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Tuesday, November 8, 2011

Disciplined doctor returns to NHS

 Guy's and St Thomas' Hospital said Mr Lauffer is working in a non-surgical role A surgeon disciplined for carrying out operations "beyond his competency" and not disclosing "restrictions" placed on him is working in a London hospital.

Gideon Lauffer was suspended for six months by the General Medical Council after it found him guilty of serious professional misconduct and dishonesty.

The cases happened when he was at King George Hospital, Ilford, in 2007-08.

Guy's and St Thomas' Hospital said the doctor is working in a non-surgical role and is under "close supervision".

The allegations relate to incidents in 2007 and 2008 when Mr Lauffer worked as a consultant general surgeon at Barking, Havering and Redbridge Hospitals NHS Trust and was in private practice at Spire Roding Hospital and the Spire Hartswood Hospital.

Continue reading the main story
The Panel is satisfied that your actions and omissions amount to misconduct and that such misconduct is serious”

End Quote Ruling in 2010 An independent panel found he "acted outside area of competency" when he performed laparoscopic incisional hernia repair in September 2007 on a patient, known as AS, as he had no formal training for it.

He also performed a surgery in March 2007 which later led to damage to the patient's testicle, but he "did not acknowledge damage was as a result of surgery" to the patient.

Soon after the case of AS, the NHS Trust informed him that he could no longer perform some procedures, including laparoscopies and varicose vein surgery.

But he "failed to inform" the two private hospitals about the restrictions and in March 2008 carried out a part of a laparoscopy on a patient, unsupervised, and "failed to obtain informed consent".

The Panel Chair said: "The Panel is satisfied that your actions and omissions amount to misconduct and that such misconduct is serious.

"The Panel has already determined that your fitness to practise is impaired by reason of your misconduct."

Suspending him for six months the GMC recommended to the independent panel that he be struck off.

GMC 'role undermined'

But earlier this year a review placed conditions on his registration, including supervision.

The GMC's chief executive, Niall Dickson, said: "Our role is to protect patients. This is undermined when panels do not take the action we believe is needed to do this.

"We are pressing for the right of appeal of these decisions as part of our ongoing reforms."

Guy's and St Thomas' NHS Foundation Trust said Mr Lauffer was employed as a clinical fellow in the emergency medicine department.

"He has returned to work to retrain in a non-surgical specialty and works as a junior doctor under the close supervision of consultant staff.

"He was employed by the trust with full knowledge of the conditions placed on his practice by the GMC and remains in close contact with the GMC, as do the staff supervising his retraining."

Dutch row over male circumcision

3 November 2011 Last updated at 02:29 GMT By Anna Amsterdam  Jews in the Netherlands fear efforts to curb male circumcision are a threat to their faith Religious groups in the Netherlands have opposed a call from the Royal Dutch Medical Association (RDMA) for male circumcision to be discouraged.

Male circumcision is legal in the Netherlands but the body representing the country's doctors wants to end the practice.

The association is urging politicians to put it on the political agenda.

It is asking parents to think twice before having their sons circumcised because it regards the procedure as dangerous and unnecessary.

Yet others see it as the latest reflection of a political shift in a country that is increasingly pressuring religious groups to stop practising what they preach.

Growing opposition

The figures vary but it is estimated that globally 30% of men are circumcised, with about 15,000 boys undergoing the procedure here in the Netherlands every year.

In much of Africa, it is seen as a rite of passage in becoming a man, with boys being taken "to the bush" to spend days hidden away in this ceremonial transition.

In the United States, it is still a relatively common procedure. However, there is a growing lobby opposing it in many parts of the US.

In some states, support for the practice remains strong - protesters in San Francisco have just lost their battle to have it banned.

The World Health Organization says circumcision can help prevent HIV and that, if done properly, there is little chance of complications.

But here in the Netherlands, some doctors disagree. Gert van Dijk is a medical ethicist and one of the authors of the RDMA's anti-circumcision advice.

'We feel circumcision is a medically unnecessary form of surgery. The patient has to give consent, but children can't give consent and we feel that is wrong and a violation of the child's rights," he said.

"In our code of medical ethics, it states that you must not do harm to the patient, but with this procedure this is exactly what you're doing."

