Barriers to syphilis testing among men who have sex with men: a systematic review of the literature.

Men who have sex with men (MSM) represent the highest risk group for syphilis in the United States and several other countries. Improving uptake of syphilis testing among MSM requires understanding key barriers to testing in this population. Using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a systematic review to assess proportions of syphilis testing among MSM and identify social, structural, and individual barriers to syphilis testing was conducted. All searches were conducted through the University of Maryland world catalogue search engine. Studies that measured syphilis testing in a sample of MSM were included. All studies were assessed for bias using JBI-MAStARI instruments. Studies were synthesised based on sample size, years of data collection, study selection method (e.g. hospital or clinic-based, community/venue-based), location (e.g. USA-based, other countries) and results of the bias assessment. For studies measuring barriers associated with testing, the measure of association, point estimate and statistical significance was assessed. Of 848 studies found in the initial search, 24 were included in the final review. The largest difference in syphilis testing proportions was based on hospital or clinic-based sampling (50-87%) compared with venue/community-based and online sampling (31-38%). Socioeconomic factors (four items, four studies, OR 0.23 to 0.68), healthcare interactions six items, five studies, OR 0.09 to 0.69) and community/interpersonal factors (seven items, five studies, OR 0.07 to 0.58) were identified as barriers to testing. Barriers to syphilis testing among MSM include socioeconomic factors, healthcare-related factors and community/interpersonal factors. Improving overall routine utilisation of healthcare services is an especially important focal point in testing promotion.

A telehealth program to perform medical screening examinations.

The importance of a timely medical screening examination on ED throughput, efficiency, and patient safety cannot be underestimated. This article describes a telemedicine program based on the provider in triage model that uses physician assistants and NPs to improve patient door-to-diagnostic evaluation times in the ED.

Role of surveillance cultures in infection control.

Hospital-acquired infections are a known menace to the primary disease, for which a patient is admitted. These infections are twenty times more common in developing countries than in the developed ones. Surveillance for colonised patients can be passive or active process. In many hospitals, active surveillance culture for certain sentinel organisms followed by contact precautions for the same is an important part of infection control policy. Specific measures can be taken on early detection of multidrug-resistant organism, allowing prevention of widespread transmission in hospitals. Cultures are the most conventional and economical microbiological method of detection. The cost of active surveillance is a major challenge, especially for developing nations. These nations lack basic infrastructure and have logistic issues. The guidelines regarding this are not very clearly delineated for developing countries. Each hospital has its own challenges and the process is to be tailor-made accordingly. The following review delineates the various aspects of active surveillance for the colonisation of various organisms and the advantages and disadvantages of the same.

Subjective Versus Objective Assessment of Cognitive Functioning in Primary Care.

PURPOSE: This study examined the clinical utility of highly efficient subjective and objective screens of cognitive impairment. METHOD: Participants (N = 124, age ≥ 65, mean = 73.59, SD = 6.26) completed a 2-item questionnaire of subjective memory functioning, a brief computerized cognitive test, and the Montreal Cognitive Assessment (MoCA). Next, participants were assigned to 1 of 4 conditions, based on their subjective (low/high) and objective (impaired/unimpaired) levels of cognitive functioning. Further analysis divided the sample into age-based groups (ie, age < 75, age ≥ 75). RESULTS: The proportion of participants in the impaired subsample (ie, MoCA < 26), who reported a high level of subjective concern about their memory, was low (ie, 0.15). Among unimpaired participants, analysis detected significant group differences across subjective memory levels (P < .0003) and age (P < .005) categories on one of the three tasks of the computerized test (ie, cognitive control). In contrast, the MoCA offered no differentiation between these groups. CONCLUSION: Screening protocols in which cognitive testing is administered subsequent to patient complaint are prone to underdiagnosis. In addition, common dementia screens are insensitive to subjective deficits and healthy cognitive aging. Therefore, they may lead to dismissing valid concerns that deserve preventive attention. Primary care needs efficient screening tools that are sensitive to prodromal decline.

Short communication: expanding the range of services to the survivors of Ebola virus disease in the Democratic Republic of the Congo.

BACKGROUND: The objectives of the article are to assess the role of a strategic response in the prevention and control of the disease and the need for extending supports to the survivors of disease. INTRODUCTION: Since the start of the August last year, a new outbreak of Ebola virus disease has been reported in provinces of the Democratic Republic of the Congo. METHODS: As of now, close to 1170 cases and 740 deaths have been attributed to the diseases due to the associated complications in the region.As of now, close to 1170 cases and 740 deaths have been attributed to the diseases due to the associated complications in the region. RESULT: In order to effectively respond to the outbreak, a wide range of strategies have been proposed. It is a fact that the survivors of the disease outbreak face multiple challenges, the task of organizing eye clinics to promote early detection of the problems among the survivors has been initiated. CONCLUSION: In conclusion, Ebola virus disease is a life threatening disease and is linked with a wide range of complications, including those involving eyes. Thus, the need of the hour is to formulate a strategic response comprising of different strategies which not only aim to reduce the incidence of the disease, but also to extend quality assured care to the survivors.

