bluuebunny/crossref_metadata_2025_split huggingface dataset:
P16 What were the reasons for low CD4 counts in patients starting antiretroviral (ARV) medication?
Authors: Baugh A , Apoola A 
Published: May 2012

BackgroundOur ARV Network's 2009 audit highlighted the large proportion of patients with a CD4 count <350. A re-audit was designed to provide more information on patients with CD4 counts in this range.MethodsWe conducted a retrospective review of case notes for all patients in the network starting ARVs in 2010. For analysis of CD4 counts the cohort was divided into two groups; those diagnosed within 1 year of starting treatment and others.Results114 patients started ARVs in 2010 from four centres in our network. 62 (54.4%) were male. Mean age was 38.4 years (range 17–62). Ethnicity data showed only 37.7% were white with the majority being Black (54.4%). 6 (7.0%) of 85 patients had a major NNRTI resistance mutation. Mean nadir CD4 count was 222 (range 5–610). 101 (88.6%) patients had a CD4 count under 350. 106 reasons for low CD4 count were recorded. 65 patients (64.3%) had low CD4 counts because of late diagnosis, 15 (14.8%) had declined ARV when initially offered while 10 (9.9%) had been lost to follow-up. The patients starting Rx within 1 year of diagnosis (no=67) had a lower mean nadir CD4 count compared to those diagnosed earlier (no=47) (162 cells vs 271 cells, p<0.5). There was no difference between the two groups in the number of patients having a pre-treatment resistance test, the mean CD4 rise 6 months after treatment initiation and the proportion of patients having an undetectable viral load 12 months after treatment initiation. At 6 months the mean CD4 count had risen from 222 at treatment initiation to 360, but 54 (47.4%) still had a CD4 count under 350. The main reasons for this were poor immune recovery in 80.7%, poor adherence 7%, poor attendance 5.3%.DiscussionA proportion of our cohort started ARVs with a low CD4 count mainly due to late diagnosis. This is an important barrier to ARV initiation and needs to be addressed and our audit data would support the need for extra support and resources directed to earlier HIV diagnosis.
P161 Routine three-site NAAT testing in MSM increases pharyngeal and rectal diagnoses of chlamydia and gonorrhoea
Authors: Dufty N , Herbert S , French P , Mercey D 
Published: May 2012

BackgroundBASHH and Health Protection Agency guidelines acknowledge the increased sensitivity of Gonorrhoea (GC) NAAT testing compared to culture at extragenital sites. Chlamydia (CT) NAAT testing is also the test of choice at these sites. Routine three-site GC and CT testing in MSM was implemented at a genitourinary medicine clinic using urethral, pharyngeal and rectal sites.ObjectivesTo compare the number of diagnoses of CT and GC before and after implementation of routine three-site NAAT testing for MSM.MethodsRecords were reviewed of MSM testing positive for CT or GC from the urethra, pharynx and/or rectum between 1 January 2010 and 1 April 2010 and compared to the same 3-month period in 2011.ResultsNumber of cases: The proportion of GC cultures resistant to >1 antibiotic increased from 15.9% (18/113) to 41.8% (28/67), however cultures were only taken in 51.1% (138/270) of NAAT positive GC specimens (see abstract P161 table 1).Abstract P161 Table 1Comparison of CT/GC diagnosedQ1 2010*Q1 2011*MSM attendances40633975MSM diagnosed166354Diagnoses of CT or GC199494CT (total)81225CT Urethra4369CT Pharynx032CT Rectum25113LGV1311GC (total)118269GC Urethra5845GC Pharynx11121GC Rectum49103MSM with infection at 1-site146 (88%)258 (72.9%) 2-site19 (11.4%)80 (22.6%) 3-site1 (0.6%)16 (4.5%)Diagnoses due to triple NAAT testing protocol (% of total):322 Pharyngeal CT32 (100%) Rectal CT106 (93.8%) Pharyngeal GC109 (90.1%) Rectal GC75 (72.8%)Diagnoses treated due to triple-site NAAT testing (% of total)234 Pharyngeal CT20 (62.5%) Rectal CT78 (69%) Pharyngeal GC76 (62.8%) Rectal GC60 (58.3%)*Q1 1st January to 1st April.DiscussionPharyngeal GC, CT and rectal GC diagnoses increased with three-site NAAT testing, making the pharynx and the rectum the main sites of GC and CT infection. This increase in diagnoses has implications for clinical service provision. The increase in antibiotic resistance to GC has important clinical implications and when using routine three-site NAAT testing, cultures should always be taken prior to antibiotics being given.
P165 GUM/HIV trainees' experience and training needs in the management of patients disclosing sexual violence
Authors: Sacks R , Coyne K , Cybulska B , Dhairyawan R , Forster G , Emerson C , Mears A , Mears A , Shah R , Spice W 
Published: May 2012

