bluuebunny/crossref_metadata_2025 huggingface dataset:
Delivery by caesarean section and risk of obesity in preschool age children: a prospective cohort study
Authors: Huh Susanna Y , Rifas-Shiman Sheryl L , Zera Chloe A , Edwards Janet W Rich , Oken Emily , Weiss Scott T , Gillman Matthew W
Published: May 2012

Objective

To examine whether delivery by caesarean section is a risk factor for childhood obesity.

Design

Prospective prebirth cohort study (Project Viva).

Setting

Eight outpatient multi-specialty practices based in the Boston, Massachusetts area.

Participants

We recruited women during early pregnancy between 1999 and 2002, and followed their children after birth. We included 1255 children with body composition measured at 3 years of age.

Main outcome measures

BMI score, obesity (BMI for age and sex ≥95th percentile), and sum of triceps plus subscapular skinfold thicknesses at 3 years of age.

Results

284 children (22.6%) were delivered by caesarean section. At age 3, 15.7% of children delivered by caesarean section were obese compared with 7.5% of children born vaginally. In multivariable logistic and linear regression models adjusting for maternal prepregnancy BMI, birth weight, and other covariates, birth by caesarean section was associated with a higher odds of obesity at age 3 (OR 2.10, 95% CI 1.36 to 3.23), higher mean BMI z-score (0.20 units, 95% CI 0.07 to 0.33), and higher sum of triceps plus subscapular skinfold thicknesses (0.94 mm, 95% CI 0.36 to 1.51).

Conclusions

Infants delivered by caesarean section may be at increased risk of childhood obesity. Further studies are needed to confirm our findings and to explore mechanisms underlying this association.
What stops hospital clinical staff from following protocols? An analysis of the incidence and factors behind the failure of bedside clinical staff to activate the rapid response system in a multi-campus Australian metropolitan healthcare service
Authors: Shearer Bill , Marshall Stuart , Buist Michael David , Finnigan Monica , Kitto Simon , Hore Tonina , Sturgess Tamica , Wilson Stuart , Ramsay Wayne
Published: May 2012

Objective

To explore the causes of failure to activate the rapid response system (RRS). The organisation has a recognised incidence of staff failing to act when confronted with a deteriorating patient and leading to adverse outcomes.

Design

A multi-method study using the following: a point prevalence survey to determine the incidence of abnormal simple bedside observations and activation of the rapid response team by clinical staff; a prospective audit of all patients experiencing a cardiac arrest, unplanned intensive care unit admission or death over an 8-week period; structured interviews of staff to explore cognitive and sociocultural barriers to activating the RRS.

Setting

Southern Health is a comprehensive healthcare network with 570 adult in-patient beds across four metropolitan teaching hospitals in the south-eastern sector of Melbourne.

Measurements

Frequency of physiological instability and outcomes within the in-patient hospital population. Qualitative data from staff interviews were thematically coded.

Results

The incidence of physiological instability in the acute adult population was 4.04%. Nearly half of these patients (42%) did not receive an appropriate clinical response from the staff, despite most (69.2%) recognising their patient met physiological criteria for activating the RRS, and being ‘quite’, or ‘very’ concerned about their patient (75.8%). Structured interviews with 91 staff members identified predominantly sociocultural reasons for failure to activate the RRS.

Conclusions

Despite an organisational commitment to the RRS, clinical staff act on local cultural rules within the clinical environment that are usually not explicit. Better understanding of these informal rules may lead to more appropriate activation of the RRS.
Design and trial of a new ambulance-to-emergency department handover protocol: ‘IMIST-AMBO’
Authors: Iedema Rick , Ball Chris , Daly Barbara , Young Jacinta , Green Tim , Middleton Paul M , Foster-Curry Catherine , Jones Marea , Hoy Sarah , Comerford Daniel
Published: May 2012

Background

Information communicated by ambulance paramedics to Emergency Department (ED) staff during handover of patients has been found to be inconsistent and incomplete, and yet has major implications for patients' subsequent hospital treatment and trajectory of care.

Aim

The study's aims were to: (1) identify the existing structure of paramedic-to-emergency staff handovers by video recording and analysing them; (2) involve practitioners in reflecting on practice using the footage; (3) combine those reflections with formal analyses of these filmed handovers to design a handover protocol; (4) trial-run the protocol; and (5) assess the protocol's enactment.

Method

The study was a ‘video-reflexive ethnography’ involving: structured analysis of videoed handovers (informed by ED clinicians' and ambulance paramedics' comments); ED clinicians and ambulance paramedics viewing their own practices; and rapid at-work training and feedback for paramedics. A five-question pre- and post-survey measured ED triage nurses' perceptions of the new protocol's impact. In total, 137 pre- and post-handovers were filmed involving 291 staff, and 368 staff were educated in the use of the new protocol.

Results

There was agreement thatIdentification of the patient,Mechanism/medical complaint,Injuries/information relative to the complaint,Signs, vitals and GCS,Treatment and trends/response to treatment,Allergies,Medications,Background history andOther (social) information (IMIST-AMBO) was the preferred protocol for non-trauma and trauma handovers. Uptake of IMIST-AMBO showed improvements: a greater volume of information per handover that was more consistently ordered; fewer questions from ED staff; a reduction in handover duration; and fewer repetitions by both paramedics and ED clinicians that may suggest improved recipient comprehension and retention.

