Scrap Plan For Physicians Assistants: Amaq

The Qld Government says it will not roll out the new position until it has been discussed with other states and territories.

They worked in Queensland in Cooktown, Mount Isa and Brisbane to see if patient care improved. A report into the trial says there was some positive feedback from doctors and nurses, but “infrastructure, staffing and financial limitations” restricted the physicians assistants in some cases. The report says it was clear that clinical staff “felt more evidence is needed” before the position is rolled out. The AMAQ says the trial wrapped up months ago and Queensland Health still had not confirmed if the positions will be rolled out across the state. AMAQ president-elect Dr Richard Kidd says the Queensland Government should abandon the idea of physicians assistants, because it takes training places and jobs from junior doctors and nurses. “Why on Earth start looking at another part of the workforce that they’re not going to employ properly either?” he said. He says there is no room for physicians assistants in a health system already crowded with medical graduates. “The need for physicians assistants – if there ever was truly a need – is going to be eclipsed by the number of young doctors that are going to be out there,” he said. “Why have a physicians assistant when you’re actually producing enough physicians?” Dr Kidd says doctor assistants are not covered under the new national registration system. The AMAQ also says the report into the trial should be made public. Plan ‘on hold’ But Health Minister Paul Lucas has rejected the trial was a waste of time and money and it was a worthwhile exercise.

additional resources http://www.abc.net.au/news/2010-09-23/scrap-plan-for-physicians-assistants-amaq/2271126

Physician is Senior Australian of the year

Emeritus Professor Ian Maddocks (R) has been named the 2013 Senior Australian of the Year. Source: AAP SENIOR Australian of the Year Professor Ian Maddocks believes his national award can help raise the importance of the role of palliative care for the dying in the medical profession. The internationally recognised palliative care specialist, 82, was honoured on Friday for his work as a specialist and academic and his passionate advocacy for peace at the Australian of the Year awards ceremony in Canberra. Prof Maddocks said more work needed to be done in the area of palliative care. “There are still people in the other professions of medicine who don’t hand over to us, who don’t bring us in earlier enough,” he told reporters. “We can work alongside them, so that people are ready for that change when the other doctors say, ‘well sorry, there is no more treatment for you’. “Yes there is, there is lots more we can do.” Receiving his award, the emeritus professor at Flinders University in South Australia said he was still keen to promote palliative care as a general part of medicine practice. “We shall all die. Some of us will deny the approach of death. Some will experience difficult treatments and then be told there’s nothing to be done,” he said. “Palliative care affirms that there is always something that can be done.” Mental health and ageing minister Mark Butler said Prof Maddocks had made a significant contribution to the development of palliative care practices throughout Australia. An emeritus professor at Flinders University, the octogenarian from the Adelaide beachside suburb of Seacliff still provides care for the terminally ill and continues to supervise postgraduate students. Prof Maddocks has been a key leader in the Medical Association for the Prevention of War and the Nobel Peace Prize winning group, the International Physicians for Prevention of Nuclear War. The married father of three, and grandfather to five, was appointed Professor of Palliative Care at Flinders University in 1988. Prof Maddocks was the first president of the Australian Association for Hospice and Palliative Care, and the first president of the Australian and New Zealand Society for Palliative Medicine.

find more http://www.news.com.au/breaking-news/national/physician-is-senior-australian-of-the-year/story-e6frfku9-1226562079092

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New Guidelines on Diagnosis and Management of Achalasia Published by the American College of Gastroenterology

The authors state that achalasia “is an incurable disease characterized by incomplete or absent relaxation of the LES and aperistalsis of the esophageal body. The symptomatic consequence of this motility disorder is the classic presentation of dysphagia to solids and liquids associated with regurgitation of bland undigested food or saliva.” The guidelines address the importance of early diagnosis in patients displaying symptoms of achalasia. Lead author Michael F. Vaezi, MD, PhD, MSc, FACG, of Vanderbilt University Medical Center, noted that “by definition, an assessment of esophageal motor function is essential in the diagnosis of achalasia.” Chest pain during meals, difficulty swallowing, weight loss and even heartburn are associated symptoms that often lead to misdiagnosis of achalasia, mistakenly as GERD. Achalasia must be suspected in those with dysphagia to solids and liquids and in those with regurgitation unresponsive to an adequate trial of PPI therapy. The guidelines also address the use of high-resolution esophageal manometry in the diagnosis of achalasia and its variant presentations. The authors have updated the approach to treating achalasia given recent outcome studies comparing pneumatic dilation and surgical myotomy as well as recommendations on long-term patient follow up. “Surgical myotomy has shown excellent results in most patients and remains the surgery of choice, with more being done laparoscopically. The benefit of adding a fundoplication was demonstrated in a double-blind randomized trial comparing myotomy with versus without fundoplication. In this study, abnormal acid exposure on pH monitoring was found in 47 percent of patients without an antireflux procedure and 9 percent in patients that had a posterior Dor fundoplication,” Vaezi said. He adds, “A subsequent cost-utility analysis based on the results of this trial found that myotomy plus Dor fundoplication was more cost effective than myotomy alone because of the costs of treating GERD.” Patient follow up concludes the guidelines and is essential in those diagnosed with achalasia. The guidelines include short-term and long-term goals for follow up and discuss the management of treatment failures, whether endoscopy surveillance for cancer is recommended and include a treatment algorithm. Dr.