BackgroundPatients attending GUM clinics may disclose sexual violence. Are GUM/HIV trainees equipped to manage these cases?AimTo assess the experience and training needs of GUM/HIV trainees in managing patients disclosing sexual violence (SV patients).MethodAn e-survey was open to GUM/HIV trainees for 12 weeks from February 2011. Data were analysed in Excel.ResultsOf the 158 current GUM/HIV trainees, 44 (28%) completed surveys. All respondents managed SV patients and 59% managed ≥ 1 SV case/month. Of these, 98% had seen females, 66% males, 73% 16–17 years/olds, 34% 13–15 years/olds, 5% under-13s. All respondents routinely asking about SV saw ≥ 1 case/month vs 50% of those who rarely/never asked. Confidence increased with frequency of seeing patients: 96% (25/26) seeing ≥ 1 SV patient/month felt confident vs 67% (12/18) seeing <1/month. Confidence in managing female, male and under-18 SV patients was reported in 86%, 79% and 58% respectively. In the six units with a dedicated SV clinic two trainees had worked in one, overall, 92% would have liked to. Similarly, 14% had worked in a Sexual Assault Referral Centre, 81% would have liked to. Respondents had trained in safeguarding children, adult SV, chain of evidence, vulnerable adults and domestic violence in 92%, 82%, 76%, 64%, 32% respectively. Abstract P165 Table 1 details respondents' reported competencies and training availability in 2010 curriculum skills.Abstract P165 Table 1Competent (%)Not competent, training available (%)Not competent, training not available (%)Emergency contraception counselling10000Referring to support organisations90100Prescribing STI/HIV/Hep B prophylaxis90100SV history taking and risk assessment in u-18s8947Forensic exam counselling/documenting injuries64297Documenting history/exam for medico-legal report461935ConclusionsWide variation exists in reported SV experience, training received and training availability, in the 28% of trainees responding. Regular accessible training is needed in identifying and managing patients disclosing SV.
P17 Four years of post exposure prophylaxis following sexual exposure (PEPSE) prescribing after sexual assault in a sexual assault referral centre (SARC)
Authors: MacDonald R , Groom T , Wardle D 
Published: May 2012

AimWe have reviewed 4 years of PEPSE use in our SARC and its follow-up and compared with BASHH guidance on PEPSE after sexual assault.MethodsRetrospective review of SARC and GUM notes from 12 October 2007 to 12 October 2011Results1233 cases seen 127 given PEPSE, for two notes not available Age range 14–55 years mean 27. 81% were female. 51% were vulnerable. Ethnicity of assailants, 81 White European, 20 African, 5 Asian, 4 Dark European, 13 unknown. One man had PEPSE twice. Mean time till received PEPSE was 25 h range 3–168 h, 5 over 72 h. Using BASHH guidelines PEPSE wasrecommendedin 22%,consideredin 50% and 26% wasnot recommendedas either >72 h or low risk exposures. 87 returned at day 3 for review. 29 stopped PEPSE early. One was HIV positive at baseline, 12 due to side-effects, three felt the assault was low risk of HIV at review, 13 for other reasons. 27% returned for HIV test at 3 months, 14% at 6 months. No seroconversions seen. 17% completed PEPSE. 43 given PEPSE while on interacting drugs. Eight were identified and given appropriate management. Most common interaction was hormonal contraception.DiscussionCompletion rates for PEPSE were low and similar low rates have been seen in alike studies. No long-term side effects were seen but only 19% of interactions were identified. PEPSE is a risk reduction method and so clients should not be put at risk of serious drug interactions. 33 were given PEPSE for low risk exposures which is “not recommended” by BASHH. 10 of these accepted full PEPSE course. The decision to start PEPSE is often made under stressful conditions so GUM now review need for PEPSE after completing the starter pack. It is vital staff starting PEPSE prescribe within the guidelines and they and GUM staff consider interactions. We have created a proforma which reminds staff only to give within 72 h and review interactions. It also outlines HIV risks after exposure and hopefully make it easier to discuss this with the client.
P181 Management Of recurrent vulvovaginal candidiasis and recurrent bacterial vaginosis in North East London Network For Sexual Health and HIV (NELNET)
Authors: Navsaria S , Lowe S M , Estcourt C S 
Published: May 2012

