UK guideline for the use of HIV post-exposure prophylaxis 2021.

We present the updated British Association for Sexual Health and HIV (BASHH) guidelines for post-exposure prophylaxis (PEP) to HIV following sexual exposures, occupational exposures and other nonoccupational exposures in the community. This serves as an update to the 2015 BASHH guideline on PEP following sexual exposures and the 2008 Expert Advisory Group on AIDS guidelines on HIV PEP. We aim to provide evidence-based guidance on best clinical practice in the provision, monitoring and support of PEP for the prevention of HIV acquisition following sexual, occupational and other nonoccupational exposures in the community. The guideline covers when to prescribe PEP, what antiretroviral agents to use and how to manage PEP. This includes (i) evidence of PEP efficacy; (ii) evidence relating to individual-level efficacy of antiretroviral therapy to prevent the sexual transmission of HIV; (iii) data on the detectable (transmissible) prevalence of HIV in specific populations; (iv) risk of HIV transmission following different types of sexual and occupational exposure; (v) baseline risk assessment; (vi) drug regimens and dosing schedules; (vii) monitoring PEP; (viii) baseline and follow-up blood-borne virus testing; (ix) the role of PEP within broader HIV prevention strategies, for example, HIV pre-exposure prophylaxis (PrEP). The guideline also covers special scenarios such as PEP in pregnancy, breastfeeding and chronic hepatitis B virus infection, and when PEP should be considered in people using HIV PrEP. The guidelines are aimed at clinical professionals directly involved in PEP provision and other stakeholders in the field. A proforma to assist PEP consultations is included. A public consultation process was undertaken prior to finalizing the recommendations.

Surgical techniques and return to work following carpal tunnel release: a systematic review and meta-analysis.

INTRODUCTION: This systematic review was conducted to evaluate return to work (RTW) following minimally invasive carpal tunnel surgery versus open carpal tunnel release. This study also assesses how RTW as an outcome measure was examined in previous randomized controlled trials (RCTs). METHODS: The bibliographic databases Medline, AMED and CINAHL were systematically searched. We found 15 relevant RCTs. Meta-analysis was possible only for four studies. RESULTS: The result indicates that minimally invasive surgery offers earlier return to work compared to open carpal tunnel release (mean difference -7.2 days; 95% CI -10 to -4.4 days). There were remarkable inconsistencies in how return to work as an outcome measure was examined in different RCTs. CONCLUSIONS: Calculating standardised mean difference in future RCTs would allow future reviews to be more inclusive of the evidence. The authors suggest more consistent approach for evaluating work-related features in future studies. We recommend that new fit note categories introduced by UK Department of Work and Pension (unfit for all work/return to modified work or work adaptations/return to normal work) would be used to identify different levels of return to work.

Temporal trend of occupational injuries; first versus second half of a working shift.

OBJECTIVES: To assess occupational injuries in the 1st versus 2nd half of a working shift in terms of (a) the likelihood of hospital referral following an injury event; (b) the external causes of injuries. METHODS: Logistic regression analyses of data from a 16-year (1991-2007) experience of ongoing surveillance of occupational injuries in a synthetic fiber factory in Iran. RESULTS: The likelihood of a hospital referral following an injury in the 1st half of a shift was higher than in the 2nd half (adjusted odds ratio [OR] 1.50, 95% confidence interval [CI] 1.10-2.00). Comparing the 2 halves of the shift, an injury occurring in the 2nd half was more likely to be due to exposure to smoke, fire and flames (OR 2.34, 95% CI 1.06-5.19) or transport accidents (OR 1.84, 95% CI 1.06-3.21). CONCLUSIONS: Time-specific safety interventions could be used in the risk management of occupational injuries. Further studies to investigate the effect of time-dependent interventions are recommended.