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British Medical Association Responds To Government's Working Time Directive Training Review
Responding to Health Secretary Alan Johnson"s announcement of a review on the impact of the European Working Time Directive on doctors" training, Dr Andy Thornley, Chair of the BMA"s Junior Doctors Committee, said:
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Poor Working Conditions For Docs May Affect Quality Of Care
"Adverse working conditions for primary care doctors, including time pressures and an unfavorable organizational culture, may lead to stress, burnout, and ultimately to lower quality patient care, a new study found," MedPage Today reports. The study, published in the July 7 issue of The Annals of Internal Medicine, found that "53.1% of primary care physicians reported time pressure during physical examinations, while 48.1% reported chaotic working environments. Only 23.7% felt that quality was strongly emphasized in their practices. ... Moreover, 48.8% described their jobs as moderately or highly stressful, while 26.5% reported burnout, and 30.1% said they were at least moderately likely to leave their practices within two years." The authors wrote that the findings "are disturbing at a time when recruitment and retention in primary care are of major concern."
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USAID Programs Used Biblical Lessons To Teach Abstinence In Africa, Audit Finds
The U.S. Agency for International Development funded programs that used biblical lessons to promote sexual abstinence in Africa, despite a prohibition on the use of taxpayer funds to support "inherently religious activities," according to a recent audit by the agency"s inspector general, the Washington Post reports.The audit focused on projects initiated from 2006 to 2007 during the administration of President George W. Bush. According to the audit, the use of Christian stories in HIV/AIDS prevention programs in Africa could be seen as showing a "USAID-funded preference for Christianity." The audit also found that officials in one faith-based abstinence program in Africa urged youth to memorize and recite a passage from the Bible"s book of Psalms. Participants were then instructed to recite the passage"s "key concept": "God has a plan for sex and this plan will help you and protect you from harm."USAID challenged the findings in a written response that said its African programs" main goals are secular in nature. It acknowledged that some of its abstinence programs included "religiously infused materials" but said that the materials showed no preference for Christian groups.According to the Post, the issue has been complicated by legal ambiguities over whether the separation of church and state applies to programs for promoting U.S. foreign policy abroad. The inspector general"s report said the Department of Justice is considering a request from USAID to determine the legality of its practices (Lynch, Washington Post, 7/23).
Diagnostics

Misdiagnosis Of Disorders Of Consciousness Still Commonplace

A sixteen-month study of consensus-based diagnosis of patients with disorders of consciousness has shown that 41% of cases of minimally conscious state (MCS) were misdiagnosed as vegetative state (VS), a condition associated with a much lower chance of recovery. Researchers writing in the open access journal BMC Neurology have demonstrated that standardized neurobehavioral assessment is more sensitive than diagnoses determined by clinical consensus. Steven Laureys, from the University of Liege, Belgium, worked with a team of researchers, including Caroline Schnakers and Joseph Giacino, to compare consensus-based diagnoses of VS and MCS to those based on the JFK Coma Recovery Scale-Revised (CRS-R), a well-established standardized neurobehavioral rating scale. Laureys said, "Differentiating the vegetative from the minimally conscious state is often one of the most challenging tasks facing clinicians involved in the care of patients with disorders of consciousness. Misdiagnosis can lead to grave consequences, especially in end-of-life decision-making". The researchers prospectively followed 103 patients with mixed etiologies and compared the clinical consensus diagnosis provided by the physician on the basis of the medical staff"s daily observations to diagnoses derived from the CRS-R. They found that of the 44 patients diagnosed with VS based on the clinical consensus of the medical team, 18 (41%) were found to be in MCS following standardized assessment with the CRS-R. According to Laureys, "It is likely that the examiners" reliance on unstructured bedside observations contributed to the high rate of misdiagnosis of VS patients. Unlike traditional bedside assessment, the CRS-R guards against misdiagnosis by incorporating items that directly reflect the existing diagnostic criteria for MCS, and by operationalizing scoring criteria for the identification of behaviors associated with consciousness". The researchers conclude, "The results of this study suggest that the systematic use of a sensitive standardized neurobehavioral assessment scale may help decrease diagnostic error and limit diagnostic uncertainty". Notes: Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment Caroline Schnakers, Audrey Vanhaudenhuyse, Joseph Giacino, Manfredi Ventura, Melanie Boly, Steve Majerus, Gustave Moonen and Steven Laureys BMC Neurology 2009, 9:35 doi:10.1186/1471-2377-9-35 http://www.biomedcentral.com/1471-2377/9/35/ Graeme Baldwin BioMed Central


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