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Specialist nurses paid higher salaries than family doctors

Parija Kavilanz, senior writer, On Thursday March 11, 2010, 2:32 pm EST
Despite the growing shortage of family doctors in the United States, medical centers last year offered higher salaries and incentives to specialist nurses than to primary care doctors, according to an annual survey of physicians’ salaries.
Primary care doctors were offered an average base salary of $173,000 in 2009 compared to an average base salary of $189,000 offered to certified nurse anesthetists, or CRNAs, according to the latest numbers from Merritt Hawkins & Associates, a physician recruiting and consulting firm.
And the firm’s projections for 2010 indicate that the average base salary for family physicians will be about $178,000 compared to $186,000 for CRNAs.
CRNAs are advanced practice nurses who administer anesthesia to patients. An important distinction between CRNAs and anesthesiologist is that when anesthesia is administered by a nurse anesthetist, it is still recognized as the practice of nursing rather than a practice of medicine
“It’s the fourth year in a row that CRNAs were recruited at a higher pay than a family doctor,” said Kurt Mosley, staffing expert with Merritt Hawkins & Associates.
CRNA salaries have trended higher as the number of surgical procedures picked up pace over the past few years, fueling demand for anesthesiologists and anesthetists.
Mosley said medical doctors and specialists, including anesthesiologists, typically have four to five years more of medical training than CRNAs. After spending a lot of time speaking with physicians around the country, he said many family doctors are starting to feel like “second-class citizens.”
This type of income disparity “won’t make them feel better,” he said. Most primary care doctors say they’re already struggling to make ends meet as their costs rise faster than what Medicare and private insurers are paying them .
Looking at these compensation trends, the biggest concern for the nation’s health care system is how to encourage more medical students to pick primary care as their specialty at a time when the nation is already facing a shortage of about 60,000 primary care doctors.
“The demand for primary care doctors will increase twofold when health reform happens and millions of more Americans have access to health care,” said Mosley. “Who is going to triage these patients? It’s not the neurologist or pulmonologist. It has to be the primary care doctor.”
The American Association of Nurse Anesthetists (AANA) maintains that CRNAs are being fairly compensated.
“From our perspective, we are fairly compensated for the level of responsibility that we shoulder,” said Lisa Thiemann, senior director of professional services with the AANA.
“We are at the head of the patient’s bed. We deliver anesthesia and we keep the patient safe,” said Thiemann, who has been a CRNA for 14 years.
“Once nurses and physicians arrive at anesthesia training, we use the same textbooks and same cases. The training is not too different between the two groups,” she said. “We all deliver anesthesia the same way.”


Robot surgeon offers scarless surgery for parathyroid

The parathyroid glands are small glands in the neck that produce parathyroid hormone

When 67-year-old Margaret Mulloy started feeling tired and anxious she put it down to her age.
But a routine blood test revealed the Londoner had a problem with four tiny glands in her neck, which needed to be removed. The four pea-sized parathyroid glands control the level of calcium in the blood.When the glands become overactive, calcium levels rise, thereby weakening bones, raising blood pressure and causing kidney stones.In the past Margaret would have faced a neck scar of at least 5cm (2in).But she became one of the first patients in the UK, possibly the world, to have scarless neck surgery after surgeons used the da Vinci robot. The system allows the surgeon to operate through smaller scars within the body with more accuracy compared to conventional surgery.
Ear Nose and Throat (ENT) consultant Mr Neil Tolley, who led the team at St Mary’s Hospital, part of Imperial College Healthcare, said the robot enabled them to make one small cut below the collar bone and three incisions near the arm pit.
“Avoiding a scar is a main benefit,” he said.
“We are achieving the same surgical goal without a scar on the neck.
“We have used this technique on six patients so far.”
Surgical precision
ENT research registrar Mr Asit Arora said all procedures had been successful with minimal blood loss. Robotic-assisted surgery has been used for several years in heart and prostate operations.The principal benefits of telerobotic surgery are improved surgical precision and minimal access capability.It gives the surgeon 3D vision, reduces hand tremor and improves manual dexterity. Margaret said it had certainly made a big difference to her. “It is marvellous,” she said.”I have just got a little mark, but if I had it the old way I would have had a scar. This is much better especially for a younger person.”She added that since her surgery her blood pressure had also dropped.
Human surgeons
Judith Taylor had neck surgery the old-fashioned way several decades ago and was left with a large scar.

