Most UK doctors experiencing moral distress, survey shows
Nearly four out of five (78%) family doctors across the UK are experiencing moral distress while caring for their patients.
New research conducted by the medical defence organisation MDDUS revealed that doctors are emotionally burdened from being unable to provide the care they want and expect to deliver due to issues such as lack of resources and delays. Moral distress occurs when the gap between what professional judgment dictates should be done and what the healthcare system currently permits is wide. Among doctors as a whole working in hospitals and GP practices, 65% said they had experienced moral distress while working in the NHS. Of doctors who said they were experiencing moral distress 83%, said it was due to the current challenges facing the NHS. The impact of the cost-of-living crisis is also contributing to this distress, with 65% of doctors saying that patients are presenting with conditions that are preventable through better diet and living conditions. The most prevalent are new severe psychological problems, with 76% of doctors saying they’ve encountered this. Doctors have also seen an increase in the Victorian-era illness scurvy (14%).
The impact of the cost-of-living conditions on children’s health has particularly affected doctors. One said their patients were in ‘inappropriate housing that was unsanitary and unsafe for a toddler’. Meanwhile, 81% of doctors struggling with moral distress due to the challenges facing the NHS said their unhappiness at work was affecting their mental health, and 74% said they were concerned that their unhappiness could have a detrimental impact on their safe practice.
Perinatal depression linked to increased risk of death
Clinically diagnosed perinatal depression is associated with an increased risk of death, particularly due to suicide and during the first year after diagnosis, finds a study published by the BMJ.
Perinatal depression was defined as any diagnosis of depression during pregnancy and up to 1 year after delivery and deaths were tracked over an 18-year period.
The association cannot be explained by shared family factors and is independent of pre-existing psychiatric disorders, the results show. The researchers say women who are affected, their families and health professionals should be aware of these severe health hazards.
The researchers set out to determine whether women with perinatal depression are at an increased risk of death compared with unaffected women and sisters.
Using Swedish national registry data from 2001 and 2018, they identified 86 551 women with a first ever diagnosis of perinatal depression and 865Û 510 unaffected women matched by age and calendar year at delivery.
To control for shared family factors, they also compared data for 24 473 of the women who had perinatal depression with 246 113 unaffected full sisters who delivered at least one baby during the study period.
A range of known risk factors for both depression and premature death were taken into account, including socio-economic status, pre-existing psychiatric disorders, adverse birth outcomes and death of a child within the first year after birth.
During the 18-year study follow-up period, 522 deaths (0.82 per 1000 person years) were reported among women with perinatal depression diagnosed at an average age of 31 years and 1568 deaths (0.26 per 1000 person years) among unaffected women.
The results show that women with perinatal depression were more than twice as likely to die than women who did not have perinatal depression. Results were similar when comparing deaths between sisters and among women who did and did not have a pre-existing psychiatric disorder.
The increased risk associated with perinatal depression was most pronounced in the first year after diagnosis, and although it gradually reduced over time, it remained higher throughout the18 years of study follow-up. Overall, the increased risk associated with perinatal depression was greater for death caused by unnatural causes (0.46 per 1000 person years) than by natural causes (0.36 per 1000 person years).
Although suicide was rare (0.23 per 1000 person years), women with perinatal depression were more than six times as likely to die from suicide, and three times as likely to die from an accident, than women who did not have perinatal depression.
These are observational findings and the researchers point to several limitations, such as only including women who sought specialist care for their depression and possible misclassification of some suicide events as accidents.
WHO decision improves children’s access to safer polio vaccine
The Medicines and Healthcare products Regulatory Agency (MHRA) has said that, with 950 million doses now delivered worldwide, nOPV2 has been prequalified by the World Health Organization (WHO) following analysis of outcomes in vaccinated populations. It says this confirms the strong safety profile and effectiveness of the vaccine. The nOPV2 vaccine helps protect children from polio while lowering the risk of vaccine-derived outbreaks.
Prequalification is a mark of quality assurance granted by the WHO and will make it easier for more countries to access and use nOPV2. Now it is granted, WHO member countries can obtain and use nOPV2 without the need to meet the strict readiness and monitoring requirements previously required. Prequalification will therefore ensure broad and long-term accessibility for international agencies to distribute nOPV2 in developing countries.
Dr Andrew Macadam, Principal Scientist at the MHRA said: ‘Until it has been completely eradicated, polio will continue to be a threat to children around the world.
‘The novel type 2 oral polio vaccine has already protected millions of children and today’s announcement from the WHO will mean greater access for many.
‘Prequalification has come following years of collaboration, and it’s through continued partnership, fast and accurate detection and broad vaccine coverage, that will finally see polio eradicated.’
Polio is an infectious disease caused by the polio virus, mostly transmitted through contact with infected faeces via contaminated food and water. While many people may never show symptoms, in extreme cases, especially for babies and children under the age of 5, polio can lead to permanent paralysis or death.
The original oral polio vaccines (OPVs), which have reduced polio cases by more than 99% since 1988, work by delivering a live but weakened version of poliovirus to children.
Unlike those used in the UK, OPVs can be transported over large distances without the need for cold storage, allowing the vaccine to be delivered in hard-to-reach parts of the world.
However, in rare instances, when not enough children are vaccinated with an OPV, the weakened virus in the vaccine can pass among under-immunised populations and, over time, change to a form which can again cause paralysis.
Similarly effective to other OPVs in protecting against polio, genetic modifications to nOPV2 have significantly reduced the risk of the poliovirus mutating and becoming harmful again.
National Cancer Audit Collaborating Centre publishes national prostate cancer audit report
The National Cancer Audit Collaborating Centre (NATCAN) has published a State of the Nation report from the National Prostate Cancer Audit (NPCA) on the care received by people with prostate cancer in England and Wales from 1 January 2019 to 31 January 2023.
The aim of the National Prostate Cancer Audit NPCA is to evaluate the patterns of care and outcomes for patients with prostate cancer in England and Wales, and to support services to improve the quality of care. The NPCA evaluates current patterns of care against these standards including guidance and quality standards from the National Institute for Health and Care Excellence.
The report states that the proportion of men diagnosed with high-risk/locally advanced prostate cancer undergoing radical prostate cancer treatment remained stable when comparing to 2019. The proportion of men diagnosed with low-risk localised prostate cancer undergoing radical prostate cancer treatment was 8% in England and 9% in Wales.
There was an increase in men newly diagnosed with prostate cancer in 2022 in England, and in 2021 in Wales, and there was an increase in men newly diagnosed with prostate cancer treated with either radical prostatectomy or radiotherapy in 2022 in England.
The proportion of patients experiencing a genitourinary or gastrointestinal complication within 2 years of radical treatment remained stable in England and Wales, when comparing to 2015–2019.
There were changes in some aspects of prostate cancer treatment, including an increased use of ultra-hypofractionated radiotherapy and a shift in the systemic agents used.
Going forward, the authors say, ‘it is important that the NPCA plays a role in continuing to improve the care of prostate cancer patients in England and Wales. Structural considerations for how prostate cancer services are designed and implemented as well as advances in new treatment techniques are a key focus for NPCA reporting in the future’.