Conclusion

IMIST-AMBO shows promise for improving the ambulance-ED handover communication interface. Involving paramedics and ED clinicians in its development enhanced the resulting protocol, strengthened ED clinicians' and ambulance paramedics' sense of ownership over the protocol and bolstered their peers' willingness to adopt it.
Male IDUs who have sex with men in England, Wales and Northern Ireland: are they at greater risk of bloodborne virus infection and harm than those who only have sex with women?
Authors: Marongiu Andrea , Hope Vivian D , Parry John V , Ncube Fortune
Published: May 2012

Objectives

In the UK, although transmission of HIV among injecting drug user (IDUs) has been limited since the 1980s, IDUs and men who have sex with men (MSM) have higher HIV and hepatitis C virus (HCV) prevalences than the general population. MSM who are also IDUs (MSM-IDUs) may therefore have a higher risk of infection than male IDUs who only have sex with women.

Methods

Analysis of data from a national survey of IDUs attending services (England, Wales and Northern Ireland) between 1998 and 2007, which collected demographic and behavioural data and oral fluid samples for HIV and HCV antibody testing.

Results

Of the 8671 men who reported injecting drugs and having sex during the preceding year, 96% (8354) were men who only had sex with women (MSW). MSM-IDUs and MSW-IDUs had similar age and number of years of injecting. MSM-IDUs had a higher prevalence of HIV (adjusted OR=4.08, 95% CI 1.9 to 8.5) and of HCV (adjusted OR =1.34, 95% CI 1.1 to 1.8) and were about four times (adjusted OR =3.78, 95% CI 2.9 to 4.9) more likely to have unprotected sex with multiple partners. Among those who injected in the 4 weeks prior to participation, the MSM-IDUs had a higher level of needle/syringe sharing (adjusted OR =1.72, 95% CI 1.3 to 2.2).

Discussion

MSM-IDUs have a fourfold higher risk of HIV; HCV prevalence in MSM-IDUs is a third higher than among MSW-IDUs, suggesting elevated risk from injecting and possibly sexual transmission. These findings emphasise the need for public health interventions specifically targeted at MSM-IDUs.
O1 Rapid automated white cell urinalysis is more accurate than urethral smear for predicting chlamydia infection in men
Authors: Pond M J , Patel S , Butcher P D , Hay P E , Sadiq S T
Published: May 2012

Background

The cut-off of ≥5 polymorphs/high power field (p/hpf) in a Gram stained male urethral smear (GSUS) for diagnosing non-gonococcal urethritis derives from evaluations using Chlamydia trachomatis (CT) culture as gold standard. There is also significant observer variation in performing microscopy.

Objective

To compare automated flow cytometry of first void urine white cell count (FVU-UWC) to GSUS for prediction of CT infection in men.

Methods

First void urines from 227 symptomatic male patients, all undergoing GSUS, were collected and patients stratified into: those treated for urethritis, diagnosed by GSUS result, history and examination (n=114) and; those not thought to have urethritis (n=113). First void urines were analysed by automated flow cytometry using the bench-top Sysmex UF-100 Analyser.

Results

CT was found in 11.6% and 6.2% urethritis and non-urethritis patients respectively and gonorrhoea (GC) in 3.6% and 1.1% respectively. There was no difference in UWC between urethritis and non-urethritis (p=0.690) nor association between GSUS grade and UWC (p=0.933). Median GSUS was higher for CT positive compared to negative patients (≥5/hpf vs 0). UWC were higher in CT (p=0.001) and GC (p≤0.001) positives. ROC area under the curve (AUC) for predicting CT was 0.844 (p≤0.001) with an optimal cut-off of >29 UWC/μl giving sensitivity of 90% and specificity of 76%. For predicting CT in urethritis and non-urethritis: the positive predictive values using the >29 UWC/μl cut-off were 20% (95%CI 9.1% to 37.5%) and 34.4% (19.2% to 53.2%) and the negative predictive values NPVs 100% (94.2% to 100%) and 97.5% (90.4% to 99.6%) respectively; for GSUS, using ≥5/hpf, positive predictive values were 10.5% (5.4% to 18.9%) and 0% (0% to 60.4%) and negative predictive values were 82.4% (55.8% to 95.3%) and 93.6% (86.8% to 97.2%) respectively.

Conclusion

UWC is (1) higher in CT and GC infection; (2) is a better predictor of urethral CT than GSUS and; (3) possibly more useful for determining non-gonococcal urethritis. Automated rapid flow cytometry may offer significantly improved utility over microscopy in the clinic.
O11 Health promotional messages in short message service (SMS) follow-up of GU medicine clinic defaulters; a tool to improve subsequent attendance rates?
Authors: Rutland E , Roe H , Weaver A
Published: May 2012

Background

Patients who do not attend (DNA) booked GU medicine (GUM) clinics waste resources and may pose a public health risk through onward transmission of sexually transmitted infections. Short message services (SMS) appointment reminders improve attendance rates, however the impact of their use in patients who have already DNA'd is unknown. In addition, health promotional tools are frequently used to improve STI awareness however there is little evidence for their effect on GUM clinic attendance.