Continue reading the main story 
The motivation is plain Islamophobia. It's not a discussion about medical ethics”

End Quote Ibrahim Wijbenga Muslim from Eindhoven Religious freedom The RDMA are fighting against what is a deeply entrenched religious practice.

It is written in the Islamic text the Hadith that Muslim men should "cut the things that grow".

Ibrahim Wijbenga is a Muslim member of the Christian Democratic Appeal in the city of Eindhoven. He was circumcised as a child and, following the family tradition, he had his son circumcised too.

Ibrahim thinks claims that these discussions are medically motivated are nonsense and is campaigning to save the practice.

"It's not that we do something illegal or that we use a rusty knife. The boys in question are anaesthetised so they are looked after by the doctors.

"The motivation is plain Islamophobia. It's not a discussion about medical ethics, it's to make a lot of bad propaganda against Muslims and about our way of life and our religion," Mr Wijbenga said. "Basically, it's an effort to stop Muslims from entering Holland."

Muslims see the anti-circumcision drive as an attack on religious freedom

Jews, too, fear these anti-circumcision discussions are a serious threat to their faith.

"It's written in the Torah, in the Bible, that we should circumcise the child when the child is 8 days old. What God tells us to do, we must do," said Rabbi Jacobs, one of the Netherlands' most senior religious leaders.

He said that being advised not to circumcise babies would have a dramatic impact on the estimated 30,000 Jews living in the Netherlands. For him, it is worse than being told they cannot cultivate kosher meat.

'I can import (kosher meat) or choose to not eat it, but with circumcision I'm stuck. Even if I take my child to a different country to do it, once I come back the doctor will see that there has been a circumcision and put me in jail.

"If you interfere with this practice, it will totally end the Dutch Jewry in the Netherlands."

Rights of the child Continue reading the main story
When you do it with a boy, there's no way back... It made me angry that somebody else decided for me.”

End Quote Michael Schaap Documentary maker Even within the Jewish community, some - albeit a tiny minority - believe circumcision can leave a lasting psychological as well as a physical scar.

"He's grabbed, his legs are pulled apart, and they cut off part of his penis. Now what does it do to the boy's mind? I think it's wrong. I think boys or men have to decide for themselves."

Michael Schaap is speaking from experience. His Jewish parents had him circumcised as a baby. He believes it is "morally wrong to cut off any part of another person's body when there is no medical reason to do it. It's mutilation".

Michael made the controversial documentary "Mum, Why Was I Circumcised?" partly motivated by the anger he felt throughout his teenage years.

"When you do it with a boy, there's no way back. I don't know how sex would be with a prepuce. It made me angry that somebody else decided for me, to do something that I probably would not have done if I was deciding for myself."

Politicians here in The Hague have yet to respond to this increasingly intense public debate, which coincides with the imminent outlawing of ritual slaughter and the proposed burka ban.

Now many Muslims and Jews are concerned their fundamental traditions are under threat and that circumcision may be the next element of religious freedom to be withdrawn.

And that is essentially what makes this such a fiercely contentious issue: the rights of the child versus the rights of religion.

English diet 'could save 4,000'

 Should there be a junk food tax? Eating like the English could save 4,000 lives a year in Scotland, Wales and Northern Ireland, a study claims.

People in England eat more fruit and vegetables and less salt and fat, reducing heart disease and some cancers, say Oxford University experts.

A tax on fatty and salty foods and subsidies on fruit and vegetables could help close the diet divide, they add.

The British Heart Foundation says the study shows inequalities in the nations that must be addressed by authorities.

Death rates for heart disease and cancer are higher in Scotland, Wales and Northern Ireland than in England, according to official figures.

Continue reading the main story
This research isn't about bragging rights to the English or tit-for-tat arguments ”

End Quote Victoria Taylor Senior dietitian at the British Heart Foundation Diet is known to be an important factor. Last year researchers estimated that more than 30,000 lives a year would be saved if everyone in the UK followed dietary guidelines on fat, salt, fibre, and fruit and vegetables.

Now, the same experts - from the Department of Public Health at the University of Oxford - have turned their attention to differences within the UK.

They looked at whether deaths from heart disease, stroke and 10 cancers linked with poor diet could be prevented in Scotland, Wales and Northern Ireland, if everyone switched to the typical English diet.

They say the diet in England is far from perfect - but should be achievable in other UK countries.

