Current trends in Communication Skills Training in UK schools of medicine.

BACKGROUND: Communication Skills Training (CST) is now mandatory for all students in UK Schools of Medicine. However, the extent to which all schools follow a similar curriculum is unclear. AIMS: This paper reports the findings of a survey of CST teaching in all UK Schools and compares the findings with an earlier survey. METHODS: A specially designed questionnaire survey was sent to all Schools, and this was supplemented by follow-up telephone interviews. RESULTS: There is a high level of consensus across Schools about the aims and objectives of CST, its location within the overall curriculum, and how it is assessed. There is also a dedicated staff member specifically responsible for CST delivery in all Schools. A wide number of different specialisms also contribute to training. However, wide variations remain in CST pedagogy. In addition, several problems were identified in relation to the integration and operation of CST. CONCLUSIONS: While the paper identifies and delineates a typical or 'modal' model of CST in UK Schools of Medicine, it also emphasizes the importance of flexibility in this part of the curriculum.

C. difficile infection - a tool for improving practice and reducing rates.

Clostridium difficile infection (CDI) is a recognized health-care-acquired infection (HAI) and as such it is vital that hospitals do more to reduce the rates of infection. Patients, especially older people, become particularly susceptible to CDI after treatment with antibiotics. Mention of CDI on death certificates is increasing and surveillance, especially when accompanied by feedback to clinicians, has long been established as an effective tool to lower HAIs. In February 2008, a Manchester hospital began to pilot the Root Cause Analysis (RCA) tool for all patients confirmed with a CDI. After receiving feedback from clinicians on its appropriateness and suitability, the RCA tool was amended accordingly and then implemented into practice. The RCA tool has significantly improved practice and collaborative working - it has enhanced teamwork and ultimately reduced infection. This article examines how the tool was embedded in the Trust, how the change process has been managed and ultimately, how patient care has benefited as a result.

Breast cancer outcomes following a national initiative in Ireland to restructure delivery of services for symptomatic disease.

BACKGROUND: A national initiative in Ireland in 2000 defined 13 designated Units to provide care for symptomatic breast cancer, and resources, including an ability to develop audit programmes, were provided. In the absence of a national audit of breast cancer outcomes, the aim of this study is to provide a detailed report of one Unit's subsequent experience, in particular comparing process and outcome data with international norms and benchmarks, and to infer on the likely impact of the national initiative. METHODS: A 5-year prospective audit of patients presenting to the Symptomatic Breast Clinic from 2001 to 2005 was conducted. All cancer diagnoses were discussed at the Breast Multidisciplinary Conference, and all clinicopathological treatment details and follow-up information were entered by a full-time data manager. Overall survival was calculated using the Kaplan-Meier method. RESULTS: Eight hundred and thirty-nine patients were diagnosed through the clinic, 18 (2%) Stage 0, 169 (20%) Stage I, 380 (45%) Stage II, 142 (17%) Stage III, and 123 (15%) Stage IV. At a median follow-up of 35 months the overall 5-year survival was 71%, with 100%, 91%, 83%, 72%, and 11% survival for Stages 0-IV, respectively, and disease-specific survival of 82%. CONCLUSIONS: The process and outcome data are consistent with international benchmarks. These data from one designated centre support the national initiatives in Ireland to restructure breast services.

Brief Report: HIV Postexposure Prophylaxis-in-Pocket ("PIP") for Individuals With Low-Frequency, High-Risk HIV Exposures.

BACKGROUND: On-demand preexposure prophylaxis may reduce one's risk of HIV acquisition; however, it is unclear if individuals with a very low frequency of HIV exposures are conferred adequate protection. We evaluated a novel approach dubbed HIV postexposure prophylaxis-in-pocket ("PIP"), for individuals with a low frequency of high-risk HIV exposures. SETTING: Two HIV clinics in Toronto, Canada, managing HIV prevention cases. METHODS: A retrospective evaluation of patients referred to HIV clinics for preexposure prophylaxis between January 1, 2013, and September 30, 2017, inclusive. After counseling and education, selected patients were initiated on PIP if they were having very infrequent HIV exposures. RESULTS: Thirty patients were prescribed PIP. Four patients (13.3%) used PIP during this study. There were no HIV seroconversions in 21.8 cumulative patient-years of PIP. CONCLUSIONS: PIP may be a useful HIV prevention modality for individuals with a very low frequency of HIV exposures.

Sexually transmitted infections and viral hepatitides in patients presenting for non-occupational HIV post-exposure prophylaxis: results of a prospective cohort study.

Data evaluating the screening practices for viral hepatitides and sexually transmitted infections (STIs) in patients presenting for non-occupational HIV post-exposure prophylaxis (nPEP) care are limited. Screening practices and prevalences of viral hepatitides and STIs were evaluated in 126 patients presenting to a dedicated HIV prevention clinic for HIV nPEP. Three patients (2.4%) were diagnosed with chronic hepatitis C infection, 28 (22.2%) did not have surface antibodies in sufficient quantity to confer immunity to hepatitis B, and six (4.8%) were diagnosed with an STI. A multivariate regression model did not predict any demographic or clinical features predictive of HBV non-immunity. Beyond screening for HIV infection, evaluation for viral hepatitides and STIs is an important feature in the care of patients presenting for HIV nPEP.

Transitioning to HIV Pre-Exposure Prophylaxis (PrEP) from Non-Occupational Post-Exposure Prophylaxis (nPEP) in a Comprehensive HIV Prevention Clinic: A Prospective Cohort Study.

The uptake of pre-exposure prophylaxis (PrEP) for HIV prevention remains low. We hypothesized that a high proportion of patients presenting for HIV non-occupational post-exposure prophylaxis (nPEP) would be candidates for PrEP based on current CDC guidelines. Outcomes from a comprehensive HIV Prevention Clinic are described. We evaluated all patients who attended the HIV Prevention Clinic for nPEP between January 1, 2013 and September 30, 2014. Each patient was evaluated for PrEP candidacy based on current CDC-guidelines and subjectively based on physician opinion. Patients were then evaluated for initiation of PrEP if they met guideline suggestions. Demographic, social, and behavioral factors were then analyzed with logistic regression for associations with PrEP candidacy and initiation. 99 individuals who attended the nPEP clinic were evaluated for PrEP. The average age was 32 years (range, 18-62), 83 (84%) were male, of whom 46 (55%) men who had have sex with men (MSM). 31 (31%) met CDC guidelines for PrEP initiation, which had very good agreement with physician recommendation (kappa=0.88, 0.78-0.98). Factors associated with PrEP candidacy included sexual exposure to HIV, prior nPEP use, and lack of drug insurance (p<0.05 for all comparisons). Combining nPEP and PrEP services in a dedicated clinic can lead to identification of PrEP candidates and may facilitate PrEP uptake. Strategies to ensure equitable access of PrEP should be explored such that those without drug coverage may also benefit from this effective HIV prevention modality.