Aims

To determine whether SMS follow-up of patients who DNA booked GUM appointments improves subsequent re-attendance rates and to assess the impact of inclusion of a health promotional message on re-attendance rates.

Methods

This prospective randomised control study included all patients aged 16–30 yrs who DNA a booked GUM appointment during the 6 month study period. Subjects were randomised to: (1) no intervention; (2) SMS notification of the defaulted appointment and invitation to attend clinic; (3) as per arm 2 including a health promotional message about Chlamydia. All SMS were sent 1 week after the defaulted appointment. Patients re-booking or attending prior to this time were excluded. The proportion of patients who re-attend within 4 weeks of the defaulted appointment were compared using the Fisher's Exact test.

Results

252 patients were included. 4.5% (4/88) in the control group re-attended clinic compared to 8.2% (7/85) receiving a text reminder (p=0.36) and 15.2% (12/79) when a health promotional message (p=0.032). None of those re attending in the control group were diagnosed with an STI compared to 29% in group 2 (Gonorrhoea and Chlamydia) and 25% in group 3 (2 × Chlamydia and 1 Herpes).

Discussion

SMS follow-up of clinic defaulters improves subsequent re-attendance rates if a health promotional message is included. The addition of a health promotional message to current routine clinic reminder texts may reduce DNA rates and warrants further study.
O2 Who should have gonorrhoea cultures in addition to gonorrhoea and chlamydia nucleic acid amplification tests? Cost effectiveness study
Authors: Hulme C , Stewart C M W , Schoeman S A , Wilcox M H , Wilson J D
Published: May 2012

Background

Nucleic acid amplification tests (NAATs) can now detect chlamydia (CT) and gonorrhoea (GC) but cultures are needed in GC NAAT positive people prior to treatment. This necessitates re-evaluation, examination and culture if cultures have not been taken initially.

Aim/Objective

To discover if it is more cost-effective to perform a NAAT plus GC culture or just a NAAT followed by recall of GC positives for culture.

Methods

3973 women performed a self-taken vulvo-vaginal swab (VVS) then clinicians took urethral and endocervical samples for GC culture. The VVSs were analysed for GC/CT by Aptima Combo 2 (AC2). Cost effectiveness was analysed using incremental cost effectiveness ratios using correct detection of GC/CT as the primary endpoint. Costs were estimated from a sub-sample of 92 patients in July 2009 and included costs of clinic time and laboratory costs. Comparisons were made of GC cultures plus a CT NAAT vs VVSs analysed by AC2 in various subgroups.

Results

VVS GC/CT NAAT with subsequent culture of GC positives was more cost-effective (8% cost-saving). The greatest saving was in women not requiring examination (37% cost saving). Cost of time taken explaining a self-taken swab was 11% of cost of examination. Savings also accrued by using AC2 rather than GC culture and CT NAAT. In contacts of GC, it was more cost-effective to include GC culture at first examination (15% cost saving).

Conclusions

VVS analysed by AC2 for GC/CT is more cost-effective and detects more infections than GC culture plus CT NAAT. In women with no symptoms self-taken VVSs give cost savings of 37%. In women with symptoms VVSs remain cost-effective unless the prevalence of GC is above 10%. We would recommend including GC culture at first examination for women who are GC contacts (see abstract O2 table 1), those with pelvic inflammatory disease or cervicitis and in other circumstances where immediate antibiotic treatment is given.

Abstract O2 Table 1

Costs of different testing strategies in whole group and subgroups

SubgroupGonorrhoea prevalenceTotal cost GC culture + CT NAATTotal cost GC/CT NAAT and subsequent GC culture if GC +veAll women n=39732.5%£199 285.68£182 769.12Symptomatic for bacterial STI n=16773.4%£84 118.32£77 650.50Asymptomatic for bacterial STI but requiring examination n=9003.4%£45 144.00£41 625.49Asymptomatic and not requiring examination n=13960.9%£70 023.36£44 230.22GC contacts n=4450%£2940.52£3382.06Previous GC n=1627%£10 826.46£10 365.43Cervicitis n=21810%£14 568.94£14 163.10Pelvic inflammatory disease n=1698.3%£11 294.27£10 888.58
O3 Gonorrhoea test of cure: outcomes in a large urban sexual health service
Authors: Cheserem E , Stevenson J , Evason R , Brady M
Published: May 2012

Background

New British Association for Sexual Health and HIV guidelines for the management of gonorrhoea in adults were introduced in June 2011. First line therapy was changed to ceftriaxone 500 mg intramuscularly plus azithromycin 1 g orally, with a test of cure (TOC) recommended for all patients at 2 weeks. Our clinic policy changed to reflect these guidelines. TOC, previously performed in selected cases, was recommended in all cases.

Aims

To identify the proportion of cases correctly treated following the change in guidelines and analyse TOC outcomes.

Methods

A retrospective case notes review was carried out from 17 June to 22 November 2011. Diagnosis of gonorrhoea was from microscopy, nucleic acid amplification tests (NAAT) and culture. The NAAT test used was Gen-Probe APTIMA Combo 2, confirmed by the Aptima GC mono-assay.