Over the three years studied there were nearly 22,000 excess deaths in total. Scotland had 15,719, Wales 3,723 and Northern Ireland 2,329.

Hamburger tax

Lead researcher Dr Peter Scarborough of the Health Promotion Research Group said: "The chief dietary factor that is driving this mortality gap is fruit and vegetables.

Continue reading the main story The researchers looked at deaths from heart disease, stroke and 10 cancers in all four UK countries from 2007 to 2009They estimated calorie intake and 10 components in the diet - including fruit and veg intake, fat, and salt - in all four UK countriesThe data showed people in Scotland and Northern Ireland ate more saturated fat and salt, and fewer fruit and vegetables, every day than people in England, while differences between England and Wales were smallerOver the three years studied there were nearly 22,000 excess deaths in total. Scotland had 15,719, Wales 3,723 and Northern Ireland 2,329Changing the diet to a typical English one would save about 11,000 of these lives - or just under 4,000 a year - with the biggest impact in Wales and Northern Ireland"Consumption of fruit and vegetables in Scotland is around 12% lower than in England, and consumption in Northern Ireland is about 20% lower than in England. Consumption levels in Wales are similar.

"Other important factors are salt and saturated fat consumption, which are lower in England than in Wales, Scotland or Northern Ireland."

The researchers believe one way to tackle the "mortality gap" is to bring in food taxes.

Denmark recently introduced a tax on foods high in saturated fat, while other countries are toying with the idea of taxing fizzy drinks or high-calorie foods.

Dr Scarborough told the BBC that while the study did not consider the effectiveness of policies and interventions, the area should be investigated.

He said: "Junk food taxes and subsidies of fruit and veg could be a very important tool in addressing health inequalities in the UK."

Continue reading the main story Northern Ireland: Spokesperson for the Department of Health, Social Security and Public Safety: "Hopefully this research helps get the message out to the general public that we have to take responsibility for our own health and that our diet has a real impact on the quality and longevity of our lives."Wales: A Welsh government spokesperson said: "Our efforts remain focused on educating people about the importance of a healthy lifestyle, such as a healthy diet, regular exercise and sensible drinking in an effort to reduce obesity and therefore the risk of heart disease, and we have a number of initiatives already in place, such as Change4Life and the MEND and food co-op programmes, aimed at addressing these issues."Scotland: A Scottish government spokesperson said: "Overall, Scotland's cancer mortality rates are decreasing - down almost 12% over the past 10 years - and through our Heart Disease and Stroke Care Action Plan, we are continuing to work to reduce the number of Scots dying from these preventable conditions.The researchers say they used the English diet as their model not because it is particularly healthy, but because it is regarded as an achievable goal.

Victoria Taylor, senior dietician at the British Heart Foundation, said: "This research isn't about bragging rights to the English or tit-for-tat arguments about how healthy our traditional dishes might be.

"This is a useful exercise in comparing influential differences in diet across the UK, namely calorie intake and fruit and veg consumption. However, saying the rest of the UK should follow England's lead to cut heart deaths isn't a foolproof solution; a quarter of English adults are obese and only 30% eat their five-a-day.

"The findings have thrown up some clear inequalities in the four nations and our governments must do everything they can to create environments that help people make healthy choices."

The research is published in the medical journal BMJ Open.

GP receptionists 'play key role'

 Are receptionists the unsung heroes in general practice? GP receptionists play a "hidden" role in ensuring patients get the correct treatments when they need them, says a study in the British Medical Journal.

Researchers from Queen Mary, University of London, analysed how four UK surgeries organised repeat prescriptions.

They found that receptionists used their knowledge and experience to make a computer-based process run safely.

Training should not just focus on technology, says the study.

Repeat prescriptions are defined as prescriptions issued without a consultation between the GP and patient.

They account for up to three-quarters of all drugs prescribed and four-fifths of drug costs in UK general practice. Around half of all registered patients receive treatment by repeat prescription and rates are rising, the authors of the study say.

With electronic records and computer systems in most GP practices, patients assume that issuing these prescriptions is a simple, automated process.

But this study, in which researchers spent 395 hours directly observing the work of receptionists and other administrative staff, found repeat prescribing to be a complex, technology-supported social practice, requiring collaboration between clinicians and administrative staff.

