Practice Nurses' views of their role in the management of Chronic Fatigue Syndrome/Myalagic Encephalitis: a qualitative study.

BACKGROUND: NICE guidelines suggest that patients with Chronic Fatigue Syndrome/Myalgic Encephalitis (CFS/ME) should be managed in Primary Care. Practice Nurses are increasingly being involved in the management of long-term conditions, so are likely to also have a growing role in managing CFS/ME. However their attitudes to, and experiences of patients with CFS/ME and its management must be explored to understand what barriers may exist in developing their role for this group of patients. The aim of this study was to explore Practice Nurses' understanding and beliefs about CFS/ME and its management. METHODS: Semi-structured interviews with 29 Practice Nurses. Interviews were transcribed verbatim and an iterative approach used to develop themes from the dataset. RESULTS: Practice nurses had limited understanding about CFS/ME which had been largely gained through contact with patients, friends, personal experiences and the media rather than formal training. They had difficulty seeing CFS/ME as a long term condition. They did identify a potential role they could have in management of CFS/ME but devalued their own skills in psychological intervention, and suggested counselling would be an appropriate therapeutic option. They recognised a need for further training and on going supervision from both medical and psychological colleagues. Some viewed the condition as contentious and held pejorative views about CFS/ME. Such scepticism and negative attitudes will be a significant barrier to the management of patients with CFS/ME in primary care. CONCLUSION: The current role of Practice Nurses in the ongoing management of patients with CFS/ME is limited. Practice Nurses have little understanding of the evidence-base for treatment of CFS/ME, particularly psychological therapies, describing management options in terms of advice giving, self-help or counselling. Practice Nurses largely welcomed the potential development of their role in this area, but identified barriers and training needs which must be addressed to enable them to feel confident managing of patients with this condition. Training must begin by addressing negative attitudes to patients with CFS/ME.

Gonococcal tenosynovitis in two HIV-infected heterosexual men: delayed diagnoses following negative urine nucleic acid amplification testing.

With recent increases in annual gonorrhoea incidence and disproportionately high infection rates amongst men who have sex with men, the clinical picture of disseminated gonococcal infection is changing. We present two cases where consideration of, and investigation for, disseminated Neisseria gonorrhoeae infection provided the answer when routine inpatient diagnostics had been unsuccessful.

Testicular self-examination amongst genitourinary medicine clinic attendees.

Advancements in the diagnosis and treatment of testicular cancer now give a five-year survival rate of 97.2%. Delayed presentation remains the primary cause of poor outcome and recommendations have stressed that men, particularly those with risk factors, should undertake regular testicular self-examination. This study aimed to determine testicular self-examination knowledge and practices amongst 740 unselected men attending a genitourinary medicine clinic via questionnaire survey. Of respondents, 75.8% of men had heard of testicular cancer, and 79.9% had heard of testicular self-examination. Of these, 41% of men had been taught testicular self-examination; 73.9% of them by a doctor or nurse. Importantly, 79.2% had previously performed testicular self-examination. The most common reason for not performing testicular self-examination was 'Don't really know what to look for' (59.5%). Men previously taught testicular self-examination were 11.5 times more likely to perform the practice than those untaught. Of respondents, 74.1% wanted more information regarding testicular self-examination whilst attending the clinic. This study shows an increased level of testicular self-examination amongst genitourinary medicine attendees than has been previously demonstrated in other patient groups. There remains room for improvement via further health promotion and research on the effectiveness of testicular self-examination.