Results

152 cases were identified; 63% of cases were in men, 75% were heterosexual. The median age was 25 years (IQR 20–33.5). 24% had previously had gonorrhoea, 29% had concurrent sexually transmitted infections and 5% had HIV co-infection. 88% of patients received correct treatment as per British Association for Sexual Health and HIV guidelines. 76% were offered TOC; of these, 43% attended for TOC. TOC was negative in all patients tested (NAAT and/or culture). 4% of patients attending TOC were retreated because of re-infection risk. 22% (82/369) of partners were tested and treated for gonorrhoea; however, written or official verification of this was limited.

Discussion

Our data show that a high proportion, though not all, of patients are offered correct treatment at our centre, but only 43% return for TOC. Of those who return, persistent infection, to date, has not been detected at our centre. This may indicate that guidelines can be refined to direct TOC towards populations at greater risk of persistent or resistant gonorrhoea infection. More data regarding the best time to offer TOC is also required, as earlier TOC may improve uptake.
O4 Pharyngeal gonorrhoea: assessing treatment responses in an era of uncertainty
Authors: Artykov R , Rabiu R K , White J A
Published: May 2012

Background

The last decade has seen a paradigm shift in diagnosis and treatment of gonorrhoea (GC). Recent guidelines are hampered by lack of evidence for optimal timing for test of cure (TOC) and method of testing. The majority of pharyngeal GC (pGC) is seen in MSM and is culture-negative. Traditionally infection is harder to eradicate at this site and TOC is now routinely recommended.

Aim

To assess treatment responses and TOC strategy for pGC over a 2-year period that included multiple changes in practice.

Methods

Retrospective case note review of all pGC diagnosed by Aptima Combo 2 (AC2) and confirmed with Aptima GC from January 2010 to January 2012 at two urban UK GUM clinics. Treatment regimens changed from oral to parenteral and TOCs performed at 2 or 3 weeks across the study period.

Results

A total of 523 cases of pGC were diagnosed; 514 (98.3%) were in men. Of the 343 where culture was taken concurrently, 63 (18.4%) were culture positive. Ciprofloxacin resistance was present in 33% of pGC isolates but none showed cefixime resistance. Of the 476 where pGC treatment was given and documented by us, most were treated with either cefixime 400 mg PO (51.3%) or ceftriaxone 500 mg IMI (40.1%), usually with azithromycin 1 g PO or doxycycline 100 mg bd ¡Ý7 days PO. Of the 386 that underwent TOC within 90 days of treatment, most had both culture and AC2 taken. Positive TOC was seen in 14 (3.6%) patients (only five were culture-positive); all had received cefixime-based regimens as their first line GC treatment. High rates of ongoing sexual risk clouded the determination of treatment failure. The majority of TOCs done at 2 weeks (31/32; 97%) or 3 weeks (43/44; 98%) were AC2-negative. Two AC2-positive TOCs at 7 and 8 days post-treatment, respectively, were difficult to interpret (see abstract O4 table 1).

Abstract O4 Table 1Antibiotic regimen used for pharyngeal GC treatmentNo. of patients with TOCNo. with negative TOC result (%)Cefixime 400 mg + AZI 1 g161153 (95%)Cefixime 400 mg + doxy ≥7 days105 (50%)Ceftriaxone 500 mg + AZI 1 g101101 (100%)Ceftriaxone 500 mg + doxy ≥7 days1616 (100%)Ceftriaxone 500 mg only99 (100%)Ceftriaxone 250 mg + AZI 1 g33 (100%)Ceftriaxone 250 mg + doxy ≥7 days22 (100%)Ceftriaxone 250 mg only55 (100%)Azithromycin 2 g only99 (100%)Ciprofloxacin 500 mg + AZI 1 g66 (100%)

AZI, azithromycin; doxy, doxycycline 100 mg bd; TOC, test of cure.

Conclusions

Our data support the new guidelines for pGC treatment with ceftriaxone 500 mg regimens followed by TOC at 2 weeks with a molecular test. Prospective studies and ongoing surveillance are needed to monitor the efficacy of this strategy.
O8 The Australian chlamydia control effectiveness pilot (ACCEPt): first results from a randomised trial of annual chlamydia screening in general practice
Authors: Hocking J S , Spark S , Guy R , Temple-Smith M , Fairley C K , Kaldor J , Donovan B , Law M , Gunn J , Low N ,   ACCEPt Consortium
Published: May 2012

Background

ACCEPt is a cluster randomised controlled trial to evaluate annual opportunistic chlamydia screening for 16–29-year-old men and women in general practice (GP).

Objective

To report enrolment and baseline results.

Methods

The unit of randomisation is a town; all GP clinics are enrolled and towns are randomised using a minimisation design. In intervention towns a multifaceted approach to increase chlamydia testing includes: an education package, a computer prompt; incentive payments; a recall system for annual testing; partner notification; and regular feedback on testing rates. The intervention will be in place for up to 4 years. Control towns will continue usual practice. The primary outcome is change in chlamydia prevalence estimated from samples of 80–100 consecutive GP patients in each town (total 4000) at the beginning and end of the trial.