Continue reading the main story
Receptionists in some practices expressed concern that doctors did not check prescriptions thoroughly before signing”

End Quote Deborah Swinglehurst Deborah Swinglehurst, lead study author and research fellow at the Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry at Queen Mary, University of London, said there was a gap between formal procedures and what actually happened on the ground in doctors' surgeries.

"This includes important 'hidden' creative work by front line reception staff."

'Tacit knowledge'

The study found that over half of the requests for repeat prescriptions were for items that either were not listed as repeats on the patient's electronic record or were listed by a different name, at a different dose, or as due earlier or later than the date they were requested.

As a result, issuing repeat prescriptions without first passing them to a GP for their attention "required explicit and tacit knowledge", the study said.

"For example, many were adept at using a formulary to match brand names with generic equivalents; they often telephoned patients to clarify ambiguous requests, and many kept (individual or shared) notebooks containing knowledge they had gleaned on the job."

Some receptionists, the study found, were aware of having to make up for the failings of their doctors.

"Receptionists in some practices expressed concern that doctors did not check prescriptions thoroughly before signing. They believed that because of this they had a heavy responsibility to undertake safety checks themselves, although these were not recognised or remunerated."

Despite not being accountable for certain aspects of quality and safety, reception staff still considered themselves informally accountable to the patient, the study added.

The study authors conclude that there is no best way of running repeat prescribing.

But they highlight the importance of ensuring that training for repeat prescribing goes beyond simply training receptionists on how to use their practice's computer system.

Writing about the research in an editorial in the BMJ, Professor Anthony Avery, professor of primary health care, University of Nottingham Medical School, said it was important to establish whether prescribing error rates vary much between general practices.

"If they do, the complex factors identified by Swinglehurst and colleagues need to be taken into account when designing and testing interventions aimed at improving safety.

"This might then produce better evidence to help guide general practices on the best ways of running their repeat prescribing systems to ensure safety while being responsive to patients' requests."

A spokeswoman from the British Medical Association said: "GPs recognise that receptionists have a very important part to play in the whole process."

'I find dating really stressful'

 Mark Savage finds dating "draining" and stressful Mark Savage has been on two dates recently and would like to meet a partner.

However, the 30-year-old from Berkshire said his dates were "draining and stressful".

Mr Savage has Asperger's syndrome, a condition which makes it hard for him to read facial cues or understand or respond to people's emotions.

"I have had one relationship, but it was quite short," he said.

"It takes me a while to judge people. I don't immediately respond to cues. I just can't jump into relationships."

Mr Savage said he had not sought relationships as a teenager and young adult, but had tried to "focus on his studies".

"I have A-levels in psychology, sociology, biology and I did media as well," he said.

"I tried studying ecology at the University of Sussex when I was 26, but I didn't gel with the people there."

Experts from Oxford and Cambridge University believe Einstein displayed signs of Asperger's

In recent years Mr Savage has gained more confidence in dealing with people socially.

He now works part-time as an admin assistant and lives with his parents in Finchampstead.

"In the future, I would like to have a stable job, and be living with a partner.

"People with Asperger's, we don't chat or gossip. We can seem rather dry.

"Dating takes us out of our comfort zones, so it would be good to have help with that."

It is hoped that people like Mr Savage living in Berkshire will now get the help they need to start dating, following a successful bid for £50,000 of NHS funding.

The bid was put together by the Ark Charity in Crowthorne, which runs events including a weekly clubbing night in Bracknell for people with learning disabilities.

The charity hopes to use this money to help people who have been diagnosed with conditions such as autism or Asperger's syndrome to find a partner, with an initiative called the Umbrella Project.

The charity hopes to provide volunteer dating chaperones and to give sex education advice to its clients.

Scott Waller, who works for the Ark on the Umbrella Project, said a survey of 105 clients who used the Ark's services found two thirds of them wanted to meet a partner.

"We also know there is a need for sex and relationship education for people with learning disabilities as there were seven unplanned pregnancies among women with learning disabilities in Bracknell last year."

Ms Waller said a 2001 Department of Health survey showed that being unable to form relationships led to people with learning difficulties to have feelings of isolation and reduced self-worth.

Continue reading the main story There were seven unplanned pregnancies among women with learning disabilities in Bracknell last yearMen are slightly more likely than women to have both severe learning disabilities and mild learning disabilities Of those diagnosed as being on the autistic spectrum, there are on average 4.3 males to 1 female."We have had people here who have met socially, we have had a couple of people who have got engaged," she said.

