Survivors of domestic abuse and sexual violence within sexual health services, how we responded, who is missing and what should be done?

BACKGROUND: Reports of domestic abuse (DA) and sexual violence (SV) continue to rise across the UK, and sexual health services are well situated to offer a safe setting for disclosure. METHODS: We performed a retrospective analysis of all safeguarding proformas completed between April and September 2019 across three sexual health clinics in London. RESULTS: 158 patients reported current and/or historical DA and/or SV during the collection period. 70% of cohort identified as female, 28% as male and 2% as transgender. 25% of the cohort identified as gay men. Black and Asian attendees were disproportionately represented in the survivor cohort. 86% were offered a same-day appointment with the health advisor team and assessment for onward referral to specialist services. Almost half of the cohort were asymptomatic at the time of attendance and disclosure. DISCUSSION: With changes to access due to ongoing COVID-19 restrictions, asymptomatic survivors may not receive opportunities to disclose as they are directed to online platforms. Healthcare services must adapt routine enquiry practices to ensure safe disclosure is possible to make all contacts count and expand these practices into other healthcare specialities to provide further disclosure opportunities for survivors not attending sexual health services.

Relative value of cystatin C and creatinine-based estimates of glomerular filtration rate in predicting long-term mortality after cardiac surgery: a cohort study.

OBJECTIVE: Renal dysfunction predicts an increased risk of both early and long-term mortality after cardiac surgery. Cystatin C enables glomerular filtration rate (GFR) to be estimated accurately and may be superior in this regard to creatinine-based estimates. We hypothesised, therefore, that cystatin C and derived estimates of GFR would independently predict long-term survival after cardiac surgery and would be superior in this respect to traditional estimates of GFR. The current study tests this hypothesis in a large and well-characterised cohort of patients. DESIGN: A prospective cohort study. SETTING: Regional cardiothoracic centre in Northeast Scotland. PARTICIPANTS: 1010 patients undergoing non-emergent cardiac surgery between 2004 and 2007. Serum creatinine and cystatin C levels were measured preoperatively and demographic and clinical variables were recorded. PRIMARY OUTCOME MEASURE: All-cause mortality, established from the National Records of Scotland. RESULTS: The median duration of follow-up after surgery was 9.7 years (IQR 8.9-10.6 years), during which 297 participants died. Preoperative creatinine and cystatin C levels and estimates of GFR derived from these were all strong predictors of death using Cox regression and remained independently predictive after adjustment for the logistic European System for Cardiac Operative Risk Evaluation, a well-validated clinical risk score and a range of other clinical predictors. Cystatin C-based measures were superior to creatinine-based estimates of GFR. CONCLUSIONS: Cystatin C and creatinine derived eGFR are powerful and independent predictors of long-term mortality following cardiac surgery. Estimates of GFR derived from cystatin C convey superior prognostic information to conventional creatinine-based estimates, but the observed differences are modest.