bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of intense airway management training on paramedic knowledge and confidence measured before, immediately after and at 6 and 12 months after training
Authors: Walker Mark , Jensen Jan L , Leroux Yves , McVey Jennifer , Carter Alix E 
Published: May 2012

IntroductionAirway management is a core component in the practice of advanced life support (ALS) paramedics.ObjectiveTo determine if an intense airway management course would improve ALS paramedic knowledge and confidence and if knowledge was retained over time.MethodsAn identical written survey (measuring demographics and confidence) and multiple-choice examination (measuring knowledge) was administered at the start and end of a 10 h airway course. At 6 and 12 months after the course, paramedics took the knowledge examination. Paired confidence and written knowledge examination scores before and immediately after the course were compared. Differences between knowledge examination scores at all four time points (before, immediately after and at 6 and 12 months) were tested using analysis of variance and Tukey's test.Results299 ALS paramedics were enrolled in the study. 209 (69%) reported 6 or more years of ALS experience. The mean pre-course confidence score was 2.74/4 and the mean post-course confidence score was 3.39/4; a difference of 0.7 points (95% CI 0.61 to 0.71). Post-course examination scores improved by 4.9 points (95% CI 4.58 to 5.20), from 7.7 to 12.6/20. At 6 months the mean score was 10.3/20, and at 12 months 10.2/20. Post-course scores were significantly better than pre-course scores. Scores at 6 and 12 months did not differ significantly and remained significantly improved from pre-course scores.ConclusionSignificant improvement in confidence and knowledge was found after paramedics completed an intense airway management course. Knowledge at 6 and 12 months remained significantly better compared with pre-course.
O17 Sexual behaviour in younger MSM and self-perceived sexual risk using a local HIV Risk Assessment Tool (HIVRAT)
Authors: Alagaratnam J , Black A , Smith A 
Published: May 2012

BackgroundHIV infection continues to disproportionately affect MSM in the UK. The 2011 HPA report “Sexually Transmitted Infections in MSM in the UK” highlights the need for one-to-one behavioural interventions. Thus, identifying those at highest risk is essential.AimsTo profile the sexual behaviour of younger MSM attending a dedicated clinic. To establish how MSM perceive their sexual risk and explore the use of a simple HIV Risk Assessment Tool (HIVRAT).MethodsMSM attending a weekly clinic offering HIV testing self-complete a 6 question HIVRAT in addition to standard history. The HIVRAT records number of male partners in previous 12 months, and number of unprotected anal intercourse (UPAI) partners (previous 3 and 12 months). It also contains a Likert scale of perceived sexual risk. Data was collected over 6 months from June 2011. Statistical analysis was performed in Excel and correlated using Spearman's Rank methodology.Results138 men completed the HIVRAT (aged 18–35). Median number of sexual partners in preceding 12 months = 8 (range 1–250, 42% reported >10 partners). Median number of UPAI partners in preceding 3 months =0 (range 0–5) and 12 months =1 (range 0–8). Perceived risk was scored as 1= Very low (20.4%), 2 (44.5%), 3 (28.5%), 4 (4.4%) and 5= Very high (2.2%). There was poor correlation between sexual behaviour and perceived risk. For MSM who had UPAI with one or more partners in the previous 3 and 12 months, there was a moderately positive correlation between actual risk and perceived risk (SRCC 0.517 and 0.544 respectively).ConclusionsOnly 6.6% of MSM judged their personal HIV risk as high in a cohort where 36% reported UPAI with two or more partners in 12 months. Tools like HIVRAT provide valuable information which is not routinely collected. Asking about UPAI during the 12-month period prior to testing showed the strongest correlation between actual and perceived risk, and could help identify MSM who would benefit most from behavioural intervention.
O6 Seniority improves specificity: differences in PID diagnosis between different grades of clinician
Authors: Morris G C , Stewart C M W , Wilson J D 
Published: May 2012

