bluuebunny/crossref_metadata_2025_split huggingface dataset:
P135 Factors that influence learning of sexual history taking for medical students
Authors: Davies J 
Published: May 2012

BackgroundTraining for medical students in the UK now incorporates formalised training in sexual health and HIV. While research has assessed knowledge and skills in medical graduates around sexual history taking, this has been largely approached from a quantitative paradigm rather than students own experience It was decided by the author to carry out a qualitative study to inform content and delivery of the current sexual and HIV module.AimTo explore the experiences of fourth year medical students in their learning of sexual history taking.MethodsSemi-structured interviews were undertaken with six fourth year medical students. Framework analysis was used to identify emerging categories and themes from the data.ResultsFour distinct categories were acknowledged: prior experience, classroom based learning, clinic based learning, and future confidence. Themes identified included patient and student embarrassment, acquisition of key phrases, the use of proformas and patient consent. Factors influencing the learning of sexual history taking were often interwoven and stemmed from both the classroom and clinical setting. One common expectation was that another healthcare professional would take over while being observed with a patient. The issue regarding confidence appeared to be intrinsically built up from the start of their overall training. Students recommended that classroom based scenarios should include non-genito-urinary medicine settings. Student confidence was improved by the recognition that classroom teaching matched the clinical consultations, with no preference to designation of the health care professional teaching.ConclusionAcknowledgement of the influences experienced by medical students while undertaking classroom and clinic based learning of sexual history taking provides useful guidance for future curriculum development.
P137 The effect of a dedicated syphilis clinic on syphilis management outcomes
Authors: Fernando K , Hall K , Ross J D C 
Published: May 2012

BackgroundPatients with syphilis are frequently managed within general sexual health clinics. Although the incidence of syphilis has recently increased, it remains a relatively uncommon STI and individual clinic staff may see only a small number of cases. It is not known to what extent the use of a dedicated “syphilis clinic,” where expertise is concentrated, can lead to an improvement in management. A dedicated specialist trainee/health advisor delivered syphilis clinic was introduced in April 2011 to optimise the care of patients with syphilis.AimTo assess, using outcomes from the UK syphilis management guidelines, the effect on patient care of introducing a dedicated “syphilis clinic.”MethodsA case record review of patients with syphilis before (control arm) and after (intervention arm) the introduction of a dedicated syphilis clinic between October 2010 and September 2011.Results101 patients were analysed, 30 in the intervention, and 71 in the control arm. Repeat testing prior to treatment was undertaken in 19 (63.3%) of the intervention arm and 45 (63.4%) of controls [p=0.99]. Receipt of appropriate antibiotic treatment was observed in 28 (93.3%) of the intervention arm and 65 (91.5%) of controls [p=0.73]. The mean number of follow-up visits required was 1.23 (intervention arm) and 3.3 (controls) [p=0.334]. Of significance, however, was consultation length, being shorter in the intervention vs the control arm—mean duration of 49.7 min cf. 61.8 min (p=0.034).DiscussionIn addition to reduced consultation duration, continuity of physician involvement and optimisation of patient care are key potential benefits of a dedicated syphilis clinic.
P138 I don't know, let's try some canestan: an audit of non-specific balanitis treatment and outcomes
Authors: Powles E , Marsden R , Gupta N K , Green T 
Published: May 2012

BackgroundBalanoposthitis commonly presents to Genitourinary Medicine and may be caused by a wide variety of unrelated conditions. The 2008 UK National Guideline on the Management of Balanoposthitis recommends biopsy to exclude malignant disease where clinical diagnosis is uncertain and balanitis persists for more than 6 weeks despite simple treatment.MethodA retrospective audit of case notes with KC60 code C6c presenting between January and June 2011.Results90 patients were diagnosed with balanitis (age range 16–71 years, mean 30, mode 22, median 25). 68 cases were treated as presumed candidal balanitis with either Clotrimazole cream, Fluconazole or Daktacort. In the remaining cases no presumptive diagnosis was made but 10 patients were given empirical Trimovate cream, three had Metronidazole tablets, one had Dermovate cream and one had Betnovate cream. Seven patients did not receive any medication. In all but one case the balanitis had fully resolved within 6 weeks. In the persistent case, initial treatment was with Clotrimazole cream for presumed Candida; when the lesions persisted this was changed to Daktacort but a clear diagnosis was not made. However, he failed to attend for further follow-up so it is not known if the balanitis resolved with the change of treatment. No cases were referred for biopsy.ConclusionThe rate of persistent balanitis was extremely low in this cohort and all except one case resolved with treatment. This patient did not return for further review and was not referred for biopsy. Penile biopsy is recommended where the balanitis persists and the diagnosis remains unclear as in this case. A robust system of recall management is needed to ensure that appropriate action is taken in such cases.
P139 Evaluation of a dedicated multi-disciplinary young person's integrated sexual health clinic
Authors: Davis T , Allstaff S L , Cunningham C 
Published: May 2012