Results

From July 2010 to December 2011, we enrolled 603 GPs from 154 clinics (clinic response rate >80%) in 52 geographically diverse towns in four Australian states (total population 72 000 16–29-year-olds). To date, 27 towns have been randomised (13 intervention, 14 control). Intervention and control towns are similar: baseline chlamydia prevalence (5.8%, 95% CI 4.4 to 7.5% vs 5%, 95% CI 3.9 to 6.3%, individual response rate 63%); past chlamydia testing rate in 16–29-year-olds (6.1%, 95% CI 5.8 to 6.4% vs 5.8%, 5.6 to 6%). After 3 months of the intervention in the first two towns the chlamydia testing rate was 10.9% (95% CI 10.1% to 11.7%; 691 people tested), a 160% increase compared with the testing rate (4.1%) in the year before the intervention.

Conclusions

Our high recruitment rate shows that Australian GPs are willing to test for chlamydia. The baseline data show a high prevalence of chlamydia among young adults in the study towns. While testing rates are increasing, ongoing work is needed to get coverage up to levels that might reduce prevalence in intervention towns.
O9 Is HIV and blood borne virus testing acceptable and indicated in psychiatric settings?
Authors: Sanger C , Hayward J , Patel G , Poots A , Howe C , Green J
Published: May 2012

Objective

Studies in North America and Europe indicate that the prevalence of blood borne viruses (BBVs) are elevated in individuals with severe mental illness. No comparable data exists for the UK. We introduced the routine offer of testing for HIV, Hepatitis B and C into an inpatient psychiatric unit, where the local diagnosed HIV prevalence is 7.29/1000.

Method

Psychiatric inpatients were approached at one central London hospital site, between April 2011 and February 2012 and offered routine BBV testing.

Results

Of the first 100 patients offered a test 83% of patients approached were assessed to have mental capacity to provide informed consent for testing. 69% of patients offered BBV testing, accepted. The prevalence of HIV was found to be 3%. One individual was newly diagnosed with HIV and transferred to specialist care. Overall, 18% of patients tested were found to have a newly diagnosed or previous infection with a BBV.

Conclusion

It is acceptable to patients to be offered routine BBV screening in a psychiatric setting and the majority have capacity to consent; uptake rate is comparable to that seen in GUM clinics. HIV prevalence rate was found to be over four times higher than that of the local population. Given the elevated prevalence rates in psychiatric patients, there is a strong case for the wider introduction of routine testing in mental health settings. There is a need to systematically ascertain rates of infection in mental health patients across a range of geographical areas since the prevalence of BBVs appears to be higher than that in the local population.
C2 Penile intraepithelial neoplasia: important lessons from a case series
Authors: Zhou J , Williams D , Howard M , Richardson D
Published: May 2012

Background

BASHH Guidelines recommend a biopsy to exclude premalignant conditions in persistent balanitis. PIN is a well recognised condition that can be difficult to identify. In UK GUM clinics, the incidence of reporting of PIN is rare compared to international studies raising the possibility of under-diagnosis. Locally, our clinic guidelines and policies have changed in line with BASHH guidance.

Aims

We describe the clinical presentation, diagnostic process and management of PIN cases presenting to the sexual health clinic.

Results

Five cases were identified from August 2010 to March 2011. The median age was 38 years (range 31–52). 1/5 was an HIV infected MSM. Duration of symptoms ranged from 3 months to 18 years. 3/5 were initially managed inappropriately; having a delayed biopsy. In each case the condition manifested differently; with clinical appearances ranging from solitary hypertrophic lesions to multiple verrucous and leukoplakic lesions. The HIV positive patient had the most atypical and florid lesions. All of the men were uncircumcised; 2/5 were current smokers and 2/5 were previous smokers. One case had possible previous exposure to agricultural chemicals. Histologically: all biopsies had evidence of HPV infection, 4/5 had PIN3 and 1 had PIN1. 2/5 also had anal intraepithelial neoplasia; 1 presented to the surgeons with an anal lesion, but his penile lesion was missed. All were referred to local urology and three were reviewed further at a tertiary centre. 1/5 was treated with topical imiquimod only, 2/5 were treated initially with topical imiquimod then subsequent surgery with resolution of lesions and two had a surgical intervention as first line treatment.

Discussion

Men presenting with atypical penile lesions should have a penile biopsy in line with BASHH guidance and a high index of suspicion for other genital dysplastic conditions, for example, AIN and clear local pathways for referral should be in place.
C6 Not all IRIS's are equal: a case of sudden death
Authors: Wainwright E , Chen F , Tang A
Published: May 2012

Background

Myocarditis is a well-recognised complication of HIV infection but is seldom observed in clinical practice in the UK. Additionally, myocarditis has been associated with sudden unexplained death in the general population. The mode of death in these cases is likely to involve arrhythmias. We present a very rare case of sudden cardiac death related to HIV-associated myocarditis.

Case report

A 47-year-old man was diagnosed with HIV in 2002. He was lost from follow-up between 2006 and 2009, when he re-presented with a CD4 of 10. He commenced HAART in November 2009 and had a good response (CD4 70; viral load <50). In March 2010 he collapsed whilst playing football and a clinical diagnosis of cardiac arrest was made; resuscitation was unsuccessful. Retrospective history from a relative indicated no prodromal illness. A coroner's post-mortem examination indicated cardiac pathology as the most likely cause of death; this was supported by abnormal macroscopic appearance of the cardiac muscle. Histological examination of the myocardium showed focal fibrosis and lymphocytic infiltration. The finding of lymphocytic myocarditis in a previously asymptomatic and well person following 4 months of HAART strongly implicates immune reconstitution inflammatory syndrome (IRIS) myocarditis as the cause of the patient's death.