BackgroundPelvic inflammatory disease is difficult to diagnose; dependent on interpretation of clinical symptoms and signs that lack sensitivity and specificity. Differences in the rates of PID diagnoses have been noted among senior sexual health physicians. Given the potential severe consequences of untreated PID, we hypothesised that clinicians with less training and experience may tend to err on the side of caution and be more likely to diagnose PID than more senior colleagues.ObjectivesTo ascertain whether the rates of PID diagnoses differ by grade of clinician.MethodsWomen attending our service as new or rebook patients between March 2009 and January 2010 were seen by eight different grades of clinician. Of these, all but Band five nurses saw symptomatic patients. Data were analysed by grade of staff conducting the consultation.ResultsChlamydia (CT) prevalence was broadly similar across all staff groups. The rates of PID diagnoses were also similar. However, the proportion of PID patients with CT differed significantly between staff groups. In the cases of PID diagnosed by more experienced staff, CT was found in 24% to 32% of patients. This is broadly consistent with the current understanding of PID aetiology. PID diagnosed by nurses and more junior doctors was less likely to have a confirmed STI aetiology. The rate ratio of diagnosis of CT positive to CT negative PID by consultants vs Band six nurses is 5.43 (95% CI 0.77 to 38.01) p=0.089 The rate ratio of diagnosis of CT positive to CT negative PID by experienced doctors (GP, SAS, Registrar, Consultant) vs nurses, FY1 and ST2 doctors is 3.09 (95% CI 1.01 to 9.43) p=0.048 (see abstract O6 table 1).Abstract O6 Table 1Rates of chlamydia and gonorrhoea infections in relation to practitioner groupGrade of staffBand six nursesFY1ST2GPSASRegistrarConsultantWhole cohortNo of staff764219641No of consultations4421402072524869969303453No of PID diagnoses178914215047166% Of cohort diagnosed with PID3.85.74.35.64.355.14.8Chlamydia prevalence (%)10.19.36.312.38.610.911.410.4Gonorrhoea prevalence (%)20.71.43.61.62.73.12.5% Of PID patients chlamydia positive5.912.511.128.523.82431.923.5% Of PID patients gonorrhoea positive5.90028.50126.48.4% Chlamydia positive patients diagnosed with PID2.27.77.712.911.91114.210.9ConclusionsSignificant differences were found in the proportion of patients with chlamydia positive PID between experienced doctors and other clinicians. The broader experience of senior doctors may help them in differentiating PID from other causes of lower abdominal pain thus improving the specificity of their diagnosis.
C1 Pharyngeal lymphogranuloma venereum: four cases in men who have sex with men
Authors: Dosekun O , Edmonds S , Stockwell S , French P , White J A 
Published: May 2012

BackgroundLymphogranuloma venereum (LGV) is an established cause of proctitis in men who have sex with men (MSM). In the UK, testing for pharyngealChlamydia trachomatis(CT) is not routine, and LGV typing is seldom performed.ObjectiveTo describe clinical features of four cases of pharyngeal LGV seen across three different urban GUM/HIV clinics, all of who had LGV-specific DNA detected at this site.Case reportsAll four cases occurred in MSM; their past STI histories included HIV (2), syphilis (3) and hepatitis C (2; one diagnosed after LGV infection). Two cases had no oropharyngeal symptoms or local lymphadenopathy (LN) but had symptomatic LGV proctitis. One case had severe odynophagia, a tongue ulcer and cervical LN, and the final case reported severe pharyngitis with large unilateral cervical LN 10 days prior. Three of the four had concurrent rectal LGV infection. The infections responded to doxycycline: 21 days was given in two cases, and the other two received 7 and 14 days treatment, respectively. Test of cure swabs performed at 6 weeks to 5 months following treatment were negative in all cases. Three MSM had new STIs diagnosed at the time of their Test of cure.Conclusion/Learning pointsWe describe a variety of clinical presentations of pharyngeal LGV infection in MSM. The oropharynx may act as reservoir for CT, and possibly LGV, and routine screening should be considered at this site for all MSM. The absence of localised symptoms does not exclude pharyngeal LGV infection. Symptomatic oropharyngeal LGV infection is probably rare but should be considered in the differential diagnosis of MSM with unusual or severe symptoms/signs at this site. There are no guidelines for treating pharyngeal CT or LGV infection, but treatment with 1- to 3-week regimens of doxycycline was effective. Ongoing high-risk sexual behaviour in this population makes outbreak containment difficult.
P10 Vitamin D levels in a sample of HIV+ patients
Authors: Brook G , Alagaratnam J , Barai K 
Published: May 2012