BackgroundRecurrent Vulvovaginal Candidiasis (VVC) and Bacterial Vaginosis (BV) are common, associated with significant morbidity, often impact on psychological well-being and can be relatively costly to manage. BASHH guidelines acknowledge that the evidence base for recommendations is poor. We aimed to describe the management regimes of GUM Consultants who routinely manage these conditions within our large network prior to introducing sector-wide guidelines.MethodWe emailed appropriate GUM consultants from the six network centres requesting their standard management regimes for both conditions. We collated the responses and used BASHH Guidelines as a standard for comparisonResultsAll 14 consultants responded. Treatment regimes for VVC were broadly similar but only three consultants prescribed according to BASHH Guidelines. 13 consultants prescribed induction regimes. All consultants used oral fluconazole, doses included 50, 100 and 150 mg. Duration of induction regimes ranged from 3 daily doses, alternate day doses, 72 h doses to daily dose for 14 days. Ten consultants prescribed maintenance therapy for 6 months, 4 stopped after 3 months. 11 consultants prescribed 150 mg weekly for at least 3 months. For recurrent BV there was considerable variation and no one followed BASHH guidelines. Regimes included oral metronidazole (2 g, 400 mg), metronidazole gel or clindamycin pessaries. Induction ranged from 5 to 14 days, maintenance from 3 to 6 months. All consultants prescribed menstrual regimes if appropriate. Three consultants also prescribed Balance Activ or equivalent.ConclusionManagement of recurrent BV and VVC varied greatly across the network. Management of recurrent VVC was more closely associated with BASHH guidelines than management of recurrent BV. Management regimes are often based on clinicians' own experience. New network guidance has now been established providing a local standard for future case record audit.
P185 A pilot programme for the undergraduate teaching of sexual health using interactive demonstration for experiential learning
Authors: Flynn B , Fernando I , Cochrane R , Boyd K , Allan B 
Published: May 2012

BackgroundIn Edinburgh in May 2011, the GUM and FP/SRH departments integrated. A priority for the new service was reviewing and improving the undergraduate teaching offered in sexual health.AimTo increase and improve undergraduate teaching, using experiential learning to develop the skills and attitudes essential for managing patients with sexual health needs.MethodsAn OSCE format with interactive demonstration was chosen as the method to achieve these aims. Stations focused on effective communication and developing appropriate skills and attitudes. Three OSCE stations, based on common and important sexual health scenarios, were designed for interactive group work using simulated patients. The fourth station facilitated open discussion of sexuality and its implications for the well-being of patients. Four pilot sessions were run. Feedback questionnaires were given to students, facilitators and simulated patients. Strengths, weaknesses, and suggestions for improvement were requested. Participants were asked to score their level of enjoyment (from 1 to 10). Students also scored the course on how useful it was in meeting their educational needs (see abstract P185 table 1).Abstract P185 Table 1Participant evaluation of interactive demonstration for experiential learningSimulated patientFacilitatorStudentNumber of returned forms122575“Enjoyment” mean score (1–10)888“Useful” mean score (Students only)8ResultsFeedback was extremely positive. Students felt the opportunity to practice their communication skills within sexual health consultations in a risk-free environment was the main strength. A request for “more scenarios” was the most commonly cited “weakness” and main suggestion for improvement.ConclusionFollowing this successful pilot, the programme will now be regularly provided to the undergraduate medical students of Edinburgh. A similar model of teaching could be achieved at other departments, and is a successful way of delivering experiential learning in teaching resource limited settings.
P192 What career choices do trainees make after attending the GU medicine taster?
Authors: Patel S , Lau R 
Published: May 2012