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Private gastroenterologists in the UK

Private gastroenterologists in the UK Gastroenterology or gastrology is the medical specialty concerned with digestive diseases. It is popularly (and incorrectly) known as “GI” (which stands for gastrointestinal). A gastroenterologist is a physician who specialises in the diagnosis and treatment of disorders of the gastrointestinal tract, including the oesophagus, stomach, small intestine, large intestine, pancreas, liver, gallbladder, and biliary system. The signs and symptoms of gastroenterological diseases may include: constipation nausea abdominal pain Theprofessional body in the UK which isresponsible for training and regulating medical practitioners who specialise in gastroenterologyis the Royal College of Physicians . The organisation focused on the promotion of gastroenterology within the United Kingdom is the British Society of Gastroenterology You canview the profile ofone of our featured private gastroenterologists below, or you can use our online database of 18,500 private consultantsto search for a private gastroenterologist . Featured gastroenterologists Matthew Banks: Consultant Gastroenterologist, London Consultant Gastroenterologist specialising in general gastroenterology, hepatology,… Rehan Haidry: Consultant Gastroenterologist, London Dr Rehan Haidry is a Consultant Gastroenterologist and Endoscopist at London’s University College… Edward Stoner: Consultant Gastroenterologist, Chelmsford, Essex Dr Edward Stoner is a Consultant Gastroenterologist practising at Springfield Hospital in… Simon Greenfield: Consultant Gastroenterologist, Hertfordshire A highly experienced gastroenterologist practising in Hertfordshire and treating most conditions… Farooq Rahman: Consultant Gastroenterologist, London Dr Farooq Rahman undertook his basic medical training at The Royal Free Hospital School of Medicine… Simon Anderson: Consultant Gastroenterologist, London Consultant gastroenterologist specialising in therapeutic endoscopy and colonoscopy, inflammatory… Abhay Chopada: Gastroenterologists Surgeon, London Consultant Surgeon with special interest in colorectal surgery,hernia surgery, laproscopic and… Stephen Grainger: Consultant Gastroenterologist, Chelmsford, Essex Dr Stephen Grainger is a Consultant Gastroenterologist practising at Springfield Hospital in…

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Australian government launches telehealth initiative

The initiative which Gillard had promised to enact during her election campaign last year has the backing of the Rural Doctors Association of Australia (RDAA), which said it has real potential to improve access to specialists for rural and remote Australians. Currently many rural patients are forced to travel hundreds and even thousands of kilometers for specialist consultations, given the significant shortage of specialists in rural and regional Australia RDAA Vice President Peter Rischbieth told reporters. These patients face significant travel and accommodation costs, and long periods of time away from work, in getting to and from these consultations, which can be required at regular intervals for many conditions. But while offering incentives to providers to implement the technology and rebates to physicians, nurses and midwives for their time spent in consultations, the real question remains: Will providers see enough of a benefit to continue offering telehealth services after the government support dries up? As part of her National Digital Economy Strategy, Gillard is pushing for roughly 500,000 telehealth consultations per year within four years a process expected to be made easier as the nation moves to adopt a National Broadband Network. “The NBN should provide us high availability, high speed connections, which will allow us to conduct both video consultations, look at images such as radiology images and also, with high definition cameras, be able to see high definition images the same as watching a high definition television,” said Nathan Pinskier, a general practitioner in Melbourne who serves as the e-health spokesman for the Royal Australian College of General Practitioners. ‘Tyranny of distance’ While Pinskier was speaking to an Australian television station on Thursday, Gillard, in Darwin in the northern part of the country, and Health Minister Nicola Roxon, far to the south in Adelaide, were demonstrating a telemedicine consult to reporters and film crews. The interviews were part of a flurry of television, print and web news stories released to promote todays launch of the initiative. “I think the change is probably going to be an incremental one but, over time as we understand the utility of telehealth and how it fits into practice, it will make some substantial differences, particularly for patients and consumers in rural and remote locations, where they suffer the tyranny of distance,” Pinskier said. According to the RACGP, 96 percent of the nations doctors use computers for some clinical purpose. To that end, the organization urged its members not to rush out and buy telehealth equipment until it can complete an implementation guide. The group is also working on a set of telehealth standards for its members, which it expects to complete in October. We encourage all GPs to wait for guidance from the College before purchasing equipment or engaging in contractual arrangements with providers, said Mike Civil, chairman of the RACGPs Telehealth Standards Taskforce, in a statement issued last week.