BackgroundOur local authority has the highest teenage pregnancy rate in Scotland. A needs assessment was undertaken and a dedicated young persons (YP) clinic was introduced for people aged 18 and under in partnership with the local youth health and information centre and the child protection team.AimTo evaluate the 6-month pilot of a dedicated YP multi-disciplinary integrated sexual health clinic.MethodsAll patients attending the YP clinic between January and June 2011 were included. Data collected included demographics, sexual orientation, STI diagnoses and the uptake of contraceptives. Data were also collected from an evaluation form offered to all patients.Results131 young people attended the YP clinic during the pilot period. 108 (81%) were female and 23 were male of which 4 (17%) were men who have sex with men. The mean age was 16 for both males and females (range 12–18). 61 (47%) were under the age of 16. Chlamydia infection rates were high (24.4%). Sub-dermal implants were fitted in 22.2% of eligible females. 75 young people completed evaluation forms (57.3%). The majority found the clinic times suitable (95%) and travelled to the clinic by public transport or on foot (76%). Young people most frequently heard about the clinic from the local youth centre or from friends. Service users frequently commented positively on the partnership working with other agencies.ConclusionsThe introduction of a YP clinic has been popular with service users. Due to the success of this service, a second clinic will be launched at the same site.
P140 Setting up a young person's contraception and sexual health (CaSH) service in a semi-rural GP practice—the first year
Authors: Hum O 
Published: May 2012

BackgroundThe National Strategy for Sexual Health and HIV talks about improving access to genito-urinary medicine (GUM) services by providing Level 2 services in other settings, including primary care. Rural teenagers often find it hard to access GUM services due to distance and time constraints. They may also dislike consulting their own General Practitioners (GPs) due to concerns about confidentiality.Aims/ObjectivesPoor access to sexual health and family planning services was noticed in our rural area. A small Level 2 service was set up within a GP practice in January 2011. It was designed in conjunction with, and widely promoted at, local schools and colleges. A walk in service, running once a week; it offers diagnosis and treatment of most STIs, registration for C card, and all forms of contraception including long acting reversible contraception (LARC). It also offers pregnancy testing, HIV testing, signposting and advice. Emergency contraception is offered at any time of the week. There are three members of staff, a GP, practice nurse and health care assistant.Results432 patients were seen, with a median age of 17, drawn from a large geographical area. 75% were female and 20% under 16. New to follow-up ratio was 3:1. 261 chlamydia tests were offered with an 11% positivity rate. 137 young people have been registered for the C card, with a short education session, and LARC was discussed with 216 patients. 102 prescriptions for oral contraceptives were given and 23 injections of Depo Provera. 17 contraceptive implants and two coils were inserted. A patient satisfaction survey with a sample size of 38 showed high satisfaction ratings. Offering a service within the non-threatening environment of a GP surgery was approved highly, and most felt that their right to confidentiality had been upheld.ConclusionsIn a semi-rural area, primary care can provide an effective, accessible and popular alternative to traditional CaSH services.
P142 Evaluating the vulval service within our genitourinary (GU) medicine department
Authors: Bradshaw C , Patel S , Dragovic B 
Published: May 2012

