BASHH UK guideline for the management of epididymo-orchitis, 2010

The BASHH UK guideline for the management of epididymo-orchitis has been updated in 2010. Consideration should be made of the changing potential aetiologies of epididymo-orchitis - mumps in non-immune individuals and tuberculosis in the immunocompromised and men from countries of high prevalence. The treatment of sexually acquired epididymo-orchitis has changed given the high levels of quinolone-resistant gonorrhoea such that ceftriaxone and doxycycline are recommended in those at high risk of gonorrhoea and doxycycline or ofloxacin in those patients where gonorrhoea is considered unlikely (negative microscopy for Gram-negative intracellular diplococci and no risk factors for gonorrhoea identified). A clinical care pathway has also been produced to simplify the management of epididymo-orchitis.

Treatment response assessment of head and neck cancers on CT using computerized volume analysis

BACKGROUND AND PURPOSE

Head and neck cancer can cause substantial morbidity and mortality. Our aim was to evaluate the potential usefulness of a computerized system for segmenting lesions in head and neck CT scans and for estimation of volume change of head and neck malignant tumors in response to treatment.

MATERIALS AND METHODS

CT scans from a pretreatment examination and a post 1-cycle chemotherapy examination of 34 patients with 34 head and neck primary-site cancers were collected. The computerized system was developed in our laboratory. It performs 3D segmentation on the basis of a level-set model and uses as input an approximate bounding box for the lesion of interest. The 34 tumors included tongue, tonsil, vallecula, supraglottic, epiglottic, and hard palate carcinomas. As a reference standard, 1 radiologist outlined full 3D contours for each of the 34 primary tumors for both the pre- and posttreatment scans and a second radiologist verified the contours.

RESULTS

The correlation between the automatic and manual estimates for both the pre- to post-treatment volume change and the percentage volume change for the 34 primary-site tumors was 0.95, with an average error of -2.4 ± 8.5% by automatic segmentation. There was no substantial difference and specific trend in the automatic segmentation accuracy for the different types of primary head and neck tumors, indicating that the computerized segmentation performs relatively robustly for this application.

CONCLUSIONS

The tumor size change in response to treatment can be accurately estimated by the computerized segmentation system relative to radiologists' manual estimations for different types of head and neck tumors.

British HIV Association (BHIVA) national cohort outcomes audit of patients commencing antiretrovirals from naïve

OBJECTIVES

The aim of this work was to audit the extent to which routine HIV care in the UK conforms with British HIV Association (BHIVA) guidelines and specifically the proportion of patients starting highly active antiretroviral therapy (HAART) who achieve the outcome of virological suppression below 50 HIV-1 RNA copies/mL within 6 months.

METHODS

A prospective cohort review of adults with HIV infection who started antiretroviral therapy (ART) for the first time between April and September 2006 was carried out using structured questionnaire forms.

RESULTS

A total of 1170 adults from 122 clinical sites participated in the review. Of these patients, 699 (59.7%) started ART at CD4 counts <200 cells/microL and 193 (16.5%) had not been tested for HIV drug resistance. Excluding patients with valid reasons for stopping short-term ART, 795 (73.5%) of 1081 patients had an undetectable viral load (VL) at follow-up. Detectable VL was strongly associated with pretreatment CD4 count below 50 cells/microL and pretreatment VL above 100 000 copies/mL, and was not associated with clinic location or case load. About a quarter of patients did not have a VL measurement during the first 6 weeks after starting ART.

CONCLUSIONS

The majority of patients who initiated ART at sites participating in this UK national audit were managed within the BHIVA guidelines and achieved virological suppression below 50 copies/mL around 6 months after commencing treatment. Poor VL outcomes were associated with very low CD4 cell count and/or high VL at baseline but not with clinic case load or location. There is an urgent need to diagnose patients at an earlier stage of their HIV disease.

Benefits of interprofessional learning: an interprofessional MSc in child health

This article addresses interprofessional education (IPE) using a case study evaluating a multidisciplinary MSc course in child health. The participants felt that the nature of the course increased their interprofessional working skills and professional confidence. They described benefits, including new insights, a balanced variety of views, development of respect and equality between professionals, improved communication and a holistic approach to child health.

Are referrals to occupational therapy for developmental coordination disorder appropriate?

AIMS

To assess children referred to the Occupational Therapy Service in Gwent with a presumptive diagnosis of developmental coordination disorder (DCD) in order to investigate the appropriateness of their referral.

METHODS

Non-urgent referrals to the occupational therapy team for children with coordination difficulties in Gwent between June 2001 and February 2002 were studied.

RESULTS

Eighty nine children, aged 5-10 years, were identified. Thirteen children who would not meet the DCD criteria were excluded. This left 76 children, 67 of whom were actually assessed. If the 15th centile for the Movement ABC is used, 26 children met and 41 failed one of the four criteria in DSM IV (38%). If the 5th centile is used, 21 children met and 46 failed one of the four criteria in the DSM (31%). Of the major groups of referrers, school nurses did the best with 48% success rate; better than the paediatricians with 32%. The worst success rate was in educational psychologists and teachers, with only 20% of cases referred actually having DCD. These differences did not quite reach statistical significance.