Conclusions

The wide spectrum of IRIS is increasingly familiar to HIV physicians but this case illustrates the need to be aware of potentially fatal forms of IRIS with increased risk in the severely immunosuppressed. Some of these forms unfortunately have no easily discernible manifestations.
P102 A highly cost-effective and targeted service promotion campaign using the social media site Facebook
Authors: Day S , Hughes A
Published: May 2012

Background

Facebook is the leading social media site in the world with over 30 million active users in the UK, 50% of who log on every day. It enables promotion to be targeted to specified demographic groups and is cost-effective because advertisers only pay for users who click through to their website. Using Facebook we led an advertising campaign to men having sex with men (MSM).

Method

The advert featured from 9th October to 31st December 2009 and offered a free rapid HIV testing and sexual health screening service to users actively logged on to their Facebook account. We targeted men interested in men, aged between 18 and 50 yrs, that were single or in a relationship and living within 50 miles of our city. Users clicking onto the advert were automatically diverted to our website's appointments section. Each click-through incurred a small fee (“Pay-per-click”).

Results

The campaign targeted 30 580 registered Facebook MSM users. Over 3 months the advert appeared 2.86 million times. Up to 9750 individuals were exposed to the advert on any given day and it frequently featured several times a day to each user. In total, 872 (2.9%) registered MSM users clicked through to our website at an average cost of £0.55 per click. These were aged 18–24 (55%), 25–34 (27%), 35–44 (14%) and 45–54 (4%) years. The total cost of the campaign was £483. Facebook provided regular statistical reports which enabled us to monitor its effect, control our budget and prospectively tailor the advert accordingly.

Discussion

This simple Pay-per-click Facebook campaign advertised to 8.5% of the UK MSM population (estimated UK MSM population is 3.6 million). Using Payment by Results income, only 0.3% (3–4) of clickers would need to attend our service to make the campaign cost-neutral. Whilst the functionality, diversity and social reach of Facebook is growing year on year, this presents a highly cost-effective opportunity for service/health promotion to hard to reach groups.
P103 Enhancing patient safety in a large HIV out-patient service: evaluation of an electronic results checking system for blood tests
Authors: Nugent D , Uthayakumar N , Ferrand R , Edwards S , Benn P
Published: May 2012

Background

HIV services face the challenge of regular monitoring of a growing patient cohort and ensuring prompt action upon abnormal results. We identified a number of issues using a paper-based results system (PBS) including: (1) missing results, (2) delayed delivery, (3) clinician error, (4) lack of audit trail, placing patients at risk of delayed identification of drug toxicity and serious conditions for example, acute hepatitis.

Aims

We piloted an electronic results checking system (ERC) which classifies results as normal or abnormal (non-urgent (NUAbn) or urgent (UAbn)) to compare the speed and performance of PBS and ERC in identifying biochemical abnormalities.

Methods

Between 4 July 2011 and 22 July 2011 we compared the time intervals from sampling to (1) receipt of results; (2) clinician review of UAbn/NUAbn and (3) review of NUAbn by a clinician. Abnormalities were graded and both systems reviewed daily. Data were analysed using STATA V.11.0. Mann–Whitney U tests were used to compare the intervals.

Results

Of 513 patients undergoing ≥ one blood test, 296 (57.7%) had ≥ one biochemical abnormality identified by the ERC (10.7 % UAbn, 42.3% NUAbn and 47% not clinically significant). Of these, PBS simultaneously identified 83%. The median interval between sampling to (1) receipt of results was 1 (IQR 1–2) vs 4 days (IQR 3–5), p<0.0001; (2) clinician review 3 (IQR 1–4) vs 3 (IQR 3–6) days, p<0.037; and (3) review of NUAbn by clinician 2 (IQR 1–4) vs 10 days (IQR 9–12), P=0.136, for ERC and PBS respectively. 11% of the missing PBS results were classified UAbn. ERC missed three abnormalities highlighting a software error which has now been corrected.

Conclusion

We demonstrate the use of IT to review blood results leads to the faster identification of biochemical abnormalities, which are common in our HIV cohort, facilitating their timely management. We anticipate the use of ERC in routine practice will avoid delay/non-identification of a significant number of abnormal results within our service.
P104 Patient views on confidentiality in the electronic era
Authors: Stachow E , Wong A , Soogun-Shah Z , Barrett S
Published: May 2012

Background

Confidentiality is a cornerstone of good medical practice. However, sharing of medical information is often essential for safe, effective care. The advent of computerised records has increased the scope for efficient data transfer. However, the same principles for patient confidentiality remain for this format. Ambiguity in current guidelines exists regarding patient data relating to sexual health. Peer-reviewed research reveals a lack of patient understanding on confidentiality, and concerns on inappropriate data disclosure within local areas.

Aims

A survey assessing patient understanding of, and views on, confidentiality and data sharing in sexual health.

Methods

Data were collected using a questionnaire distributed to 203 consecutive patients seen in our busy inner-city sexual health clinic and analysed using Microsoft Excel 2007.