BackgroundVulval disorders with their psychosocial and psychosexual impact are frequently encountered within GU clinics. Dedicated specialist clinics should ideally be multidisciplinary with input from dermatology, GU and gynaecology; however this is not always feasible. A need for this service was recognised at our urban clinic—thus in 2005, a monthly vulval dermatoses clinic was set up and led by a GU physician with training in genital skin disease. In 2009 a monthly vulvodynia clinic was set up, staffed by a trained GU physician and psychosexual counsellor.AimsTo review our service provision over a 1-year period.MethodsRetrospective notes review of monthly vulval dermatoses and vulvodynia clinics were performed from November 2010–2011.ResultsThere were 145 vulval clinic appts; patients were only counted once—94 notes were reviewed. Vulval dermatoses clinic (n=40; 20 new, 20 f/u): median age 36 (IQR 29–44); referred by GUM 85%, derm/gynae 10%, GP 5%. Referral symptoms: itching (23), burning (8), dyspareunia (6), vulval pain (5), other (12); median length of symptoms 2 yrs (IQR 1–3). Predominant conditions were: psoriasis 28% (11) and lichen sclerosis 28% (11). Vulvodynia clinic (n=54; 24 new, 30 f/u): median age 28 (IQR 25–32); referred by GUM 67%, GP 26%, gynae/derm 7%. Referral symptoms: superficial dyspareunia (42), vulval pain (11), itching (2); median length of symptoms 2 yrs (IQR 1–5). Diagnosis of vulvodynia made in 74% (40/54). 22/40 were seen for f/u, 73% (16/22) reported at least 50% improvement in their symptoms with treatment.ConclusionOur vulval service meets the needs of a significant number of symptomatic women allowing timely diagnosis, management and f/u. Recognising the multifactorial nature of vulval disorders means patients receive a thorough assessment in one clinic visit with a GU screen, dermatology review and psychosexual input, thus providing a service tailored to the patient.
P143 Patient satisfaction with their sexual health services in Yorkshire and Humber
Authors: Mammen-tobin A , Lee J , Andrews M 
Published: May 2012

BackgroundPatient derived outcome measures such as patient satisfaction surveys are a vital tool in evaluating current services and can also be used to guide future health care provision.Aims/ObjectivesTo undertake a re-audit of the initial survey in 2008 and incorporates specific questions about the process and experience of care that patients have received.MethodsService users were asked to complete the questionnaire anonymously and leave it in the sealed box provided. Seven clinics across Yorkshire and Humber participated in the survey with a total of 329 questionnaires returned.ResultsCompared with previous audit there were improved scores for ease of access as by then the 48-h target had been achieved in the region while the overall positive experiences of service remained high. The survey highlighted variations in the amount of time patients could expect to spend, with some reporting more than 60 min in clinic and this evidence will be helpful in influencing change. GPs and other medical services were still important sources of referral however increasingly service users used the internet to self-diagnose symptoms and obtain information about their local sexual health services. Preferences for clinic appointments were for evenings between 17:00–20:00, mornings 9:00–12:00 and afternoon's 13:00–17:00 in that order. Service user's experiences of services were overwhelmingly positive, and almost all would be happy to recommend the service to others.ConclusionsThis re-audit highlighted the need for some clinics to re-examine patient flows with the aim of reducing clinic waiting times. All clinics are advised to incorporate more evening appointments. The audit also highlighted the internet as a source of information about sexual health in general and local services in particular and it is important that individual clinics address this need.
P144 Chronic pelvic pain syndrome: should we be managing patients with this complex condition?
Authors: Crofts M , Mead K , Horner P 
Published: May 2012