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CANADIAN DOCTORS DEMAND MORE PAY

‘That terrifies us’: Canadian doctors get virtually no training on handling a patient’s desire to die

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There is a similar clash in Manitoba, and over the last four years doctors have shown discontent at times in almost every province. Officials speak of the Canadian health system as ”one of the best in the world,” but the Canadian Medical Association says the system is underfinanced. Doug Geekie, spokesman for the association, said Canada was devoting to health care 7.2 percent of its gross national product, the sum of all goods and services produced. He said that among Western nations only Britain spent less than this and that the United States devoted about 10 percent of its G.N.P. to health care. Ottawa Cuts Contributions With inflation running high and the federal Government anxious to keep its deficit down, the 10 provinces, which are responsible for their own health systems, are undergoing a particularly tight financial squeeze this year. Ottawa has cut the rate of growth of its contributions to the provinces for health care by about 15 percent. Well before the cuts, doctors’ incomes were losing ground to those of other professional groups, the Medical Association says. It cited tax figures indicating that between 1971 and 1977 lawyers, dentists and accountants increased their incomes at a much faster rate than doctors. In Ontario, according to an association spokesman, the average net income for a doctor is about $53,000 a year. The doctors want their yearly incomes increased to well over $100,000 in some cases, and Mr. Geekie acknowledged that it was difficult to get support for this from ordinary Canadians making much less.

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Librach respectfully declined every time, insisting that the patient would be sufficiently sedated in his final moments to make the end bearable. It didnt quite unfold that way, the death being much less peaceful than planned, but the case underlined a little-known dilemma for many health-care workers. As other Canadians debate assisted suicide as a largely academic issue, doctors and nurses are routinely asked by dying patients for a medical push over the edge, specialists say. And yet, they get little preparation for arguably the most difficult conversation they will ever have with a patient. Most doctors finish their degrees and five years of specialty training with virtually no instruction on how to deal with death generally, let alone patients who ask for help with suicide, said Dr. Mike Harlos, medical director of palliative care for the Winnipeg Regional Health Authority. The most frightening interface with the health care system is the dying bit. That terrifies us, said Dr. Harlos. And yet its the least addressed. In response, Dr. Librach has developed a unique program to teach health professionals how to deal with assisted-death requests in a country where saying Yes could lead to murder charges and a flat No might cut short an important conversation. The course offered through the University of Torontos Joint Centre for Bioethics suggests that a cry for help with suicide likely points to unidentified suffering. So health-care workers are urged to put aside their personal reservations and fear of the law to get to the bottom of those problems. Everybody who is terminally ill thinks about, Is it easier just to shorten my life? said Dr.

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Porter Health Care System Welcomes New Physicians

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Dr. Alvarez is a graduate of Chicago Medical School and completed his internship in Racine, Wisconsin. Dr. Alvarez completed his residency at Deaconess Health Center in Evansville, Indiana and is board certified by the American Board of Family Medicine. Dr. Alvarez will be seeing patients at DeMotte Physicians, 520 8th Ave. NE, in DeMotte. Family Medicine Physician Shane Bush, M.D. Dr. Bush is a graduate of Saba University School of Medicine in Devens, Massachusetts. He completed his residency at Resurrection Medical Center in Chicago and is board certified by the American Board of Family Medicine.

