Non-consultant career grade doctors in genitourinary medicine - are they up to the job? National survey 2007.

Non-consultant career grade doctors in genitourinary (GU) medicine have been called 'a reliable silent backbone of the specialty' and 'a spare pair of hands' [Hiscock E. Non-consultant career grade staff in GU medicine; a reliable backbone or, a spare pair of hands? Int J STD AIDS 1996;7:375-7]. But are they adequate pairs of hands? This survey, conducted in July 2007, examined the work, qualifications and experience of these doctors. A summary of the 154 (19%) responses is presented. Respondents contributed 773 sessions per week, including 164 special interest sessions; 30 (19.5%) were doing regular HIV work. Non-clinical work was described by 134 (87%), especially teaching (132 [86%]) and management roles (26 [17%]). Postgraduate qualifications were cited by 148 (96%), including DipGUM or Dip Ven (51 [33%]), contraception qualifications such as DFFP, MFFP or FFFP (110 [71%]), MRCGP (43 [8%]) and qualifications in psychosexual medicine/therapy (10 [6.5%]). Over half were trained in general practice. Certificate of completion of specialist training or equivalent was held by 55 (36%), including two in GU medicine. These doctors are well qualified, and an asset to the specialty.

Genitourinary medicine clinic KC60 coding for first episode genital herpes: a lesson from north of the border?

A survey of the accuracy of applying the KC60 diagnostic code for genital herpes: first attack (C10A) was undertaken by non-consultant career-grade doctors working in genitourinary (GU) medicine in England, Wales and Northern Ireland. In total, 148 forms were returned (58% response). Overall, 88/148, 59.5% (95% confidence interval 51.5-67.4%) applied the correct codes for all the clinical scenarios presented. Of doctors who personally assigned codes to clinical episodes, 57/104 (54.8%), were correct compared with 31/44 (70.5%) who did not personally apply codes. There was no difference between these two groups (P=0.08). The main error was assigning code C10A on clinical grounds only when there was no laboratory confirmation of herpes simplex virus. The authors suggest that the KC60 C10A code for first attack genital herpes should be simplified to accept a clinical diagnosis rather than insisting on viral confirmation. Alternatively, consideration could also be given to adopting a more comprehensive system (such as the Scottish example) for first attack genital herpes. We believe that either option would help improve the accuracy of GU clinic data relating to genital herpes.

Non-consultant career grade doctors in genitourinary medicine: as revalidation approaches, are some jobs at risk?

The Genitourinary Medicine Non-Consultant Career Grade Group (GUM NCCG Group) was established for the purpose of looking at training and contractual issues for this heterogeneous group of doctors. In June 2003, 700 questionnaires were posted to NCCG doctors in the UK to enquire about various aspects of working conditions. A summary of the 244 replies (35% response) is presented. Eighty-four (34%) had a job plan and 81 (33%) had had an appraisal. Just over one-third (38%) had time allocated for continuing medical education (CME), audit and administration. The response of employers to attempts by NCCGs to upgrade was poor. In all, 195 (80%) said they were registered for the purpose of continuing professional development (CPD), 43 (18%) were not and six people did not know whether they were registered or not. These results give cause for real concern at this point regarding revalidation pathways. Our survey highlights that NCCGs are disadvantaged in terms of appraisal, CPD and career progression and some jobs will be at risk as revalidation approaches.

Risk of pulmonary aspiration among patients receiving enteral nutrition support.

We investigated the prevalence, incidence, and risk factors for pulmonary aspiration in all tube-fed adult patients over 6 months. Twelve aspiration events occurred among 276 patients (prevalence, 4.4%; 95% confidence interval, 2.2% to 7.6%). The incidence of aspiration was 2.4 per 1000 tube-feeding days (95% confidence interval, 1.2 to 3.9 per 1000). Despite 17% overall mortality, there was no excess mortality and little morbidity associated with aspiration. The major risk factors for aspiration were patient age (p less than .015) and location in the hospital (p less than .008): the probability of aspiration in the intensive care units (n = 113) was 0.9% compared with 4.9% on medical or surgical wards (n = 142), 16.7% among patients transferred from the intensive care unit to the ward (n = 18), and 33% among patients transferred from the ward to the intensive care unit (n = 3). Pulmonary aspiration is an uncommon and generally benign event among enterally supported patients. More frequent aspiration among ward than intensive care unit patients suggests that aspiration is not an inevitable consequence of severe illness, but can be prevented with adequate nursing care and pulmonary precautions. The fear of aspiration is not a sufficient cause to withhold enteral nutrition support in acutely ill patients.

Clinical uses of herpes simplex virus type-specific serology.

Type-specific serological tests to distinguish between infection with herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) have largely been used for studies which have contributed to our knowledge of the epidemiology and natural history of these infections. Such tests could be used as diagnostic tools in clinical situations provided that clinician and patient are aware of the test characteristics, which may result in false negative and false positive results. The use of serological tests in the screening of populations or sub-populations, such as pregnant women, has been advocated to attempt to halt the worldwide spread of the infection. However, there is little evidence currently to support this strategy.

