News and Media

A new front in the National Assembly against the reduced requirements for managers was formed.

The Health Minister Petar Moskov has proposed a liberalization of the requirements for managers in the Medical Institutions Act and virtually anyone who has a master degree in economics may become head of a hospital. This formed a new front of Members of parliament from different groups against the proposal of the Minister.

According to the current law a manager or executive director of a hospital can only be a person who has a master’s in general or dental medicine and acquired qualification in health management.

The other option is a master degree in economics and management, and board certification in medical informatics and health management or health economics.

Now, however, Moskov has proposed in the draft law to eliminate the requirement for qualification in health management, and for the economists to have knowledge in the field of health. In the health committee he explained that if a young man, a graduate of Cambridge, decided that he wanted to pursue a career as Head of St. Anna Hospital, the Members of the Parliament should not impede him.

The Members of Parliament: We will not draft a law for one person.

“I disagree with this proposal; I believe the current requirements should remain because they provide a guaranteed level of competence in management. We will not make laws for an individual from Cambridge. I think we need to draft a law for those who live in Bulgaria. Moreover, after the New Year there will be enough freelance hospital managers who will seek employment,” said the Member of Parliament from the Reformist Bloc Assoc. Prof. Dimitar Shishkov.

Prof. Georgy Kyuchukov from the Alternative for Bulgarian Revival is also adamant that the criteria should not be lowered. “Receiving his education at Cambridge, he will be better informed about the needs of the British health system, but not of ours. Moreover, the opening of a faculty in health management in each medical university losses its meaning,” said Prof. Kyuchukov.

The Member of Parliament from the PP Citizens for European Development of Bulgaria Dr. Krassimir Petrov is also adamant that his party will not allow the lowering of the standards for hospital executives, provided that the reform aims at better management. They will even propose the requirement of master’s degree in health management, not just qualifications. Of the same opinion is Djevdet Chakarov, his colleague from the Movement for Rights and Freedoms. “It is evident that there is a huge need for effective management. The nature of the medical activities and services should be known. The amendments may have a different interpretation – that the door to change the hospital bosses is opened,” said Chakarov.

The results of a retrospective study published in the Journal of the American College of Cardiology show that the patients with critical limb ischemia who took statins had a significantly lower incidence of major adverse cardiac events (MACE) and amputations.

The register of patients with peripheral arterial disease (PAD) from 2006 to 2012 was analized and 380 cases were selected with at least one episode of critical limb ischemia confirmed by angiography with or without endovascular therapy. The average age in the study group was 69 years and the mean follow-up period – 409 days.

The patients were divided into two groups according to whether they are receiving (65%) or not (35%) statins prior to the episode of critical ischemia. The most commonly used statins in the study were simvastatin and atorvastatin.

In the group on statin the frequency of concomitant diseases (diabetes, hypertension, coronary heart disease, myocardial infarction, carotid stenosis, or stroke) was significantly higher.

Despite the higher comorbidity, after one year of follow up of patients receiving statin, the combined endpoint of myocardial infarction, stroke, and mortality was significantly lower (18%) compared with those who were not taking a statin (23%) before and after the incident of critical limb ischemia.

Interesting here is that the mortality is the main factor that determines the difference in frequency of MACE – 15% mortality in the presence and 21% in the absence of statin therapy

The combined risk of death or amputation of a limb is reduced by half when taking a statin.

The survey results support the recommendations in recent clinical guidelines that the administration of statins is indicated for all patients with PAD, even when the disease is in the final stage.

Despite all the strong evidence of the benefit of statins, only 65% ​​of patients in this retrospective study were taking statins. This indicates that the application of the guidelines for behavior in clinical practice has not yet reached the required level.

Tchaikapharma High Quality Medicines Inc. offers on the Bulgarian market the following statins:

Simvacor (Simvastatin) – CF 710 – 10 mg 

Simvacor (Simvastatin) – CF 711 – 20 mg

Simvacor (Simvastatin) – CF 712 – 40 mg

Atorva (Atorvastatin) – CF 996 – 10 mg 

Atorva (Atorvastatin) – CF 997 – 20 mg

Scientists from the Edinburgh University announced that they had found the mechanism that allows breast cancer to spread to the lungs, wrote The Guardian.

