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Influenza outbreak in Barcelona causes a crisis
POLICY AND PEOPLE
Medical association seeks protection for doctors he Indian Medical Association has sought an end to attacks on doctors in various parts of the country. In a resolution passed at its annual meeting (Hyderabad, India; Dec 27–29, 1998), the association said “harassment and assault on doctors have become a rule rather than exception. Both the general public and the government should appreciate the plight of doctors in situations beyond his or her control”. Although the IMA has so far not compiled figures relating to attacks, an IMA official said more and more of the 1400 local branches of the IMA are reporting attacks on
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doctors by patients, their relatives, and extortionists. Recently, a doctor was murdered by extortionists in Kalyan, a town near Bombay, while an opthalmalogist in Delhi was attacked by a patient’s relatives. As a result, doctor–patient relationships are becoming strained. The IMA has noted that the medical community is demoralised because of the Consumer Protection Act of 1986 (which covers the medical profession), and it has called for changes in the act to exclude doctors from its purview.
New implant restores bladder function On Jan 5, the US FDA approved the bladder-control device Vocare bladder system, made by NeuroControl (Valley View, OH, USA). This pacemakertype receiver-stimulator, implanted under the chest or abdomen, sends electrical signals to the bladder. The patient controls the implant with an external, cassette-playersized unit. The device is suitable for those who are skeletally mature, have a complete spinal-cord lesion, and reflex bladder contractions.
Dinesh C Sharma
Olivieri relieved of duties Haematologist Nancy Olivieri, who has been involved in a protracted dispute with the Toronto Hospital for Sick Children over events related to her 1993 agreement with Apotex to carry out a clinical trial on the effectiveness of deferiprone on children (see Lancet Dec 19/26, p 1996), has been relieved of her duties as head of the haemoglobinopathy programme. She will be allowed to continue to work as a clinician and scientist with full medical privileges, the hospital announced on Jan 8.
Influenza outbreak in Barcelona causes a crisis he Catalonian Health Department (DSGC) has implemented a “Special Plan for Winter Emergencies” initiative, expected to last at least 3–4 weeks, to counter the breakdown in emergency medical services as a result of an outbreak of influenza in Barcelona during Jan 1–3. The DSGC and the local city council’s measures include: an increase of 15 emergency beds per hospital; a 30% increase in the number of home-care doctors, including those from the 061 phone number home service; and a 15% increase in doctors in primary-care centres. The availability of all hospital emergency-unit beds will also be monitored three times a day and further measures will be adopted accordingly. The council has started an information campaign explaining the symptoms of influenza and distributing the addresses of the 11 primarycare centres that are open all year round. One of the factors which contributed to the crisis was that during the three consecutive public holidays around the New Year only 11 of the 51 primary-care centres in Barcelona were open. Over the New Year, the surge in demand for emergency services from 35% to 75% led to 4–5 hour delays in patient consultations at tertiary-care centres, and up to a 12-hour delay for patients waiting
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News in brief
for home visits. In some hospitals ambulances were forced to queue to off-load patients, and in some instances long waiting times caused tempers to fray as patients’ families started to threaten doctors to get relatives treated. The Catalonian government has asked the DSGC to explain the crisis, and opposition parties have asked Eduard Rius, the head of the DSGC, to account for the complete lack of foresight. DSGC sources have suggested the crisis is in part a combination of the public’s lack of awareness about which primary-care facilities were available and in part, general misuse of Barcelona’s emergency facilities. Other sources have pointed out that less than a quarter of Barcelona’s primary-care centres were open during the public holidays, and these centres had to deal with all emergency and minor complaints. The lack of available facilities also caused emergency home-care services to be abused. Probably less than 10% of patients who visited emergency units between Jan 1–3 actually required admission and 80% of cases could have been treated at primarycare centres. In the meantime, the crisis is expected to continue for some time because the influenza outbreak will probably peak in 3 weeks .
Dogs get psychoactive drugs The US FDA has approved the first two mood-altering drugs for dogs, both of which have been used in human beings. On Jan 5, the FDA approved Novartis Animal Health’s clomimpramine hydrochloride (Clomicalm) to treat separation anxiety, and Pfizer’s selegiline hydrochloride (Anipryl) for canine cognitive dysfunction syndrome. US approval of COX-2 inhibitor On Jan 1, the US FDA approved Searle’s celecoxib (Celebrex), the first cyclooxygenase-2 inhibitor, for osteoarthritis and rheumatoid arthritis. Trials showed that patients on celecoxib had a substantially lower risk of ulcers than when on non-steroidal antiinflammatory drugs, but this needs testing in thousands of patients, the FDA said. Users will be advised that the drug poses risks of gastrointestinal ulceration, bleeding, and perforation. Side-effects include dyspepsia, diarrhoea, and abdominal pain. Contraindications include allergy to aspirin, NSAIDs, or sulphonamides.
