bluuebunny/crossref_metadata_2025_split huggingface dataset:
O4 Pharyngeal gonorrhoea: assessing treatment responses in an era of uncertainty
Authors: Artykov R , Rabiu R K , White J A 
Published: May 2012

BackgroundThe 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.AimTo assess treatment responses and TOC strategy for pGC over a 2-year period that included multiple changes in practice.MethodsRetrospective 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.ResultsA 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.ConclusionsOur 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

BackgroundACCEPt is a cluster randomised controlled trial to evaluate annual opportunistic chlamydia screening for 16–29-year-old men and women in general practice (GP).ObjectiveTo report enrolment and baseline results.MethodsThe 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.ResultsFrom 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.ConclusionsOur 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

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

BackgroundBASHH 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.AimsWe describe the clinical presentation, diagnostic process and management of PIN cases presenting to the sexual health clinic.ResultsFive 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.DiscussionMen 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

BackgroundMyocarditis 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 reportA 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.ConclusionsThe 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

BackgroundFacebook 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).MethodThe 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”).ResultsThe 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.DiscussionThis 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

BackgroundHIV 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.AimsWe 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.MethodsBetween 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.ResultsOf 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.ConclusionWe 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

BackgroundConfidentiality 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.AimsA survey assessing patient understanding of, and views on, confidentiality and data sharing in sexual health.MethodsData 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.ResultsThe 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.ConclusionPatients 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

IntroductionHelping 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.MethodsWeb 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.ResultsThere 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.ConclusionA 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

BackgroundSexual health providers/organisations are increasingly using the web as a powerful tool to market their services and educate people.ObjectiveThis study explored the quality of sexual health websites in the UK in order to help facilitate learning and development.Methods7 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 1Number of clicks required to reach information according to websiteNumber 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>101ResultsCommon 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/ConclusionsPopulating 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

BackgroundThe 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.AimsWe present a single service experience of using Electronic Patient Records (EPR) to help identify such children.MethodsA 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.ResultsThere 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.DiscussionVerifying 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.