BackgroundThe GUM taster (running annually in London since 2009) is a 2-day educational programme for junior doctors before they apply for specialist training. It is popular and oversubscribed, receiving excellent feedback. We sought to investigate the career choices made by trainees who had attended previous GUM tasters.MethodsAll trainees who had attended one of three previous GUM tasters were contacted about their career progression. Four questions were asked, covering: (1) current specialty, (2) current year of training, (3) career choices/plan, (4) reasons for choice of specialty.ResultsTrainees were contacted by email and telephone, response rate 86% (90/105). Trainees currently in specialty or GP training (52%, 47/90) are listed below: The remaining trainees (43/90) were in: non-training clinical posts/working abroad (21), still in F2/CT1/CT2 (19), clinical fellowships (2) or had left medicine (1). Of these, 37% (16/43) planned to apply to GUM as their first choice specialty; with 26% (11/43) planning to apply for GP training. 71% (15/21) of trainees planning a career as a GP wanted to continue with GU as a specialist interest. Reasons given for choosing GU medicine included interest, work-life balance, opportunities for research/work abroad, lively colleagues, diverse patients and avoiding general medicine (see abstract P192 table 1).Abstract P192 Table 1Delegates choosing GUM as a speciality following taster daySpecialtyNumber of trainees (% choosing specialty)GUM17 (36)GP10 (21)Microbiology/radiology3 each (6)ID/Public health/Surgery/O&G2 each (4)Dermatology/oncology/geriatrics/rheumatology/ACCS/psychiatry1 each (2)Total47Discussion37% (33/90) of those attending our GU Tasters were either already in GU training or considering applying for GU as their first choice specialty. In 2011, the Taster was successfully organised in London and in the Midlands (for the first time). The course has allowed trainees to be better informed about the specialty and has highlighted GU medicine as a popular alternative or additional career option for many.
P194 The use of capture re-capture to assess completeness of reporting of syphilis cases and to guide interventions for improvement
Authors: Waldram A , Gorton R 
Published: May 2012

BackgroundTwo North East Syphilis outbreaks underlined the need for complete reporting of cases. Completeness was assessed by comparing GUMCAD with regional Enhanced Syphilis Surveillance. Capture–recapture studies were undertaken at yearly intervals to estimate the true number of cases and put forward recommendations to improve reporting completeness.ObjectivesThe objectives were to assess completeness of reporting of Syphilis cases in two surveillance systems, estimate the true number of cases, and provide recommendations for improving Syphilis reporting.MethodsCompleteness of reporting was assessed for the period January 2010–June 2010 using capture–recapture methodology to estimate the true number of cases. Intervention A (clinic visits discussing findings) was performed and the effect measured by repeating the process. Follow-up studies were undertaken covering January 2010 to Jun 2011 to measure the effect and a different intervention B (linelists sent to clinics) was performed.ResultsIn the initial audit neither system included more than 73% of the estimated true burden of cases, although the aggregate figures suggested they were similar. After intervention A this increased to 94% in GUMCAD. The second audit showed a decreasing trend of reporting completeness after June 2010 to an average of 84% in January 2010–June 2011. After intervention B this improved to 96%. Causes of incompleteness in GUMCAD included incorrect coding and failure to record cases identified during screening leading to under-matching and overestimation of the total burden.DiscussionCompleteness of reporting before intervention was 84% in GUMCAD suggesting the true number of syphilis cases was 19% higher than reported by official statistics. Completeness increased after intervention A but subsequently declined and a further intervention was required to maintain data quality. Regular feedback of case lists to clinics to check for missing cases can enhance completeness of Syphilis surveillance.
P196 Service evaluation: sexual health promotion a “missed” opportunity for young people?
Authors: Lutterodt C , Wong-Taylor L , White B , Lewis G 
Published: May 2012