"A lot of people we help are on the autistic spectrum or have Asperger's syndrome.

"They behave differently to other people. They tend to have a limited social life and not that many achieve relationships."

The survey carried out by the Ark showed that major barriers to forming new friendships or relationships included lack of confidence, difficulties with transport, prejudice and stigma, money and always socialising with the same group of people.

"We hope the Umbrella Project will allow them to meet a wider range of people," said Ms Waller.

"We have about 40 - 50 learners who come to the Ark, we are trying to widen this circle to include more people."

'I was forced to stop modelling'

 Victoria Sanderson was a 17-year-old model when her life was turned upside down by a serious skin condition.

First, she started to notice red blotches on her elbows. Then, within days, she was covered from head to toe in painful, itchy patches of red skin which would not go away.

"I had to stop modelling altogether because nobody could use me and I lost my job at a Chinese restaurant because the boss said I was putting people off their food."

Victoria's GP told her the problem would disappear in a week, so she was not prepared to cope with a devastating condition called psoriasis.

"I didn't understand what it was. I thought it was just a rash that would disappear. Nobody told me I would have it forever."

She started using cream to treat it, but her skin became increasingly dry, cracked and tight. Even brushing her hair was painful.

Continue reading the main story
People think psoriasis must be contagious, that it must be the result of eating the wrong things. Their first reaction is to take a step back”

End Quote Prof Christopher Griffiths When she finally saw a dermatologist three months later, Victoria was in a terrible state.

"I couldn't stand up, I couldn't use my hands. Just wearing clothes, feeling them rubbing against my skin, was a nightmare."

The Psoriasis Association says the condition affects 2-3% of people in the UK and over a third of them develop psoriasis before they are 16.

As a result, they have launched a new website for young people with the condition which includes information, practical tips and a place to get advice and support.

Christopher Griffiths, professor of dermatology at the University of Manchester and spokesman for the British Skin Foundation, says developing the condition as a teenager or young person is particularly difficult.

"It can often appear at this sensitive stage of life, around the same time as exams or first jobs and when young people are starting relationships. It can be life-ruining."

'Lonely disease'

Although most patients have a genetic pre-disposition to the disease, it is also thought to be triggered by something like a sore throat or a stressful event.

Not only is it a sore and uncomfortable skin condition, it is also a visible problem which can have a major impact on patients' quality of life.

Victoria says it makes her self-conscious and nervous about meeting people for the first time and worried about people staring at her.

Now a 28-year-old marketing consultant, she is very aware of the pressure to look attractive when representing her client's brands.

She says: "It is a lonely disease which, at times, can make me want to hide away".

Prof Griffiths says that the general public still does not understand people with skin disease.

"People think psoriasis must be contagious, that it must be the result of eating the wrong things. Their first reaction is to take a step back. Imagine how that affects people with the condition."

Psoriasis is caused by a speeding up of the usual skin replacement process. Normally skin cells take about 21-28 days to replace themselves. In psoriasis, skin cells can be replaced every two to six days.

Continue reading the main story
People ask if it's HIV, sometimes they ask if I have had a car crash. I try to explain that it's an auto immune disease”

End Quote Victoria Sanderson This results in a build-up of skin cells on the surface of the skin. The redness of the skin is due to the increase in blood vessels required to support the increase in cell production.

In recent years, new and more effective treatments for psoriasis have improved the lives of many sufferers.

Topical therapies and vitamin D creams are now available for more limited cases of psoriasis, while biologic therapies - in the form of injections which target the immune system - are now used to treat severe psoriasis which has not responded to any other treatment.

"None are cures, but they can cause considerable improvement and can bring social functioning back to normal," says Prof Griffiths.

Victoria found light therapy to be her salvation. After eight weeks of intensive UVB treatment she was clear of the red patches which had covered her skin.

They slowly came back, however, and now she undergoes treatment with ultraviolet light every six months to keep the condition at bay.

"It's hard to avoid talking about my skin problem," Victoria says.

"People ask if it's HIV, sometimes they ask if I have had a car crash. I try to explain that it's an auto-immune disease and it's not contagious.

"Suddenly it's not this hideous, disgusting thing..."

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