The team of scientists found that blocking it in mice with the disease reduced the number of secondary tumors in the lungs. The researchers hope that their achievement would lead to new therapies to stop the breast cancer development. The reason for the majority of deaths in this form of cancer is the penetration of malignant cells in other body parts, the lungs being the first organs affected.

The team from the Centre for Reproductive Health at the University has researched the role of an immune cell called a macrophage in relation to the spread of cancerous cells from the primary tumor. Previous studies have shown that cancer cells use macrophages to penetrate into the lungs. The new study found that macrophages communicate with the cancer cells through chemokine signaling molecules. When these signals in mice are blocked, the number of secondary tumors decreases by up to two thirds. Moreover, the suspension of the signal stopped the entry of malignant cells in the lungs through the bloodstream and prevented the already entrenched cells to form new tumors.
Cells in the human body use chemokines signals to communicate with each other, which gives hope that as a result of the discovery new treatments for other body parts can be created.

The party Patriotic Front (PF) would propose a change in the Hospitals Act with which to establish a Register of Medical Errors. This was announced by MP Dr. Sultanka Petrova. Building the system had been discussed for years, leading specialists and the Doctors’ Union had kept demanding that from time to time, but it hadn’t taken place up to that moment. The last to speak of this Register were the new leaders of the professional organization, according to whom this would be finalized in two years’ from that time.

“At the moment we have no idea who goes wrong and how, but when the Register starts running, it will become clear where the problems are rooted – to what extent they are due to the lack of motivation, specialization or professional exhaustion,” indicated Dr. Petrova. She added that the doctors at fault should be removed for a certain period from the system and continue their education. But the details of this process had to be put down in an Ordinance.

The Institution better known as the medical State Agency “National Security” announced: “The creation of the Register is established in the updated Health Strategy 2014 – 2020 as one of the priorities which the Executive Agency ‘Medical Audit’ should work on”. According to it, one first needs to start with a clarification of the terminology in this area – i.e. to adopt a clear and unambiguous concept of what a medical error is and its varieties. The Agency added that it was necessary to classify the errors, so they could be reported. Experts said that if there was a good organization and cooperation between doctors, nurses, patients and control officers for a year and a half or two, the Registers might start working. “And its purpose is to serve as information for all workers in the system. Moreover, the medical community has to regularly get acquainted with the analysis of the results from the Register, to draw the necessary conclusions and to prevent errors’ re-admission”, maintained “Medical Audit”. The public would also be informed.

The Supervisory Board of the National Health Insurance Fund is expecting from the BMA proposals for solving the problem of clinical pathways overspending. This became clear from the words of the member of the Supervisory Board Dr. Evgeni Tasovski. “We look at where the pain is, and this is the spot that is to be treated. And as good diagnosticians, we have let the BMA find the problem, so they should propose the solutions. The doctors themselves have to be analyzed, not the administrative structure, the problems have to be systematized and there has to be an indication what is to be done,” he said.

Dr. Tasovski said that the Medical Association had requested data on which were the most expensive pathways, how much were the overspent funds, and which hospitals had been overspending. He noted that at the meeting between the two parties a few days ago a decision had been reached by the experts of the professional organization and the NHIF to get together and discuss lighter measures than lowering the prices. The situation would be discussed again in two weeks from that time, said the supervisor.

When asked whether the NHIF had not come up with any suggestions to the BMA about which pathways could be transferred from hospital to outpatient services and if analysis had been made on what the savings would come up to, Dr. Tasovski said that no such proposals had been made. According to him, only the Manager of the Health Fund Dr. Glinka Komitov had presented ideas in this regard, but they had not yet been fully formed before the supervisor and the doctors. According to him, Dr. Komitov most likely would be ready the week after. Dr. Tasovski added that at that time there had been no talk about reducing the prices of pathways. “Supervision does not want to display force, but simply wants to show an understanding of the BMA,” he said.