BackgroundChronic pelvic pain syndrome (CPPS) affects 2%–6% of men who present to GUM departments. It is associated with a significant morbidity and there are no reliably effective treatments.AimTo evaluate the management of men with CPPS attending a dedicated clinic.MethodsWe performed a retrospective study on men with CPPS attending between September 2010 and November 2010. We extracted information regarding patient's clinical presentation, management and outcome. Outcome was quantified by the difference between the first and last scores generated by the National Institute of Health Chronic Prostatitis Symptoms Index (NIH-CPSI). A 4–6 point fall or a >25% reduction in score is considered significant. Scores can range between 0 and 43, with scores closer to 0 reflecting a more favourable status.ResultsNotes were available for 19 men, mean age 38 years (Range 23–59 years). The average number of clinic visits prior to referral to the specialist clinic was 9 (Median 3.00), with a mean of 98 days from onset of symptoms (Range 21–365). 21% had urethritis and the mean number of courses of antibiotics prior to attendance was 3 (Range 0–15). All patients had a discussion on the aetiology of CPPS and the importance of pelvic floor relaxation. 16 patients received antibiotic therapy, 12 received α-blockers, 8 tricyclic antidepressants and 10 were referred to urology. The mean number of consultations was 8 (Range 2–35). The mean NIH-CPSI score fell by 8.1 (36%) (p<0.01). 13 out of 19 patients (68%) found a >25% improvement in their symptoms score after attending the clinic (see abstract P144 table 1).Abstract P144 Table 1NIH-CPSI score before and after attending dedicated clinic for CPPSDomainNIH-CPSI scorep ValueFirst attendanceLast attendancePain10.86.7<0.01Urinary symptoms3.72.90.11Quality of life8.54.8<0.01Total22.614.4<0.01ConclusionsA significant fall in NIH-CPSI was observed in men with CPPS attending a dedicated clinic indicating that this condition can be successfully managed in GUM departments. Earlier identification and effective management may lead to better outcomes.
P147 Are video recordings of consultations in HIV and genitourinary medicine (GUM) acceptable to patients and staff?
Authors: Daniel B , Cohen C E , Day S , Mandalia S , Theobald N J 
Published: May 2012

BackgroundVideo recordings of consultations (VC) are used in general practice to improve junior doctors' training, having been shown to be acceptable to patients.AimsTo determine the acceptability of VC in GUM/HIV, excluding physical examinations.MethodsAfter identifying potential VC concerns from a pilot study, patient surveys were distributed within GUM/HIV clinics September 2010–May 2011. Staff (ST) surveys were distributed electronically and via post October 2011–January 2012. Both included questions on confidentiality, videotape storage, potential impact on the patient-clinician interaction and additional time incurred.ResultsOf 1171 patient questionnaires distributed, 1002 (86%) were returned; 57% (570) were GUM and 43% (432) HIV clinic attendees; 86% (860) aged 20–49 years. Two–thirds (659) were male, of whom 77% (507) were men who have sex with men. Nearly half (47%) considered VC acceptable. After adjustment for other factors, multivariate analysis showed non-acceptability was independently associated with concerns re confidentiality RR 10.7 (95% CI 6.5 to 17.5, p<0.001) and with not wanting the consultation to take two extra minutes RR 17.2 (95% CI 9.3 to 31.9, p<0.001). ST surveys were distributed to 140 members; 31% (44) returned. Of note, distribution coincided with introduction of a new coding system. In total, 34% (15) were nurses, 25% (11) consultants/associate specialists, 18% (8) ST/trust grades, 14% (6) trainee doctors, 9% (4) other. Two-thirds (29) were female. Of all ST, 73% (32) found VC acceptable. Univariate analysis did not show any possible cause for likelihood of non-acceptability.ConclusionNearly half our patients thought VC acceptable, with concerns cited around confidentiality and time, compared to nearly three quarters of ST. ST survey uptake was low, perhaps due to the time constraints noted above. Once the specific patient concerns have been addressed, VC could be introduced in GUM/HIV as a valuable educational tool for all clinical ST.
P149 Evolution of the NCSP: Integrating chlamydia screening into community health services; policy and practice developments in England
Authors: Clarke J , Bone A 
Published: May 2012