BackgroundIn the last few years it has been highlighted that vitamin D deficiency is common in the general population however, the extent of the problem in different HIV+ cohorts is less clear.AimsIn a cohort of HIV+ patients in North West London we looked at the vitamin D levels to see what the prevalence of deficiency was and see if there were any correlates with ethnicity or season.MethodsAll HIV+ patients at this centre and who had a recorded vitamin D test result in the last 2 years were identified. The first result while not on treatment was recorded. The patients' electronic case records were examined to identify any correlates with the results. Vitamin D was classified as deficient, insufficient or adequate with total 25-hydroxy vitamin D blood levels of <12.5, 12.5–50 and >50 nmols/l respectively.Results143 patients had a least one vitamin D level measured. Of these 7 (5%) had vitamin D deficiency, 83 (58%) insufficient levels and 53 (37%) had adequate levels. Comparing patients who had levels tested in the winter months with those tested in the summer, they were more likely to show deficient or insufficient levels than adequate levels (44/90 (49%) vs 6/53 (11%) p<0.0001). All patients who showed gross deficiency were black or Asian but there wasn't a correlation between ethnicity and insufficient/deficient levels. Three (42%) of the patients with deficient levels had a raised serum alkaline phosphotase and/or a low serum phosphate.ConclusionsHigh rates of vitamin D deficiency and insufficiency were found in this cohort, only part of which is explained by doing the test in the winter months. Some evidence of metabolic effects of deficiency on bone was found
P117 Audit on uptake of HIV test in sexual health clinic, antenatal and TOP services in Dumfries between January and June 2011
Authors: Steshenko O 
Published: May 2012

BackgroundBASHH introduced “UK National Guideline for HIV testing 2008” recommending universal HIV testing in GUM or sexual health clinics, antenatal and termination of pregnancy services. Early identification HIV positive persons help to reduce further transmission of HIV infection to others and allow referring them to appropriate services for further treatment.Aims and ObjectivesThe audit was undertaken to identify compliance of local sexual health clinic, antenatal and TOP services with “UK National Guideline for HIV testing 2008”. To establish uptake of HIV test by patients accessing Sexual Health Clinic, Antenatal and TOP services in Dumfries between 1st January and 30th June 2011 and give recommendations according to findings.MethodsRetrospective audit of electronic patients' records of all persons accessing the local sexual health clinic in relation to STI issues, pregnant women attending antenatal clinic, patients receiving TOP service care between 1st January and 30th June 2011.ResultsFrom 844 episodes of care in sexual health clinic, HIV test performed in 400 (47%) episodes. 511 women attended antenatal clinic and 507 (99.2%) of them had HIV test. From 42 patients having TOP, 6 (14.2%) women had HIV test.DiscussionNot all patients might have been offered the HIV test in sexual health clinic. TOP service does not offer the HIV test routinely.RecommendationsSexual health clinic should offer HIV test to all patients accessing their service and document in patients' medical records that the HIV test was offered. When patients decline the HIV test, reasons for declining have to be documented. TOP service should update their local TOP guideline instructing their nurses, midwives and doctors to offer HIV test to all patients accessing their services. To present findings of the audit to medical staff at local, regional and national levels. To conduct re-audit in 3–6 months once changes have been implemented.
P12 HIV testing: are we doing enough? A staff awareness survey in East Midlands
Authors: Dhar J , Nyatsanza F 
Published: May 2012

BackgroundThe overall HIV prevalence in East Midland is low and since 2000 most of the new cases in our region continue to be diagnosed in the same three Primary Care Trusts, peaking in the 35–39-year-old adults in 2009/2010. HIV uptake rates vary from 69% to 80% and high coverage remains a possibility as demonstrated by 96% antenatal uptake rates.ObjectiveTo collect information from hospital and community based staff about HIV testing, to develop effective regional strategies.MethodsA 10 min online Questionnaire was completed by staff members via Survey Monkey this included gender, age, time since qualification, experience of HIV test use, training issues etc.Results1067 responses have been analysed, >75% of respondents being female, representing a wide range of specialties including general practice. 21%, 28%, 28%, 22% are aged between 20–30 years, 30–40 years, 40–50 years and >50 years respectively. 25.5%, 21%, 25%, 29% of the respondents were qualified <5 years, 5–10 years, 10–20 years, more than 20 years respectively. 46.8% had no prior experience of offering an HIV test. 39.9% felt they had the necessary skills a similar proportion 39.5% felt they lacked them. 21.8% of the respondents would have concerns offering a test. While the majority 81.6% agreed with NICE guidance on expanded testing 57.7% would require further training, 50.2% saying they would be unable to answer patients questions on HIV testing. 85.1% agreed that HIV updates need to be incorporated in induction provided to health care professionals with 45.9% stating that current methods were not adequate.ConclusionsThe survey highlights that while health care professionals are aware of the need to have a HIV test nearly half of them have never offered one and a large proportion have identified anxieties around consultation. Inadequate training was cited as a major factor for not considering or offering a test.
P121 Do guidelines help promote sexual health screening (SHS) and detect sexually transmitted infections (STIs) in older adults with HIV?
Authors: Baugh A , Taylor R , Bellingham L , Ahmed I 
Published: May 2012