Judith Taylor has a neck scar

I had surgery for thyroid cancer 45 years ago when I was 15 and was very self-conscious about the scar when I wore low-cut dresses or a bikini,” said the trustee of the British Thyroid Foundation, a charity which supports those with thyroid disorders. Two more operations on her neck followed, including surgery to remove an over-active parathyroid gland.She said she would welcome a technique that reduced scarring, but what was more important to her was that everyone needing thyroid or parathyroid surgery had access to highly-skilled surgeons whether robotic or human.
She added: “I now wear my scar with pride, and the good news is that, thanks to my surgeons, I have my voice, I still sing as a hobby, I have two remaining functioning parathyroids – and I have my health.”
BBC News

Anti-retrovirals could halt Aids spread in five years

South Africa has the world's highest incidence of HIV/Aids

Anti-retroviral treatments (ARVs) and universal testing could stop the spread of Aids in South Africa within five years, a top scientist says.

Dr Brian Williams says the cost of giving the drugs to almost six million HIV-positive patients in the country would be $2-3bn per year.

Only about 30% get the life-saving drugs, he said, but early detection and treatment would prevent transmission.This, he said, should be complementary to the search for an Aids vaccine. An effective vaccine, he said, was still a long way away. Dr Williams, a leading figure in the field of HIV research, is based at the South African Centre for Epidemiological Modelling and Analysis (Sacema) in Stellenbosch.
Success story
Speaking at at the annual meeting of the American Association for the Advancement of Science (AAAS) in San Diego, he said 30 million people around the world were infected with HIV – with two million dying each year.
We could break the back of the epidemic
Dr Brian Williams, Sacema
“The tragedy is that the disease continues unabated. The only real success story is the development of these extremely effective drugs that keep people alive and reduce their viral load by up to 2,000 times. They become close to non-infectious.
“While the rapid scale-up in the provision of ART in the last five years has exceeded expectations, it has not reduced HIV-transmission and Aids-related TB because it has been given too late in the course of infection.”
Dr Williams argued that by the time people started ART, they had infected “most of those that they would have infected anyway”.
“We’ve been using drugs to save lives, but not stop the infection,” he said.
“It’s time to look beyond that.”
He said that if clinical trials started now, all of the HIV positive people in South Africa could be on ARV treatment within five years.
Dr Williams said a few clinical trials were already beginning in the US, Canada and sub-Saharan Africa – and he hoped to have the answer “in one or two years”.
Kenneth Mayer, professor of medicine at Brown University in the US state of Rhone Island, agreed that treating patients early with ARVs was a matter of “public health”.
The US National Institute of Allergy and Infectious Diseases is planning a trial in New York and Washington – in districts that have an HIV positive population at a similar level to African epidemics.
“We need to get answers [from these trials] quickly. That will help us move forward,” Dr Williams said.
“We could break the back of the epidemic. If we can do it, I’m confident it will work.”
BBC News

Obesity rise on death certificates, researchers say

There has been a “dramatic rise” in deaths in England in which obesity was a contributory factor, researchers say.
They said death certificates showed there were 757 obesity related deaths in 2009, compared with 358 in 2000.
There were likely to be many more such deaths where obesity was not recorded, the University of Oxford team said in the European Journal of Public Health.