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State senators urge maker of OxyContin to turn over names of physicians

OxyContin maker closely guards its list of suspect doctors

The Connecticut-based company amassed a database of some 1,800 doctors who showed signs of dangerous prescribing. Purdue has not alerted authorities to its concerns about the vast majority of those doctors, referring only 154 cases to law enforcement or medical regulators since the program began in 2002. An attorney for Purdue said the decision of whether to refer a doctor was “essentially a judgment call” made on a case-by-case basis after an internal review. Andrew Kolodny, a New York addiction doctor who is leading an effort to curb narcotic painkillers, said such decisions should not be made by a pharmaceutical company. “That judgment needs to be made by state medical boards, not a corporation that benefits from overprescribing,” he said. “Purdue should make the list available to state medical boards so that physicians on the list can be investigated.” A company spokesman, reached after hours Monday, did not have an immediate comment. State Sen. Ted Lieu (D-Torrance) said he sent a letter to Purdue on Monday asking the company to disclose the names of California doctors in its database. “If Purdue Pharma is going to sell a highly potent, highly addictive narcotic in California, then the company has a duty to inform authorities in California of those doctors the company believes may be irresponsibly prescribing OxyContin,” Lieu wrote, according to a copy of the letter he provided to The Times. “This duty may or may not be a legal one, but at the very least the company has an ethical duty to let authorities know about dangerous doctors.” State Sen. Mark DeSaulnier (D-Concord) said he would join Lieu in making the request of Purdue. DeSaulnier said he has been asking the company for years to help fund California’s prescription drug monitoring system, known has CURES, but hasn’t had much success. He said the cynical view of some pharmaceutical firms is that they don’t want to help with prescription drug abuse because they profit from the problem. Purdue has sold more than $27 billion worth of OxyContin since its introduction in 1996. “I would like to think that these big companies have more of an ethical backbone than that,” DeSaulnier said. For Purdue, he said, sharing information on California doctors is “an easy chance for them to actually help with the problem.” Sharon Levine, president of the Medical Board of California, said she was pleased by the senators’ request and hoped that Purdue would comply.

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Only 16% of Canadian doctors would assist in euthanasia

Here are two authoritative polls. An article published earlier this year by Postmedia News reported on a survey by the Canadian Medical Association (CMA) that found very few Canadian doctors are willing to kill a patient by euthanasia, if requested. The survey was done in response to the Carter case in BC that seeks to legalize euthanasia and assisted suicide in Canada, and Quebec Bill 52 that would legalize euthanasia in Quebec. The CMA defines euthanasia as:knowingly and intentionally performing an act that is explicitly intended to end another persons life in cases of incurable illness and the act is undertaken with empathy and compassion. Canadas criminal code prohibits euthanasia and assisted suicide, making it an offence to counsel or assist someone to commit suicide, or agree to be put to death. The CMA opposes euthanasia and medically assisted suicide in a 2007 policy. The July 2011 CMA online survey that was completed by 2,125 Canadian doctors is considered accurate within plus or minus 2.1% 19 times out of 20. The CMA survey found that: 44% would refuse a request to assist a death, 26% were unsure how they would respond to a request, 16% would assist a death, 15% refused to answer the question while 16% stated that they were asked to assist a death within the past 5 years. Click “like” if you are PRO-LIFE ! A similar survey by the Canadian Society of Palliative Care Physicians (CSPCP) published in November 2010 found that of the CSPCP members who responded to the survey, the overwhelming majority 88% were opposed to the legalization of euthanasia while 80% were opposed to the legalization of assisted suicide. The CSPCP survey also found that 90% of responding members would not be willing to participate in the act of euthanasia while 83% of responding members would not be willing to assist a suicide. The Postmedia article reported that Dr.

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Canadian doctor is new president of MSF International

Canadian doctor is new president of MSF International

I read a book about a doctor in Afghanistan … in the middle of nowhere, trying to do his best. I remember telling myself, This is what I would like to do one day. CMAJ: How did that impact your first experience in the field? Liu: I always laugh when I think about my first mission, because I’d been dreaming and hoping for such a long time 17 years since I read that book that I was doomed for disappointment. It was primary health care but there were no real emergencies, except possibly difficult deliveries. … I was waiting for trauma and action. CMAJ: What are the emerging challenges for MSF? Liu: Health care structures and staff are being targeted. Basically, it’s to build a community of concern about the fact that international humanitarian law is not respected in the field. … There’s also the issue of access to vaccines at reasonable prices … and the big, big coming [challenge] of nontransmittable and chronic disease. CMAJ: How will your telemedicine experience influence MSFs approach to these issues? Liu: We need to scale up use of higher tech diagnostic tools, as well as telemedicine.