Results

The 90 respondents demonstrated a good understanding of the definition of confidentiality (92%). Of the 54 respondents that were happy for information to be shared, 9% preferred this to be in paper format, 37% electronic, 54% were happy with both. 30% would be happy with medical record sharing between sexual health clinics, and 58% of these would prefer this information to be shared locally rather than nationwide. 50% agreed with the use of a shared database between our Trust's sexual health centres.

Conclusion

Patients understand the concept of confidentiality. Pertinent to the increasing use of electronic patient records, patients prefer the transfer of information to be in an electronic format. Opinions vary on data sharing practices, and at present, half of patients agree with the prospect of a shared database.
P106 Post (zip) code power: a new web/SMS tool to market providers and sign post clients
Authors: Menon-Johansson A
Published: May 2012

Introduction

Helping clients to find the right service in the right place at the right time is important for individual and public health. Many websites try to address this; however, providers lack control of their web profile and the accuracy of sign posting varies. A free confidential web/SMS service (http://www.sxt.org.uk) was therefore developed to support both providers and clients. All texts are charged at the standard SMS rate. Data collected were then evaluated for service utility, ability to provide gap analysis, met and unmet need and the capture of client feedback.

Methods

Web site traffic was analysed by Google analytics whilst SMS usage, provider sign up, met and unmet need and gap analyses were made possible from data downloads. Marketing was initiated by business card adverts to South London colleges and MSM venues as well by Google Ads to London users.

Results

There are currently 23 providers of sexual and reproductive health in SXT across 10 London boroughs. These providers include hospital and community sexual health clinics, primary care physicians and pharmacies. In addition, out of hours post-exposure prophylaxis providers and the three sexual assault referral centres have been included in SXT. All early adopters were able to edit their profile and add services within 20 min. Over 3 months, 701 unique visitors viewed the website with a bounce rate of 41%. Gap analyses of key services have been produced to inform service development in the London boroughs of Lambeth and Southwark. The SMS service had 74 users and the met need was 32%. Only 31 (0.04%) of all web and SMS users opted-in to provide qualitative feedback.

Conclusion

A scaleable web/SMS tool has been developed to match provider services with client needs that both supports local marketing initiatives and captures client feedback. Additional provider, client and commissioner feedback is required to optimise SXT.
P107 Cyberspace and sexual health: an objective review of website quality and navigability
Authors: Sutherby J , Menon-Johansson A S
Published: May 2012

Background

Sexual health providers/organisations are increasingly using the web as a powerful tool to market their services and educate people.

Objective

This study explored the quality of sexual health websites in the UK in order to help facilitate learning and development.

Methods

7 websites were selected to represent a range of providers (eg, NHS vs charitable organisations) and target audience (youth vs adult). The following areas were rigorously analysed: (1) Common content (2) Clarity (quality of flow/ease of navigation) (3) Innovative features and (4) Number of clicks to important information (see abstract 107 table 1).

Abstract P107 Table 1

Number of clicks required to reach information according to website

Number of clicks to …CambridgeKingstonSWISHBrookBirminghamTHTNHS choiceEmergency Contraception1121232Post Exposure Prophylaxis112Cannot findCannot find3Hard to findSTI test ‘specifically’ for Gay menCannot find22Cannot findCannot find2No search functionNumber of Innovative features3>5>5>10>10>101

Results

Common content covered by the websites were Clinic Information, Contraception, Pregnancy, STIs, HIV, Sex/Relationships, Sexual assault and The Law. Interestingly, sites with more innovative features had less clarity, and vice versa. Examples of innovative features include image galleries/videos/films, newsfeeds, voting tools, online feedback forms, contraception tools, clinic finders, online booking and risk assessment tools.

Discussion/Conclusions

Populating the website with more innovative features appears to reduce clarity. Are they mutually exclusive? To answer that question, user feedback should be sought and web site analytics used to determine if features have real utility or are just superfluous.
P108 “Don't forget the children”, using electronic patient records as a tool to achieve HIV testing of children of HIV positive parents
Authors: Naidoo R , Williams B , Murphy S , Le Prevost M , McSorley J , Brook G , Alagaratnam J
Published: May 2012

Background

The HIV status of children of HIV positive adults in the UK should be known as a matter of urgency. Implementing robust systems to identify and then test this vulnerable group of children remains a challenge.

Aims

We present a single service experience of using Electronic Patient Records (EPR) to help identify such children.

Methods

A clinical proforma to record the HIV status of all children of all HIV positive adults attending this service was developed on the EPR system in early 2010. Using the EPR Lilie database the records of all adult patients attending the service in 2010 and 2011 were searched for details of the HIV status of their children under 18 years.

Results

There were 389 HIV positive patients and 306 children identified. 278 of these children live in the UK. Of these, 242 (87%) had a verified HIV status and 36 (13%) an unverified HIV status. Of the 36 with unverified status, 12 (33%) were said to be HIV tested (negative) but this was unconfirmed, 9 (25%) had an HIV positive father and a mother who was said to be HIV negative but this was unconfirmed. 7 (19%) had been referred to paediatrics for testing and 8 (22%) children were untested for mixed reasons.