BackgroundThe National Chlamydia Screening Programme is a major component of sexual health provision in England. Over 1.4 million tests were performed on asymptomatic under 25-year olds in 2010/2011, and over 87 000 diagnoses made. The expansion of chlamydia testing services in the NHS has occurred predominantly outside of GUM utilising both traditional health services and introducing alternative approaches for young people to access testing. Coverage of screening has been higher in deprived areas and among young people at increased risk of infection.DiscussionThe NCSP is evolving from a stand-alone programme to one that is integrated in primary care and sexual health services, with outreach screening being restricted to hard to reach groups. This integration is occurring both in terms of the way chlamydia screening is commissioned and provided, and in terms of data collection, removing the requirement for chlamydia-specific services. This process is expected to substantially improve value for money and maximise synergies between chlamydia prevention and other services. Clinical research and modelling, comparison with other programmes around the world and the major organisational changes in the NHS and public health system continue to shape the commissioning and delivery of screening. Clinical practice, from distribution of test kits to partner notification and treatment, is increasingly dependent upon electronic resources. Key discussion points include: How can we continue to develop flexible, responsive community sexual health services that include chlamydia screening as a core component? Will evaluation criteria for quality assurance and for clinical effectiveness currently applied to a stand-alone NCSP be valid in the integrated models?
P15 Are we following BHIVA guidelines in newly diagnosed HIV patients?
Authors: Thomas J , Fadzillah N H M , Carey P B , Bates C M 
Published: May 2012

BackgroundBHIVA published guidelines in 2008 on the treatment of HIV infected adults. These guidelines were used as a basis for optimal patient care.AimsTo audit the following against BHIVA guidelines: (1) Initial investigations, assessment and monitoring after diagnosis (2) Choice of first line ARV regimen (3) Attainment of target HIV viral load <50 by 6 months of treatment (4) G.P. involvement in patient care.MethodsThe medical records of 24 HIV positive patients, who were diagnosed and started on ARV medication during the preceding 12 months, were reviewed.ResultsInitial investigations and assessment were done in all patients (100%), with the exception of cardiovascular risk assessment which was documented in only 20% of patients. 18/24 patients (75%) were started on the first line regimen recommended [2NRTI and 1 NNRTI], out of which 14 patients (58.3%) were started on Atripla. 5 patients (20.8%) received [2NRTI and boosted PI] and one patient was on [2NRTI and integrase inhibitor]. 20 patients (83.3%) achieved the target VL<50 within 6 months of treatment. In 3/24 (12.5%) patients the viral load was still detectable at 6 months. One patient moved away from the region. The G.P. was informed about the HIV positive status in only 62.5% patients.ConclusionSeveral areas of clinical practice were identified for improvement and the following actions recommended: the use of a web-based virtual clinic resource which includes links to CVS risk calculators; proactive discussion with patients regarding the importance of disclosure of HIV status to their GP for safe and efficient care.
P153 Female genital mutilation (FGM)—providing a holistic approach and challenging taboos in a sexual health setting
Authors: Dominguez L , Dominguez L , Hopkins K , Mutalak O , Harish S , Nalabanda A , Osman S , Robinson L , Cohen C , Jones R 
Published: May 2012

BackgroundIn England and Wales nearly 66 000 women are living with FGM and a potential 22 000 girls are at risk each year. Due to increasing demand, a dedicated FGM service within the sexual health setting was initiated in partnership with a dynamic Somali facilitator and a voluntary community organisation.AimsTo analyse the attendances of women with FGM to our dedicated clinic.MethodsRetrospective analysis of all attendees to the FGM clinic between 1 December 2010 and 31 December 2011.ResultsOf 197 attendees, 96% were from Somalia (190); mean age was 38 (14–72 years) with 52% living locally. Of those in whom we had documented information, FGM was mainly undertaken for cultural reasons (83/105, 79%), the majority (50/68, 73%) being cut in groups at their home (66/113, 58%). Mothers were the main instigators (58/81, 71%). Nearly half (84/173, 49%) had female children and seven women reported having their daughters cut abroad. The majority were against the practice (112/114, 98%). Reasons for attendance included chronic pelvic pain (57%), dyspareunia (44%) and sub fertility (24%). There was a high uptake of sexual health screening, with almost all patients (191, 97%) having serology for HIV and syphilis. Interestingly, no HIV was detected but 7% (13/185) were hepatitis B surface antigen positive and 31% (58/185) had cleared hepatitis B. There were six diagnoses of late latent syphilis and two of chlamydia.ConclusionsOur Somali facilitator has played a key role in challenging the taboo of sexual health issues within FGM-practising communities, providing a service that is culturally and linguistically appropriate. The rate of blood-borne viruses in this vulnerable group proves the importance of engaging them with sexual health services. Fast track referrals to on-site gynaecology and hepatitis clinic have facilitated re-engagement of some patients with medical care.