Randomised trial of telephone counselling to improve participants' adherence to prescribed drugs in a vascular screening trial.

A total of 1446 participants, 65- to 74-year-old men diagnosed with abdominal aortic aneurysm (AAA), peripheral arterial disease (PAD) or high blood pressure (HB) in the Viborg Vascular (VIVA) screening trial, were consecutively included and randomised to a telephone counselling (TC) or no TC 3 months after being screened positive. Data from VIVA were linked to data from Danish registers from 2007 to 2016. The primary outcome was a composite outcome of proportion of days covered by statin, antithrombotic drugs and antihypertensive agents and for each specific drug class at 6-month follow-up. The same outcomes were assessed at 12 and 60 months and considered secondary outcomes. Outcome measures are reported as risk differences (RD). There were no differences between the groups in relation to the composite of all three drug classes over 6 months of follow-up, RD = 4.1 (95% CI: -1.0; 9.1). A significant increase in redeemed statin prescriptions was observed in the intervention group at 6 months, RD = 9.8% (CI 95%: 0.5; 19.0). There was no intervention effect observed after 12 and 60 months. TC 3 months after screening improved adherence to statin at 6-month follow-up, but had no effect on the composite treatment, statins, antithrombotic or antihypertensive treatment over 60 months of follow-up.

ACR Appropriateness Criteria® Screening for abdominal aortic aneurysm

Abdominal aortic aneurysm (AAA) is a significant vascular disease found in 4% to 8% of the screening population. If ruptured, its mortality rate is between 75% and 90%, and it accounts for up to 5% of sudden deaths in the United States. Therefore, screening of AAA while asymptomatic has been a crucial portion of preventive health care worldwide. Ultrasound of the abdominal aorta is the primary imaging modality for screening of AAA recommended for asymptomatic adults regardless of their family history or smoking history. Alternatively, duplex ultrasound and CT abdomen and pelvis without contrast may be appropriate for screening. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation

The Significance of Vitamin D Status in Breast Cancer: A State of the Science Review.

The potential role of vitamin D in the development of breast cancer has been the subject of considerable interest. Laboratory and genetic studies demonstrate promising anticarcinogenic effects of vitamin D. However, inconsistencies persist in results of human studies that have assessed vitamin D supplementation for the prevention of primary and secondary cancers. Despite these discrepancies, screening for vitamin D deficiency and vitamin D supplementation have increased dramatically in the past decade. No official institutional guidelines recommend vitamin D supplementation for cancer prevention, and yet these newly adopted practice norms have outpaced rigorous scientific study. Higher circulating levels of vitamin D [25-hydroxyvitamin D, or 25(OH)D] appear to be associated with reduced risk and improved survivorship of certain malignancies. However, the association has not been found for all cancers. This state of the science review examines the association between vitamin D supplementation, circulating 25(OH)D level, vitamin D receptor polymorphisms, and the risk and mortality of breast cancer. The review addresses the role of supplementation and optimal 25(OH)D levels.

The American Society of Colon and Rectal Surgeons clinical practice guideline for the management of inherited polyposis syndromes

The American Society of Colon and Rectal Surgeons (ASCRS) is dedicated to ensuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Clinical Practice Guidelines Committee is composed of society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus, in addition to the development of Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than to dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient.

Alkoholitarvitamise häirega patsiendi käsitlus / Management of the patient with alcohol use disorder

The update of the treatment manual "Management of the patient with alcohol use disorder" was initiated because five years had passed since the publication of the original manual in 2015. The updated treatment manual helps to ensure modern treatment of patients with alcohol use disorder in Estonia. At the first meeting, the working group of the treatment guideline reviewed the questions that formed the basis for the preparation of the original guideline and found that, over time, scientific evidence may have been added regarding the different treatment methods used for alcohol abusers and alcohol-dependent patients, as well as the duration of pharmacological treatment of alcohol dependence. It was also desired to assess the timeliness of the alcohol unit and the low-risk limits of alcohol consumption in Estonia, and to get a fresh overview of the management of patients with alcohol use disorder, as well as treatment and support options in Estonia.

Ravijuhendi "Alkoholitarvitamise häirega patsiendi käsitlus" ajakohastamine algatati, kuna algse juhendi ilmumisest 2015. aastal oli möödunud viis aastat. Ajakohastatud ravijuhendi aitab tagada alkoholitarvitamise häirega patsientide nüüdisaegse käsitluse Eestis. Ravijuhendi töörühm vaatas esimesel koosolekul läbi algse juhendi koostamise aluseks olnud küsimused ja leidis, et nii alkoholi kuritarvitavatel ja alkoholisõltuvusega patsientidel kasutatavate erinevate ravivõtete kui ka alkoholisõltuvuse farmakoloogilise ravi kestuse kohta võib aja jooksul olla lisandunud teaduslikku tõendusmaterjali. Samuti sooviti hinnata Eestis kasutusel oleva alkoholiühiku ja alkoholitarvitamise madala riski piiride ajakohasust ning saada värske ülevaade alkoholitarvitamise häirega patsiendi käsitluse korraldusest, ravi- ja toetamisvõimalustest Eestis.