Adopting universal testing for HIV in intensive care for patients admitted with severe pneumonia: results from our change in practice.

Early identification of HIV infection is of obvious benefit to patients' health, yet many remain unaware of their diagnosis, with detrimental consequences. Current guidelines suggest patients with pneumonia are offered an HIV test. Early diagnosis of HIV infection in critically ill patients within intensive care is vital in reducing mortality and morbidity. In 2015, we established automated HIV testing for patients with pneumonia admitted to our intensive care unit. Prior to our change in practice, our HIV testing rate in patients with pneumonia was 29% within two weeks of admission. After implementation, 80% of patients with pneumonia were tested for HIV within 48 h (73% with 24 h). This intervention also facilitated an early and unexpected HIV diagnosis in one patient, which then allowed prompt tailored therapy and was a significant factor in their survival. Based on our success, we suggest other centres may benefit from employing a similar automated HIV testing system, especially in targeted patient groups such as severe pneumonia.

Assessment of an urgency classification for assisted vaginal delivery.

We performed a prospective observational audit to evaluate the application of the Lucas caesarean section urgency classification to assisted vaginal delivery in the operating theatre. We collected data from 400 women having category 1-3 delivery in the operating theatre. Twenty percent of the caesarean sections and 4% of the vaginal deliveries were category 1. The median (IQR) decision-delivery interval was 25 (19.5-37) min for category 1 caesarean section and 19.5 (15-29) min for category 1 vaginal delivery, and 43.5 (36-57) min and 45 (32-57) for category 2 caesarean section and vaginal delivery, respectively. Sixty-three percent of category 1 caesarean section and 75% of category 1 vaginal delivery were performed in ≤30 min. Antenatal or intrapartum risk factors were present before the decision for delivery in 82% of caesarean sections and 80% of vaginal deliveries. The application of the Lucas urgency classification to assisted vaginal delivery merits further evaluation.

Medical students' perspective on the teaching of medical statistics in the undergraduate medical curriculum.

Two undergraduate medical students at the University of Bristol commented on their experiences of learning medical statistics. In general, medical students' focus is on acquiring skills needed to practice clinical medicine, and great care must be taken to explain why disciplines such as statistics and epidemiology are relevant to this. Use of real examples and an emphasis on the need for evidence has meant that medical students are increasingly aware of the pressure on clinicians to justify their treatment decisions, and the associated need to be able to understand and critically appraise medical research. It was felt that medical statistics courses should focus on critical appraisal skills rather than on the ability to analyse data, which can be acquired by particular students when they need to do this. Medical statistics should be taught early in the curriculum, but there is a need to reinforce such skills throughout the course. Teaching and assessment methods should recognize that what is being taught is a practical skill of clinical relevance. This means that problem based small groups, data interpretation exercises and objective structured clinical examinations will be more productive than traditional teaching and examination methods.