Encouraging HIV testing in GUM clinics--can we dispense with the pre-test discussion? Genitourinary Medicine.

In a genitourinary medicine (GUM) clinic on the periphery of the London conurbation, HIV testing was promoted during a one-month period by offering testing without preliminary pre-test discussion to patients who assessed themselves to be low risk. The testing rate rose from 5.9% to 10.8% in women and 12.6% to 20% in men. One new HIV-positive patient was identified.

Inherent moral practice in group psychotherapy.

The large amount and variety of group psychotherapy practiced today enjoins us to determine its morality, that is, its rightness or wrongness. In this essay group therapy and morality are briefly defined. Using the writings of both philosophers and psychologists, evidence of morality is sought in the intentions and actions of both the patients and therapist and in the group process itself. Paying attention to "personal valuative acts," which are moral in nature and in outcome, group psychotherapy results in the good of the patient, of the therapist, and of the art or practice of group psychotherapy itself.

"Existential" therapists and their group therapy practices.

Existential philosophical thought insists that human behavior is indeterminate and subject only to the individual's will. It is, therefore, skeptical of all dynamic psychologies based as they are on Freudian determinism. Group therapists imbued with this philosophy stop short of its extreme. Their existential position, however, does greatly modify treatment, and yet they preserve both the form and goals of therapy. They place properly selected and prepared patients in a group where their individuality and authenticity are highly valued. Finding most technical procedures irrelevant, the therapists themselves, that is, their evolving personalities are central. The key to patient change is the spontaneous meeting of members and the therapist which the therapist orchestrates. Instead of the usual interpretation, members are encouraged to confront the paradoxes in their lives, their humanness, and especially their finitude. Patients are to be brought up to the threshold of their self-knowledge so they can choose. Choice, therefore, along with action coupled with responsibility are frequent themes. Unless the individual is incompetent, decisions made for him or her by the therapist or by group consensus are thought to be nontherapeutic.

A national audit on the management of pelvic inflammatory disease in UK genitourinary medicine clinics.

The prompt and effective treatment of pelvic inflammatory disease (PID) may reduce the risk of complications such as infertility, ectopic pregnancy and pelvic pain. We conducted a national audit to investigate the treatment of women diagnosed with PID and associated rates of partner notification in genitourinary (GU) medicine clinics during 2008 and compared our results with the British Association of Sexual Health and HIV (BASHH) 2005 national guideline. Among a total of 1,105,587 female attendees, national data showed 18,421 cases of PID diagnosed in GU medicine clinics, giving an incidence of 167 cases per 10,000 attendences. We audited a national sample of 1132 PID cases for review. Of those, 504 (44.5%) received a recommended treatment regimen and 447 (39%) of named male contacts were treated. Adherence to recommended treatment and partner notification did not reach national standards.

The acceptability of the introduction of a type specific herpes antibody screening test into a genitourinary medicine clinic in the United Kingdom.

OBJECTIVE: To determine the uptake of a type specific herpes simplex antibody test if it were offered as part of routine screening in a genitourinary medicine clinic in a district general hospital in the United Kingdom. METHODS: Stage 1. A series of 207 consecutive new attenders and 205 patients who had attended the clinic previously were given written information about the test and asked whether they would want to have the test if it were available. They were asked whether they would wish to discuss it further with a counsellor before making a decision. Stage 2. Another series of 434 consecutive patients were offered the test after reading an information leaflet detailing the advantages and disadvantages of being tested. They were also offered the opportunity to see a counsellor for further information. RESULTS: In stage 1 of the study, 51% of men and 54% of women said they would want the test if it were available. 32% of men and 40% of women requested counselling. In stage 2, when the test was offered, 41% of men and 37% of women chose to have it, and 23% of men and 7% of women requested further information from the counsellor. 20 patients were herpes simplex virus type 2 (HSV-2) positive-four of whom would have been diagnosed on clinical grounds at the time of presentation. A further 12 men and 20 women excluded themselves from the study because they were known to have genital herpes. Therefore, type specific serology contributed 30% to total diagnoses in this population-16 out of a population of 52 would have remained undiagnosed without having had the test. CONCLUSION: In this population, the uptake of the type specific herpes simplex antibody test was much less than expected and screening was of limited benefit in identifying large numbers of previously unrecognised HSV-2 positive patients.

Malacoplakia of a cadaveric renal allograft: a case report.

A case of malacoplakia in a cadaveric renal allograft is presented. Infection and immunotherapy are presented as possible etiologic factors. The pathogenesis of malacoplakia is discussed with reference to histologic findings in this specific case. The suggestion is made that an altered macrophage response in this disease is the reason for this granulomatous lesion of the bladder.

Managing the very young patient: a conflict between the requirements of the Children Act and the VD regulations?

We describe the case of a 12 year old girl who presented requesting screening for sexually transmitted infections and discuss a conflict between concerns of clinicians to maintain confidentiality and concerns of social workers to investigate the possibility of sexual abuse.