CONCLUSIONS

Less than a third of referrals to occupational therapy for DCD actually have the diagnosis. This suggests that referrers need further training and guidance. This includes a knowledge and understanding of the DSM IV criteria and their interpretation. This would reduce the number of time consuming, unnecessary assessments being done. A triage procedure with a checklist would be a good way forward and we hope to devise one to assist referrers with this process.

Connections and themes of spirituality in family therapy

In this article, we provide an overview of current considerations of spirituality in family therapy literature and practice. We suggest that whatever practice of therapy is undertaken, implicity or explicitly it will reflect views on the connection between spirituality and family therapy--connections involving clients' and therapists' beliefs. A thematic framework based on dimensions of the instrumental and metaphysical is outlined. Clinical approaches and practices within these connections are discussed.

Interactive multimedia information program for use by breast-care nurses--a patient acceptability study

AIMS

To design an interactive multimedia program for use by breast-care nurses and evaluate the acceptability of this technology to patients in the clinical setting.

METHODS

In order to ensure that the clarity of the information was maintained the multimedia program was developed by a multidisciplinary team, including non-medical personnel and patients. A prospective analysis of the subjective impressions of patients with symptomatic breast disorders and breast-care nurses to a multimedia patient information system was then performed using a standard questionnaire and semi-structured interviews.

RESULTS

Fifty women were recruited for the study. Thirty-six (72%) considered the multimedia counselling to be superior to the traditional modalities. Forty-nine (98%) graded the system as good or better. No patient regarded the technology as anxiety-provoking or inferior to the traditional leaflet-based approach. Women over 55 years old found the system as acceptable and easy to use as the younger women.

CONCLUSIONS

The multimedia breast counselling programme was acceptable to patients and was considered superior to the traditional leaflet-based approach by the majority. The inherent advantages of this technology will lead to its increasing utilization in the clinical setting.

A case-control study of somatic and behavioural symptoms in sexually abused boys

OBJECTIVES

To ascertain how often sexually abused boys present with somatic and behavioural symptoms.

DESIGN

A case-control study.

SETTING

A primary school in South Wales where a male teacher had been convicted of sexually abusing boys since 1981. The police investigation started in 1993 and he was convicted in 1994. A similar large primary school where abuse had not taken place.

SUBJECTS

All 107 boys who had been identified by a police inquiry to have been subject to sexual abuse by a single teacher in a single primary school; 107 age matched controls.

MAIN OUTCOME MEASURES

Symptoms that might have had a somatic or behavioural basis reported in general practice, hospital, and school health records.

RESULTS

Somatic and behavioural complaints were uncommon in both cases and controls. There was no significant difference between the numbers of cases and controls who had presented with somatic and behavioural complaints (18 cases v 25 controls). However the difference between the cases and controls with symptoms lasting over a year was significant (p < 0.05). There were no differences in the nature of reported symptoms between the control and abused groups.

CONCLUSIONS

This suggests that extensive investigation for possible abuse is not indicated where are short lived somatic symptoms but it should be considered as a possible diagnosis where symptoms are long standing.

The treatment of childhood nocturnal enuresis in the community

The nature of childhood nocturnal enuresis and its psychological treatment are briefly reviewed and the major features relevant to providing a community service are identified. A treatment system is outlined, based on criteria for inclusion, particular treatment packages, specifiable number of contacts and predetermined definitions of success. The operation of this treatment system by a small multidisciplinary team in a community clinic setting is described and data to demonstrate the running and efficacy of the service are presented.

Behaviour problems in children followed from 5 to 8 1/2-9 years of age and their relation to educational attainment

Children from a cohort of consecutive births identified with behaviour problems by the Richman Screening Questionnaire at the age of 5 years continued to have behaviour problems, as assessed by the Rutter parental questionnaire and the Bristol Social Adjustment Guide, more frequently at the age of 8 1/2-9 years than matched control children. No difference between the groups in non-verbal IQ was identified by the Pidgeon Non-Verbal Test BD. The Neale Test of Reading Ability showed delays of 5 months for both accuracy and comprehension for the study group compared with the controls. These results confirm the recent findings of Richman and others (1982) in a different setting.

Death associated with nitrite ingestion: report of a case

The tissue concentrations of nitrite and nitrate found at autopsy of a case of intentional ingestion of nitrite salts have been reported. The percentage of methemoglobin and the serum nitrite concentrations are consistent with those reported for acute overdoses. We conclude that noth nitrite and nitrate salts may be identified in tissues from persons ingesting only nitrite salts and that a significant conversion to nitrate may result from oxidation of nitrite during the conversion of heme iron to Fe3+.