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  1. 200 still wait for foundation places

    Concerns are growing about the ability of this year's Foundation Programme to find training places for all graduates.

    The first batch of reserve list applicants was allocated to places yesterday - leaving many more waiting for places than in previous years.

    Some 352 applicants have been waiting for places and fewer than half of these - some 133 - have now been found places.

    The programme has been oversubscribed for some years - but in previous years has always found places for all applicants left on its lists by the end of July.

    There are now 213 applicants on the reserve list. A year ago 133 students remained without a place after the first round of allocations from the reserve list.

    Programme national director Professor Derek Gallen said it was "still" a difficult time for the 213 applicants still waiting for places. The next round of allocations is due to be announced at the end of June.

    Places become vacant as applicants withdraw from the process - some may take "gap years" - or fail their courses.

    Professor Gallen said: “I am pleased that 133 reserve list applicants have been allocated on the first batch allocation date but understand that for those applicants who have not yet been allocated to a foundation school it is still a difficult time.

    "We will continue to support these applicants until the end of the process.”

  2. UK and Ireland face paracetamol overdose questions

    Britain and Ireland have much higher rates of liver failure caused by paracetamol overdoses than most of the rest of Europe, researchers warned yesterday.

    In the UK the rate of liver failure is twice the European average - while in Ireland it is six times as high, according to a major study in the British Journal of Pharmacology.

    Paracetamol overdose has been a common way of attempting suicide - but it can also be caused by overuse of the drugs.

    The requirement that pills should be sold in blister packs in the UK had helped to reduce overdoses by preventing desperate people consuming handfuls of pills.

    Researchers found one case in three years for every 286,000 people in Ireland - but in Italy there was one case for every 180 million people.

    The study also examined France, Greece, the Netherlands and Portugal.

    Researchers studied records of patients placed on waiting lists for liver transplant - indicating they had suffered liver failure but had not died immediately as a result of the overdose.

    They report that paracetamol overdose was responsible one in six cases of liver failure.

    Researcher Sinem Ezgi Gulmez, the associate Professor of Pharmacology at the University of Bordeaux, France, said: “Since we do not have event rates for overdoses not leading to liver failure, we cannot conclude anything about the rates of non-acute liver failure leading to transplant overdoses in the different countries, but indicators point to more common use of paracetamol for self-poisoning in these countries.

    “The differences in the figures for harm caused by paracetamol within different countries in Europe are not marginal, and suggest that there are some underlying causes.

    "Paracetamol overdose is a serious public health issue and we should start looking into hepatotoxicity associated with paracetamol at normal doses."

    Gulmez S.E. et al. Liver transplant associated with paracetamol overdose: results from the 7-country SALT study. British Journal of Clinical Pharmacology 28 May 2015; doi: 10.1111/bcp.12635 [abstract]

  3. GPs urged to update STD knowledge

    Many British GPs may be using out of date treatments for patients with gonorrhoea, it was claimed today.

    The drug ciprofloxacin ceased to be a recommended treatment for the disease a decade ago - but as recently as 2011 it was used for 20% of treatments, according to the study.

    The research showed the 2005 guidelines had little immediate effect as in 2007 the drug was responsible for 42% of prescriptions.

    More than a third of cases of the disease involve bacteria that are resistant to the drug.

    The study, in BMJ Open, also concludes that most patients with chlamydia are treated correctly.

    GPs were responsible for 17,000 diagnoses of gonorrhoea and 193,000 diagnoses of chlamydia between 2000 and 2011.

    This represents a minority of cases as most patients are diagnosed in specialist clinics.

    Researchers from Public Health England studied a database with records from 680 practices to reach their conclusions.

    Researcher Dr Gwenda Hughes writes: “Antimicrobial resistance in gonorrhoea is a global problem and may become an issue for Chlamydia in future.

    “Practitioners should be alert to the likelihood of revisions to national treatment guidelines and of treatment failure in their patients.”

    Diagnosis and treatment of chlamydia and gonorrhoea in general practice in England 2000-2011: a population-based study using data from the UK Clinical Practice Research Datalink BMJ Open 29 May 2015; doi 10.1136/bmjopen-2015-007776 [abstract]

  4. Call to cut pregnancy transfusion risk

    Pregnant women may sometimes need blood transfusions - and new guidelines today set out how British doctors are expected to reduce the risks linked to these.

    Haemorrhage remains one of the main causes of maternal death in the UK - and more than 4,000 pregnant women a year may suffer from this problem.

    Women with severe anaemia may also be deemed to need transfusions.

    The new guidelines call for hospitals to have protocols to ensure multi-disciplinary teams, including haematologists and anaesthetists, are involved as soon as possible.

    They also call for preparations to be made at an early stage by screening women for anaemia as early as possible and by checking blood group and antibody status early also.

    The guidelines say iron pills should be used to tackle iron deficiency to reduce the risk of needing a blood transfusion in labour.

    Experts at the Royal College of Obstetricians and Gynaecologists warn that blood transfusion carries risks, including those of infection and transmission of prion diseases - together with potential shortages of blood and the costs of the procedure.

    Dr Manish Gupta, who led the guideline committee, said: “Blood transfusion may be a life-saving procedure, but it is not without risk. Rarely, recipients may develop transfusion-transmitted infection or have a negative reaction to it. The major risk, however, is of a patient receiving an incorrect blood component.

    “Strict adherence to correct sampling, cross-match and administration procedures is therefore of paramount importance, even in an emergency.”

    Dr Laura Green, a consultant in transfusion medicine, said: “All maternity units should have a clear local protocol on how to manage major obstetric haemorrhage, which should include early involvement of a consultant obstetrician, anaesthetist, haematologist and the blood bank.

    “The protocol should be updated annually and practised in ‘fire drills’ to inform and train relevant personnel.”


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