BackgroundThere is currently no widely accepted guidelines regarding sexual health promotion for paediatric staff. Consequently, valuable opportunities to provide much needed education are unfortunately being “missed”. Young people (YP) in hospital have an ideal opportunity to discuss sexual health in confidence with healthcare workers.ObjectivesThe objective of this service evaluation was to assess the role of healthcare professionals and their views on providing sexual health education to adolescents on the wards. Understanding perceived views and identifying barriers and leavers is crucial in exploring some of the reasons behind why potentially ideal situations to provide sexual health information are currently being “missed”.MethodsQuestionnaires were completed by paediatric staff members. The responses were anonymised and data were collected from mid-October 2011 until the end January 2012.ResultsThe overall response rate was 81%. The skills paediatric staff felt they possessed were: advising how to protect against pregnancy (91%), STDs (90%), prescribing contraception (61%), screening for psychosocial issues (26%), testing (34%) and treating STDs (40%). Almost 20% did not know about local sexual health centres. Furthermore, GPs were cited as the most appropriate healthcare professional to provide sexual health information.ConclusionThere appears to be a role for sexual health education within secondary care. We suggest that opportunistic health promotion should be considered by paediatric staff when dealing with YPs. Clearer guidance would minimise the number of “missed” opportunities and additional information sources (eg, leaflets) for patients and staff would enhance the provision of health promotion.
P21 Post-exposure prophylaxis following sexual assault
Authors: Dhairyawan R , Muckart L , Forster G E 
Published: May 2012

BackgroundHIV post-exposure prophylaxis (PEP) is recommended for survivors of sexual assault. Completion rates are often lower than for PEP prescribed in other settings, which may be related to psychological issues faced by survivors immediately after the assault and a lower threshold for prescribing.AimsTo study outcomes of survivors of sexual assault prescribed PEP (Truvada and Kaletra) at an inner city sexual assault referral centre (SARC).MethodsForensic and follow-up notes were interrogated for data on clients prescribed PEP between 1 June 2010 and 31 May 2011.ResultsData were available on 54 clients; 46 were female. Median age was 25 (range 14–40 years). Ethnicity: White European 35/54, 11/54 Black African/Caribbean and 8/54 Asian. 48/54 initiated PEP at the SARC, 4 in A&E and 2 in sexual health and all within 72 h. Exposure: 37 RVI, 14 RAI, eight unknown. 20/54 had an additional risk: 11 multiple assailants, eight defloration and seven ano-genital trauma. The assailant HIV status was unknown in all cases, but 11 were assessed to be high risk. 16/54 of the clients had never tested for HIV, 14 had tested negative previously and 24 were not documented. All had PEP prescribed within BASHH guidelines (2006). 36/54 continued care at the SARC. 20/36 (56%) completed 28 days of PEP. Nine were lost to follow-up, four discontinued due to side effects (Grade 1–2 nausea and vomiting), One due to abnormal blood results (Grade 1 rise in ALT and creatinine), one chose to stop and one was not documented. None had their PEP modified. 13/36 had an HIV test at 3 months post-PEP and all were negative.ConclusionsThis study shows that PEP was prescribed within national recommendations. Completion rates were comparable to a local tertiary sexual health/HIV clinic that followed-up patients prescribed PEP after occupational and sexual exposure (66%) but lower than the 2006 BASHH standards (75%). This suggests that survivors of sexual assault may require greater adherence support.
P22 A user centred approach to the design of p-of-care and self-test mobile phone diagnostics for sexually transmitted infections (STIs)
Authors: Gkatzidou V , Hone K 
Published: May 2012

BackgroundEffective Sexually Transmitted Infection (STI) control is being challenged by inadequate access to prompt diagnosis and treatment for patients and relatively poor community STI surveillance. This work forms part of a larger eSTI2(Electronic Self-Testing Instrument for Sexually Transmitted Infections) consortium developing diagnostic devices for pathogen detection and integrating point-of-care tests with mobile technology.Aim(s)/Objective(s)Harnessing the widespread mobile phone use, this research develops innovative eSTI2technologies for reducing STIs transmission and providing greater personal control of sexual health. The aim of this study is to develop a wireless web-based management system that links chlamydia self-test diagnostics to further patient care pathways.MethodsThis research adopts a user centred approach to the development of a Human Technology Interface for self-managing STI diagnosis. The research methodology begins primarily with initial exploratory pilot studies to gather functional and user requirements regarding ethical and regulatory requirements of the Human Technology Interface. Iterative development of functional prototypes exploring design possibilities and technology features will be followed by the formative evaluation of interface design through qualitative and controlled usability studies with target users.ResultsIn this paper we report on a user centred approach that allows for the successful capture and integration of social science methods to encapsulate user requirements with usability principles in order to develop an effective and user acceptable self-managing STI system.Discussion and/or ConclusionsWorking in a cross-discipline collaboration the overall aim is to investigate the impact of user-centred methods in the design of innovative mobile phone and web technology based rapid testing.