BackgroundAdults over 50 with HIV comprise 20% of the national cohort. BASHH/BHIVA guidelines recommend all patients have a sexual health assessment documented at presentation and 6-monthly, with a full SHS offer annually and outcome documented.AimsWe audited practice against these guidelines, to establish any difference in services offered to over-50s. We also examined rate of STI detection.Methods80 case notes were retrospectively audited–40 aged over 50 and 40 aged under 50.ResultsAbstract P121 Table 1 Shows the demographics of the groups. Only 75% of over-50s had sexual history documented at presentation compared to 86% of under-50s. 45% of >50s had SHS documented at presentation (Chlamydia, GC and Syphilis), with a further 15% having Syphilis test only. 77% of over-50s had full SHS at baseline. In 24 baseline SHS performed in the over-50s we found 8 STIs: 2 Syphilis, 1 HSV, 1 Hepatitis B, 1 Chlamydia and 3 Gonorrhoea. In the 34 SHS performed in under-50s we found 11 STIs: 1 HPV, 2 Syphilis, 2 HSV, 1 Hepatitis B, 3 Chlamydia and 2 GC. Sexual history documentation in 2010/11 was poor in both groups. In the >50s, only 28% had a documented sexual history. In the under-50s, 35% had documented sexual history. SHS in 2010/11 was offered to 20% of over-50s with 1 declining and in 35% of under-50s with 2 declining. Positivity was low; 1 case of Syphilis in each group.Abstract P121 Table 1Demographics of HIV cohort<50 years>50 yearsMean age82%62%Male gender6936MSM40%35%White ethnicity55%68%ConclusionIn our sample, fewer over-50s had a sexual history and SHS offer documented at presentation. Screening at presentation identified STIs in both groups. Few patients declined SHS, suggesting patients find it acceptable. There were more STIs in the under-50s group at presentation, correlating to national trends. However, we tested more young patients, possibly explaining this difference. STI rate in 2010/11 was low but didn't differ with age—it is important to perform a sexual history in all patients and offer SHS, so we are developing a proforma to prompt clinicians.
P122 Management of sexual assault in the East Kent community
Authors: Abubakar M , Shakya A , Forey K 
Published: May 2012

BackgroundKent community health NHS Trust provides sexual health services (SHS) in East Kent serving an approximate population of 750 000 based in eight clinical sites. SHS see a significant number of sexual assault (SA) case referrals in this region as there is no designated Sexual Assault Referral Centre.AimThis audit was conducted to determine if the management of SA cases in the services is in accordance to the standards outlined by British Sexual Health and HIV(BASHH) SA auditable outcome measures.MethodCase notes coded as SA based on a local code audited from the period of October 2010 to October 2011. Data were collected from the local SA proforma and case note documentation which identified information regarding victim's and assailant's profile and documentation of essential historical elements of SA. Other auditable outcomes measured included injury documentation, HIV risk assessment and post exposure prophylaxis (PEP) offer, police referral for crime and forensic examination (FME), self harm and child protection assessment. Data regarding emergency contraception, prophylactic antibiotics and hepatitis vaccination offered, testing for STIs and referral to EKRL were also collected.ResultsTotal no SA codes92:7 notes missing: total 85 casesSource of referralsSelf: 59 (69.4%) Other: 26 (30.6%)Time since SA54 (63.5%) seen within 6 weeksAssailant detailsKnown: 51 (60.0%) Unknown: 34 (40.0%)HIV risk assessment: 100%Vaginal: 68 (81.9%) N=83Oral: 11 (12.9%) N=85Anal: 13 (15.3%) N=85High risk: 13—2 eligible for PEP. Offered but declinedReferral for FMEYes 19 (22.3%) No 66 (77.7%) 10 (11.7%) had FME prior attendanceReferral to A and ENoneEmergency contraceptionYes 6 (7.0%) No 79 (93.0%)Prophylaxis antibiotics for STDsYes 6 (7.0%) No 79 (93.0%)Hepatitis B vaccination59 (69.4%) indicated 43 (72.9%) vaccinatedFirst visit testYes 64 (75.3%) No 21 (24.7%)Repeat testYes 33 (38.8%) No 52 (61.2%)Child protection assessment under 1618 (94.7%) N=19Referral to police55 (64.7%) offered 5 (0.09%) declinedReferral to EKR lineYes 48 (56.4%) No 37 (43.6%)Follow-ups offered59 (69.4%)Total follow-ups seen40 (47.0%)ConclusionsThis audit highlighted the importance of clear documentation of treatment and care offered and provided to victims of SA. Poor documentation of management is likely to underestimate the overall outcome of care offered, but when a treatment is indicated and initiated there is a good clear documentation. The local SA proforma is concise and user friendly for any trained and qualified healthcare individuals and covers all aspects of care as recommended by BASHH except for the self harm assessment which will be included upon revision. A close working partnership with local police, SHS and EKRL is essential to ensure the management of SA within the community is in accordance with national standards.
P124 A motivational interviewing (MI) intervention aimed at reducing sexual risk taking in men who have sex with men (MSM): the launch of a pilot service
Authors: Yap S Y , Traynor D 
Published: May 2012

