Non-EEA doctors in EEA countries: doctors or cleaners?

BACKGROUND: Migration of non-EEA doctors to EEA-countries has become a common phenomenon. As coordination within the EEA has not yet been established, every EEA-country is re-inventing the wheel of assessment of foreign medical degrees and developing additional programmes for non-EEA doctors. There is hardly any knowledge about assessment procedures in other EEA-countries. AIM: To examine how 10 European Economic Area (EEA) countries deal with non-EEA doctors. Both national and university policies regarding non-EEA doctors were examined. METHODS: This was a qualitative study based on two structured questionnaires. One was used for staff members of national health departments and the other was used for staff members of university medical faculties. Staff members from the health departments of mid-European and north European countries, and staff members from universities in Austria, Belgium, Denmark, France, Germany, Norway, Sweden, UK, Spain, and The Netherlands participated in the study. RESULTS: There is no EEA directive concerning non-EEA doctors. Each EEA country, therefore, has devised its own policy towards non-EEA doctors. To enable non-EEA doctors to obtain a full license, thereby preventing them from ending up as unskilled labourers, the health departments in the Nordic countries and the UK have developed a 'fast-track' process for non-EEA doctors. In Austria, Belgium, and The Netherlands, however, non-EEA doctors are more dependent on programmes offered by university medical faculties. The situation in Germany is between these two extremes. As a rule, the programmes for non-EEA doctors in Belgium, Germany, and The Netherlands are two to three times longer than in the Nordic countries (18-36 months vs. 12-18 months, respectively). Financial aid is not available in most countries. CONCLUSION: As the influx of non-EEA doctors is increasing, harmonisation within the EEA is strongly advisable. As long as there is no EEA directive about non-EEA doctors, the assessment procedures (diploma evaluation, medical-knowledge tests, language requirements, length of additional programmes, etc.) need to be coordinated.

Is the distinction between superficial pressure ulcers and moisture lesions justifiable? A clinical-pathologic study.

OBJECTIVE: Pressure ulcers are classified into 4 distinct stages, which allows comparisons between institutions and even countries. Recently, attempts have been made to single out so-called moisture lesions from the early stages of pressure ulcer lesions as a distinct entity. METHODS: To investigate the justification for this development, 14 histopathologic samples from patients with both incontinence and pressure ulcer lesions were studied in an attempt to delineate differences in the pathophysiology and histopathology. RESULTS: Two distinct histopathologic pictures emerged: an ischemic pattern and a pattern of irritation. The latter appeared to be associated with lesions that clinically fit the description of moisture lesions, but this association was not absolute. CONCLUSIONS: There is no justification for singling out moisture lesions from pressure ulcer lesions. The distinction may even be dangerous when proper preventive measures for the development of pressure ulcers are not taken because of the existence of a possible moisture lesion.

Pressure ulcer risk in hip fracture patients.

Hip fracture patients have a high risk of pressure ulcers (PU). We followed 121 hip fracture patients for the development of pressure ulcers and evaluated a risk assessment tool for sensitivity and specificity. More than half of the patients presented with PU, mostly stage I. Risk factors for PU were high age and the length of time on the operating table. The risk assessment tool had a low predictive value, however. It is thus hard to predict which patients will develop PU and which will not. Accordingly, we propose maximum preventive measures against PU for all patients presenting with hip fractures.

Prospective cohort study of routine use of risk assessment scales for prediction of pressure ulcers.

OBJECTIVE: To evaluate whether risk assessment scales can be used to identify patients who are likely to get pressure ulcers. DESIGN: Prospective cohort study. SETTING: Two large hospitals in the Netherlands. PARTICIPANTS: 1229 patients admitted to the surgical, internal, neurological, or geriatric wards between January 1999 and June 2000. MAIN OUTCOME MEASURE: Occurrence of a pressure ulcer of grade 2 or worse while in hospital. RESULTS: 135 patients developed pressure ulcers during four weeks after admission. The weekly incidence of patients with pressure ulcers was 6.2% (95% confidence interval 5.2% to 7.2%). The area under the receiver operating characteristic curve was 0.56 (0.51 to 0.61) for the Norton scale, 0.55 (0.49 to 0.60) for the Braden scale, and 0.61 (0.56 to 0.66) for the Waterlow scale; the areas for the subpopulation, excluding patients who received preventive measures without developing pressure ulcers and excluding surgical patients, were 0.71 (0.65 to 0.77), 0.71 (0.64 to 0.78), and 0.68 (0.61 to 0.74), respectively. In this subpopulation, using the recommended cut-off points, the positive predictive value was 7.0% for the Norton, 7.8% for the Braden, and 5.3% for the Waterlow scale. CONCLUSION: Although risk assessment scales predict the occurrence of pressure ulcers to some extent, routine use of these scales leads to inefficient use of preventive measures. An accurate risk assessment scale based on prospectively gathered data should be developed.