Discussion

Verifying the HIV status of the children of HIV positive parents is a complex, multidisciplinary exercise requiring excellent documentation and cooperation between different teams. The first crucial step is identifying the at risk children. The proforma in the patient records acted as a prompt to the clinician to obtain this information from the patient. Information was then easily identifiable in the EPR. The results demonstrate the strength of the EPR system. All proformas were completed showing that of our cohort of children living in the UK 87% have verified HIV status and in 13% there is enough information to pursue HIV testing or verification.
P110 Development of a web-based partner notification network linking general practice, CASH services and community pharmacy with specialist GUM services
Authors: Sutcliffe L , Symonds M , Roberts T , Mercer C , Estcourt C
Published: May 2012

Background

Partner notification in primary care is problematic and of limited effectiveness despite enthusiasm from primary care providers to engage with sexually transmitted infection (STI) management. Often it relies on the clinician informing the patient to advise his/her sex partners to attend a sexual health clinic for investigations and treatment despite evidence suggesting that only around half of sex partners informed in this way receive treatment. Many of those referred on to a sexual health clinic by a GP fail to attend and follow-up is infrequent.

Aim

To develop a robust, web-based tool for managing partner notification for patients diagnosed with bacterial STIs in primary care with broad geographical and service applicability for use in our Accelerated Partner Therapy randomised control trial in primary care.

Method

We applied a user-centered design approach to develop a web-based partner notification tool linking different types of community sexual health providers with the specialist GU service. The approach included a pre-design phase using discussions with primary care health professionals, and sexual health clinic health advisers, to determine their needs, current activity and work habits, to ensure that the web-based tool would be successfully integrated in their daily work practice. The web-tool was designed to our specifications by a bespoke software company.

Results and Discussion

We have designed a secure, simple to use web tool that allows users in a variety of settings to easily initiate, manage and monitor partner notification. A major advantage of this platform compared to other visualisation tools is its web-based format, which requires no software installation or data downloads. Data are collected in real time, and all partner notification outcomes are recorded. The platform is extendable to facilitate centralised partner notification within sexual health clinical networks across many different heath care providers.
P112 Texting or talking? Which works better to reduce hazardous drinking by sexual health clinic attendees?
Authors: Baguley S
Published: May 2012

Background

Hazardous drinking is associated with an increased risk of catching an STI, getting pregnant unintentionally, being sexually assaulted and sexually assaulting someone else. An Alcohol Brief Intervention (ABI), a type of motivational interview, has been shown to reduce hazardous drinking in men over the age of 25. There is an paucity of evidence of the benefit in younger people or in women. Texting has been shown to be useful in supporting smoking cessation, weight reduction and diabetes control. There have been no studies of its potential value in reducing hazardous drinking or its consequences.

Aim

To compare the effect of texting vs an ABI on hazardous drinking and associated sexual illhealth amongst attendees at an urban sexual health clinic.

Methods

Potential subjects are being recruited from a city sexual health clinic. Initial screening is done using the Alcohol Use Disorder Identification Test - a self-completed questionnaire marked out of 40. Consenting subjects are then randomised to texting (12 texts over 4 months), an ABI or a leaflet and then followed up by phone at 4 months. At follow-up, subjects are rescreened for hazardous drinking and asked about incident STIs, regretted sex, sexual assault, use of emergency contraception and for their evaluation of the intervention method.

Results

To end of January 2012, 6279 attendees have been screened of whom 2554 were hazardous drinkers and 799 have consented to take part in the study. (The target sample size is 1090). By the time of the conference, all subjects will have been recruited and most results will be available.

Conclusion

This is the first RCT of texting for hazardous drinking and should inform national policy in this area.
P115 Learning from patients to redesign an HIV service
Authors: Kegg S , Goddard S , Russell J
Published: May 2012

Background/Aims

Our HIV cohort more than doubled between 2004/11 with no increase in clinic capacity or staffing. Some of our service users have complex health needs—related to delayed HIV diagnosis, poor adherence to ART and co-morbidities—but an increasing number are stable on treatment and more than half have their medication delivered to their home. We are reviewing our service model to focus on the needs of our complex patients but at the same time providing a responsive, quality service to the stable patients. A key part of this review is to elicit our patients' views on the current service and how it might be improved.

Methods

A self-administered questionnaire completed by HIV+ service users.

Results

50 people completed a questionnaire and 76% described their current health as good to excellent. 43% were attending appointments 3–4 monthly, with 39% attending more frequently. 72% wished to continue to be seen at the same frequency. Most (76%) reported that appointments were available at suitable times. Barriers to clinic attendance included poor car-parking (44%) and lack of transport links (13%). A majority (84%) have access to a personal computer and 53% have a webcam—of these 50% would value an online consultation. 32% would consider HIV monitoring by their GP and 33% would like to receive some of their care in this setting. Of the people currently receiving ART delivered to their home 35% would like monitoring to be performed by the individual delivering the medications.

Conclusions

Most patients are satisfied with the current model of care and may be reluctant to be seen less often. However there is a softening in the reluctance to involve GPs in HIV care and a willingness to consider models using newer technologies and care at home. We have reviewed our clinic template increasing the number of early and late appointments and are actively developing pilots to explore new ways to deliver care to increase choice and flexibility for our patients.