mesure the stomach-image:BBC

It comes as the Scottish government warned of a “ticking time bomb”, saying 40% of Scots could be obese by 2030.
One public health expert said people often did not realise obesity was linked with many serious conditions. The researchers said as obesity was rarely listed as the main cause of death, a simple snapshot of death certificates would not have picked up the rise.
The marked increase was apparent when they included contributing causes of death in the analysis.
Other figures recently released by ministers showed more than 190 people under 65 died as a direct result of obesity in 2009 compared with 88 in 2000.
When contributing factors were included, there were 757 obesity related deaths in 2009 compared with 358 in 2000.
About a quarter of adults in the UK are now obese.
Obesity and problems caused by being overweight are thought to cost the NHS more than £3bn a year.
The Scottish government said 40% of Scots could be classed as obese by 2030, if things do not change.
Scotland’s Public Health Minister Shona Robison is due to launch an anti-obesity strategy later.
Study leader Professor Michael Goldacre said although the death certificate figures tallied with rises in levels of obesity in the population over the same period, they did not know before the study whether doctors would be recording obesity on death certificates.
“We know for example obesity contributes to heart disease but if someone dies of heart disease you don’t necessarily expect doctors to note if they were obese.
“But this shows doctors are increasingly recognising obesity as a cause of death.”
He added: “One of the key messages is you can’t rely on underlying causes alone – if you don’t look at other causes you cannot see what is contributing to disease.”
Professor Alan Maryon-Davis, president of the Faculty of Public Health, said people in the “early stages” of obesity did not often realise how dangerous being overweight could be and their weight commonly “creeps up” without them noticing.
“People do not realise how closely linked it is with serious conditions, such as heart disease, stroke, high blood pressure and diabetes.
“We have to take obesity seriously.

By Emma Wilkinson
Health reporter, BBC News

Oral conception. Impregnation via the proximal gastrointestinal tract in a patient with an aplastic distal vagina. Case report

The patient was a 15-year-old girl employed in a local bar. She was admitted to hospital after a knife fight involving her, a former lover and a new boyfriend. Who stabbed whom was not quite clear but all three participants in the small war were admitted with knife injuries.

The girl had some minor lacerations of the left hand and a single stab-wound in the upper abdomen. Under general anaesthesia, laparotomy was performed through an upper midline abdominal incision to reveal two holes in the stomach. These two wounds had resulted from the single stab-wound through the abdominal wall. The two defects were repaired in two layers. The stomach was noted empty at the time of surgery and no gastric contents were seen in the abdomen. Nevertheless, the abdominal cavity was lavaged with normal saline before closure. The condition of the patient improved rapidly following routine postoperative care and she was discharged home after 10 days.

Precisely 278 days later the patient was admitted again to hospital with acute, intermittent abdominal pain. Abdominal examination revealed a term pregnancy with a cephalic fetal presentation. The uterus was contracting regularly and the fetal heart was heard. Inspection of the vulva showed no vagina, only a shallow skin dimple was present below the external urethral meatus and between the labia minora. An emergency lower segment caesarean section was performed under spinal anaesthesia and a live male infant weighing 2800 g was born…

…While closing the abdominal wall, curiosity could not be contained any longer and the patient was interviewed with the help of a sympathetic nursing sister. The whole story did not become completely clear during that day but, with some subsequent inquiries, the whole saga emerged.

The patient was well aware of the fact that she had no vagina and she had started oral experiments after disappointing attempts at conventional intercourse. Just before she was stabbed in the abdomen she had practised fellatio with her new boyfriend and was caught in the act by her former lover. The fight with knives ensued. She had never had a period and there was no trace of lochia after the caesarean section. She had been worried about the increase in her abdominal size but could not believe she was pregnant although it had crossed her mind more often as her girth increased and as people around her suggested that she was pregnant. She did recall several episodes of lower abdominal pain during the previous year. The young mother, her family, and the likely father adapted themselves rapidly to the new situation and some cattle changed hands to prove that there were no hard feelings.


A plausible explanation for this pregnancy is that spermatozoa gained access to the reproductive organs via the injured gastrointestinal tract. It is known that spermatozoa do not survive long in an environment with a low pH (Jeffcoate 1975), but it is also known that saliva has a high pH and that a starved person does not produce acid under normal circumstances (Bernards & Bouman 1976). It is likely that the patient became pregnant with her first or nearly first ovulation otherwise one would expect that inspissated blood in the uterus and salpinges would have made fertilization difficult. The fact that the son resembled the father excludes an even more miraculous conception.”

British Journal of Obstetrics and Gynaecology