

    But it is complex, the report says.

    “In addition to delivering ongoing health programmes, healthcare workers must also address additional needs that can include conflict-related injuries, increases in infectious diseases and outbreaks, malnutrition, mental health problems and gender-based violence,” continues the report.

    "The health emergency workforce face huge challenges, including overwhelming demands, insufficient resources, ongoing insecurity, lack of training, supplies and medicines, heightened anxiety and fear on the part of patients and families, limited access, bureaucratic hurdles, stress and exhaustion.

    “The most disturbing challenge for health care providers during emergencies is when they themselves are the victims of attacks – real or threatened, targeted or indiscriminate,” the report says.

    “Yet we witness with alarming frequency a lack of respect for the sanctity of health care, for the right to health care, and for international humanitarian law: patients are shot in their hospital beds, medical personnel are threatened, intimidated or attacked, hospitals are bombed.”

    For the report, WHO analysed available secondary data from open sources on individual attacks on health care in emergencies. Attacks are defined as any act of verbal or physical violence or obstruction or threat of violence that interferes with the availability, access and delivery of curative and/or preventive health services during emergencies.

  2. Surgeons back non-medical practitioners

    Doctors must do more to support non-medical practitioners, according to senior surgeons.

    Surgeons in particular should ensure these practitioners are part of the surgical team, according to the Royal College of Surgeons.

    The findings come from a study of the roles of practitioners, including physician associates, surgical first assistances and advanced nurse practitioners, in eight centres.

    The report finds that the practitioners can build up "significant" expertise in their area of work - but were often isolated and lacked contact with peers.

    The RCS says Health Education England should consider whether enough physician associates are being trained - and whether they get enough exposure to surgery during clinical placements.

    As part of the surgical team, the associates can help give more flexibility to doctors in training, the report says. They can enable them to leave the wards to attend teaching, clinics and theatres.

    They can also allow trainees to position themselves at the best point in the theatre for learning and help new doctors settle into rotations, the report says.

    They can also reduce the number of occasions that senior surgical trainees are called out of theatre.

    The report says there was no evidence that increased use of practitioners diluted surgical training for doctors.

    Orthopaedic trainee Johnny Matthews said: “Surgical rotas are becoming increasingly difficult to fill, with patient care maintained by the goodwill and hard work of those junior doctors present, often at the detriment to their own training.

    "The extended surgical team can realise its potential when designed to complement rather than substitute junior doctors, allowing better allocation of tasks and an opportunity to really improve surgical training alongside patient care as we have seen in the various case studies in the report."

    College vice-president Ian Eardley said: “Surgeons support non-medical roles being more deeply integrated into surgical and medical teams. At the sites we visited many were highly trained and experienced practitioners helping to provide better continuity of care for patients and improve surgical training for junior doctors.

    “Practitioners we spoke to often lacked peers to share ideas with and felt they played an isolated role in the wider team.

    “If we as surgical leaders don’t do more to align them with our profession, making them feel part of the surgical team, the benefit this vital workforce brings to patient care will not be fully realised.”

  3. Europe moves against colistin misuse

    New European rules could restrict the use of the antibiotic colistin on farms, it was announced yesterday.

    The rules will call for strict national targets for reducing colistin use - and says the maximum level should be 5mg per population correction unit.

    The European Medicines Agency has drawn up the proposed rules for the European Commission after the discovery of new resistance genes finding their way into colistin.

    The mcr-1 gene can jump between bacteria and was first detected in South China but has now been found in Europe.

    The EMA says colistin should be reclassified so it is only used for treating infections in animals for which there are no effective alternatives.

    Meanwhile UK Prime Minister David Cameron is to tell a summit of world leaders that tackling antimicrobial resistance was a priority for him.

    Speaking to the G7 summit in Japan, he is to promise "tough" new targets for reducing overuse of antibiotics by 2020.

    His announcement comes after GPs successfully reduced antibiotic prescribing last year by 7% following a national campaign.

    He will say that the NHS will be ordered to reduce antibiotic prescriptions by 2.1 million a year. He will argue that 10% of the 42 million prescriptions issued annually in England are inappropriate.

  4. Leaks reveal contract dispute secrets

    BMA leaders brushed aside embarrassing revelations last night about junior doctor discussions during the contract dispute.

    A leak of 1,000 pages of messages suggests the BMA junior doctors committee planned to "tie the Department of Health up in knots for the next 16-18 months."

    The plan was to draw the dispute out with "punctuated action for a prolonged period," the Health Service Journal, which obtained the messages, claimed.

    The BMA said the messages reflected the "anger and frustration felt by junior doctors across the country due to the government’s refusal to listen to their concerns."

    The journal said the messages highlighted divisions in the BMA. Two members of the junior doctor committee's executive resigned earlier this month - and messages criticised the BMA leadership.

    It says the messages show that some committee members felt pay was the key issue, not safety. One executive member described weekend pay as "the only real red line."

    Committee chair Dr Johann Malawana is cited as discussing an overall increase in pay that might lead the juniors to concede on the weekend issue.

    But he told members that the abortive talks in January were "rubbish" and the BMA should only take part to "play the political game of always looking reasonable."

    Meanwhile JDC chair Dr Johann Malawana has been quoted as calling for junior doctors to stop "scaremongering" about the negotiated contract.

    The Guardian obtained access to private forums and cited Dr Malawana as saying that some posts were "simply scaremongering and abusive."

    It says he has come under attack for apparently conceding the government's plans for a seven-day service.

    In his responses, he continues to insist that junior doctors must study the detail of the proposed contract before reaching a verdict.

    The paper quotes him as describing "people that are trying to hijack the legitimate concerns of a group of employees and use that groundswell to prove political points."

    He adds: "The vast majority of doctors I have talked to though don’t want to have this dispute hijacked for political reasons and want the focus to be on getting the best deal for members."


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