Xavier Bosch
THE LANCET • Vol 353 • January 16, 1999
Medical association seeks protection for doctors he Indian Medical Association has sought an end to attacks on doctors in various parts of the country. In a resolution passed at its annual meeting (Hyderabad, India; Dec 27–29, 1998), the association said “harassment and assault on doctors have become a rule rather than exception. Both the general public and the government should appreciate the plight of doctors in situations beyond his or her control”. Although the IMA has so far not compiled figures relating to attacks, an IMA official said more and more of the 1400 local branches of the IMA are reporting attacks on
T
doctors by patients, their relatives, and extortionists. Recently, a doctor was murdered by extortionists in Kalyan, a town near Bombay, while an opthalmalogist in Delhi was attacked by a patient’s relatives. As a result, doctor–patient relationships are becoming strained. The IMA has noted that the medical community is demoralised because of the Consumer Protection Act of 1986 (which covers the medical profession), and it has called for changes in the act to exclude doctors from its purview.
New implant restores bladder function On Jan 5, the US FDA approved the bladder-control device Vocare bladder system, made by NeuroControl (Valley View, OH, USA). This pacemakertype receiver-stimulator, implanted under the chest or abdomen, sends electrical signals to the bladder. The patient controls the implant with an external, cassette-playersized unit. The device is suitable for those who are skeletally mature, have a complete spinal-cord lesion, and reflex bladder contractions.
Dinesh C Sharma
Olivieri relieved of duties Haematologist Nancy Olivieri, who has been involved in a protracted dispute with the Toronto Hospital for Sick Children over events related to her 1993 agreement with Apotex to carry out a clinical trial on the effectiveness of deferiprone on children (see Lancet Dec 19/26, p 1996), has been relieved of her duties as head of the haemoglobinopathy programme. She will be allowed to continue to work as a clinician and scientist with full medical privileges, the hospital announced on Jan 8.
Influenza outbreak in Barcelona causes a crisis he Catalonian Health Department (DSGC) has implemented a “Special Plan for Winter Emergencies” initiative, expected to last at least 3–4 weeks, to counter the breakdown in emergency medical services as a result of an outbreak of influenza in Barcelona during Jan 1–3. The DSGC and the local city council’s measures include: an increase of 15 emergency beds per hospital; a 30% increase in the number of home-care doctors, including those from the 061 phone number home service; and a 15% increase in doctors in primary-care centres. The availability of all hospital emergency-unit beds will also be monitored three times a day and further measures will be adopted accordingly. The council has started an information campaign explaining the symptoms of influenza and distributing the addresses of the 11 primarycare centres that are open all year round. One of the factors which contributed to the crisis was that during the three consecutive public holidays around the New Year only 11 of the 51 primary-care centres in Barcelona were open. Over the New Year, the surge in demand for emergency services from 35% to 75% led to 4–5 hour delays in patient consultations at tertiary-care centres, and up to a 12-hour delay for patients waiting
T
220
News in brief
for home visits. In some hospitals ambulances were forced to queue to off-load patients, and in some instances long waiting times caused tempers to fray as patients’ families started to threaten doctors to get relatives treated. The Catalonian government has asked the DSGC to explain the crisis, and opposition parties have asked Eduard Rius, the head of the DSGC, to account for the complete lack of foresight. DSGC sources have suggested the crisis is in part a combination of the public’s lack of awareness about which primary-care facilities were available and in part, general misuse of Barcelona’s emergency facilities. Other sources have pointed out that less than a quarter of Barcelona’s primary-care centres were open during the public holidays, and these centres had to deal with all emergency and minor complaints. The lack of available facilities also caused emergency home-care services to be abused. Probably less than 10% of patients who visited emergency units between Jan 1–3 actually required admission and 80% of cases could have been treated at primarycare centres. In the meantime, the crisis is expected to continue for some time because the influenza outbreak will probably peak in 3 weeks .
Dogs get psychoactive drugs The US FDA has approved the first two mood-altering drugs for dogs, both of which have been used in human beings. On Jan 5, the FDA approved Novartis Animal Health’s clomimpramine hydrochloride (Clomicalm) to treat separation anxiety, and Pfizer’s selegiline hydrochloride (Anipryl) for canine cognitive dysfunction syndrome. US approval of COX-2 inhibitor On Jan 1, the US FDA approved Searle’s celecoxib (Celebrex), the first cyclooxygenase-2 inhibitor, for osteoarthritis and rheumatoid arthritis. Trials showed that patients on celecoxib had a substantially lower risk of ulcers than when on non-steroidal antiinflammatory drugs, but this needs testing in thousands of patients, the FDA said. Users will be advised that the drug poses risks of gastrointestinal ulceration, bleeding, and perforation. Side-effects include dyspepsia, diarrhoea, and abdominal pain. Contraindications include allergy to aspirin, NSAIDs, or sulphonamides.
Xavier Bosch
THE LANCET • Vol 353 • January 16, 1999