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Stanford pediatric gastroenterologist responds to your questions on celiac disease

Below I discuss future treatment options that may become available, but still only considered within research frameworks at this time. Mylea Charvat asks: With celiac will I ever be able to eat regular pastas and breads again? Is there any research into medication to help those diagnosed with celiac disease digest and tolerate gluten? I wish there were better news for the here and now. Unfortunately, as you know, a strict gluten-free diet a for now a is the only treatment option for celiac disease. Regular pastas and breads are definitely hard to give up, especially if you really enjoy them. With that said, many laboratories around the world are evaluating different strategies to offer celiac patients more therapeutic options in the future. One hopeful approach is aglutenase therapya where an enzyme could break down the gluten and render it non-toxic. Other working ideas include: blocking the immune reaction (i.e., auto-antibodies) through an ingestible polymeric resin, adesensitizinga the bodyas immune system response to gluten via serial protein-based injections and developing a celiac vaccine. Looking ahead, it is conceivable that celiac patients will one day be able to eat gluten-containing foods, but definitive alternatives to gluten avoidance are not yet ready for general consumer use. Antonio Ruben Murcia Prieto asks: What aboutAoats for celiac disease? The topic of oats is very much an evolving discussion among celiac experts. Generally, oats are an excellent source of good nutrients, including vitamins, minerals and antioxidants, and dietary fiber, such as soluble beta-glucans. They are high in protein, and are even thought to help maintain steady insulin levels. The working idea is that the biochemical nature of oats is gluten-free, but the manufacturing process of oats contaminates it with a common cereal protein called prolamins , which are found in wheat, barley and rye containing seeds that celiac patients have to avoid.

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Celiac Disease: Getting to Know the Gastroenterologist

Find out how to prepare and what to expect at your first visit. Medically reviewed by Christine Wilmsen Craig, MD If you suspect that you have celiac disease (also known as celiac sprue) but have not yet been diagnosed, youll need to see a gastroenterologist (GI). A gastroenterologist is a medical doctor who specializes in the digestive tract, which includes the stomach, intestines, liver, and pancreas. Your gastroenterologist will run the tests necessary to diagnose celiac disease and advise you on what to do next. Ritu Verma, MD, director of the Children’s Celiac Center at Children’s Hospital of Philadelphia and the section chief of gastroenterology, hepatology, and nutrition, tells you what to expect from your first visit. Your First Gastroenterologist Visit: What to Expect Your first visit to a gastroenterologist will be pretty similar to a regular doctor visit, Dr. Verma explains. The GI will take a medical history and do a complete physical exam, and possibly a rectal exam if youre experiencing bloody stools. If celiac disease is suspected, the gastroenterologist will order blood tests (known as a celiac panel) to help diagnose celiac disease. It can take between three days and two weeks to receive the results, Verma says. Then the next step is to schedule an endoscopy. An endoscopy involves passing a small tube with a camera on the end of it into the mouth, through the stomach, and into the small intestine. Biopsies (tissue samples) can be taken of the small intestine to confirm the diagnosis of celiac disease. Your First Gastroenterologist Visit: How to Prepare To prepare for your first visit to the gastroenterologist: Dont change your diet. The most important thing, if you think you might have celiac disease, is to not modify your diet. If you start a gluten-free diet beforehand, celiac testing wont be accurate, Verma says.

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Gastroenterologist Offers Tips For Choosing A Probiotic

Raymond offers her tips for choosing a probiotic: – Assess your health needs: There is a very large variety of strains of probiotics available and some are better suited to assist with certain problems than others. “If you’re someone who simply suffers from occasional constipation , then a probiotic yogurt may do the trick,” advises Dr. Raymond. “However, if you suffer from chronic, serious conditions, a supplement may be more appropriate, as more serious conditions require a probiotic dosage of at least 1 billion live micro-organisms in order to have an effect.” Foods cannot sustain a number of micro-organisms that high. – Look for scientific research. As more U.S. physicians are starting to accept probiotics as a legitimate therapy, more studies are being done with them. “For example, Saccharomyces boulardii , a yeast-based probiotic strain commonly sold under the brand name Florastor , has been shown in studies to provide significant benefits in managing even severe illnesses such as C. diff-associated disease, Crohn’s disease and Ulcerative Colitis,” says Dr. Raymond. Talk to your doctor to find out about the available science that supports the use of probiotics. – Consider your lifestyle. The form in which a probiotics is packaged may be integral in how successfully you take it. “If you are a frequent traveler looking to combat issues like traveler’s diarrhea , a probiotic that needs refrigeration may not be appropriate for you,” suggests Dr.

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