BackgroundHIV is one of the fastest growing serious health conditions in the UK. HIV+ MSM have an increased burden of sexually transmitted infections (STIs). Effective interventions are needed to reduce the risk to MSM's health. MI is an evidence based goal-directed approach to behaviour change. There is some evidence for its use in risk reduction in sexual health. A clinic was set up to deliver an MI based intervention to MSM who engage in “high risk” sexual activity. The aim is to reduce the frequency of patients' unprotected sex, thereby reducing risk of transmission/acquisition of STIs.AimsThe aim of this paper is to review the level of need for a MI based risk reduction clinic. An audit of referral data to the MI clinic was compared with an audit of referrals to the general sexual health psychology clinic. The latter receives referrals from sexual health; a proportion of total referrals to this service include clients who engage in high risk sexual activity.MethodsThe MI clinic was publicised by presenting the clinic at teaching and multi-disciplinary clinic meetings. Patient leaflets outlining the service were distributed across clinic rooms. A survey of staff was carried out to assess potential need for the service. A comparison audit of referral data to the MI clinic vs the general sexual health psychology clinic over a 6-month period was carried out.ResultsA comparison of the average number of referrals per month to the general psychology service vs the MI clinic was carried out. The MI clinic averaged 30% more referrals per month than the general sexual health psychology service. A survey of referrers showed that 67% of staff who were aware of the MI service reported that they had patients who would benefit from the service.DiscussionThese results highlight the need for a specific service to address sexual risk taking. Further research is required to investigate whether MI is an effective intervention in this area.
P128 The acceptability of using soccer clubs as venues for chlamydia screening in young men: results from a qualitative study
Authors: Saunders J M , Sutcliffe L J , Hart G J , Estcourt C S 
Published: May 2012

BackgroundMany non-clinical, including sports, settings have been used in an attempt to screen more men for Chlamydia. While feasible there is very little research exploring their acceptability among users of these settings.ObjectiveWe explored the acceptability of, and the best way to deliver, Chlamydia screening in soccer clubs among young men who play amateur soccer.Methods18 semi-structured, face-to-face interviews with men aged between 18 and 35 who play soccer in London-based non-professional leagues. Interviews were carried out from October to December 2011 and analysed using a framework approach.ResultsSoccer clubs are acceptable venues to access Chlamydia screening because they offer several potential benefits over screening in traditional settings. Importantly they are discreet testing venues and allow screening to take place within the context of normal daily routines. Having testing kits handed out to all team members by a senior member of the club (captain/coach/manager) or a visiting health care professional (HCP) meant that no one would feel singled out for testing and overcome barriers to asking for, or collecting a kit from central collection points. While some men preferred to use the test kit there and then and return samples to a collection point at the club, others preferred to use kits at home and return samples to the laboratory by post. However, concerns about confidentiality and test tampering meant that some men favoured a visiting HCP to coordinate testing rather than a member of the club.ConclusionSoccer clubs appear to be acceptable venues for young men who play soccer to access self-collected testing kits for Chlamydia. Processes for accessing, using and returning test kits should be discreet, easy and quick. We will be developing testing pathways in soccer clubs to pilot in six London clubs during the 2012–2013 season.