RESUMO
More HIV-positive patients are living longer and presenting to non-infection specialties with non-HIV-related issues (eg diabetes, heart disease). National recommendations advise routinely offering HIV testing to all new registrants to primary care and all general medical admissions where community prevalence exceeds 2:1000. It is, therefore, imperative that all physicians are educated and competent in HIV infection, counselling and testing. This study aimed to establish regional medical registrars' opinions on teaching provision, and confidence in, HIV medicine. The results indicated a lack of confidence in HIV medicine and, in those without postgraduate rotations in HIV medicine or infectious diseases, a perception that HIV and infection-related teaching provision is inadequate.
Assuntos
Atitude do Pessoal de Saúde , Educação de Pós-Graduação em Medicina/normas , Educação de Graduação em Medicina/normas , Infecções por HIV/prevenção & controle , Estudos Transversais , Inglaterra/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Prevalência , Medicina Estatal , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To evaluate the risk of septic arthritis (SA) in patients with rheumatoid arthritis (RA) treated with anti-tumour necrosis factor (TNF) therapy. METHODS: Using data from the British Society for Rheumatology Biologics Register, a prospective observational study, the authors compared the risk of SA between 11 881 anti-TNF-treated and 3673 non-biological disease-modifying antirheumatic drug (nbDMARD)-treated patients. RESULTS: 199 patients had at least one episode of SA (anti-TNF: 179, nbDMARD: 20). Incidence rates were: anti-TNF 4.2/1000 patient years (pyrs) follow-up (95% CI 3.6 to 4.8), nbDMARD 1.8/1000 pyrs (95% CI 1.1 to 2.7). The adjusted HR for SA in the anti-TNF cohort was 2.3 (95% CI 1.2 to 4.4). The risk did not differ significantly between the three agents: adalimumab, etanercept and infliximab. The risk was highest in the early months of therapy. The patterns of reported organisms differed in the anti-TNF cohort. Prior joint replacement surgery was a risk factor for SA in all patients. The rate of postoperative joint infection (within 90 days of surgery) was 0.7%. This risk was not significantly influenced by anti-TNF therapy. CONCLUSIONS: Anti-TNF therapy use in RA is associated with a doubling in the risk of SA. Physicians and surgeons assessing the RA patient should be aware of this potentially life-threatening complication.
