Diagnosis and management of pelvic inflammatory disease at an outpatient sexual health clinic: a chart audit

Background/Aims: To compare the management of pelvic inflammatory disease (PID) at the Townsville Sexual Health Services (TNSHS) with the Queensland Sexual Health Clinical Management Guidelines (QSHCMG), and identify areas of discrepancy. Methods: A retrospective chart audit of patients diagnosed with PID between January 2012 and December 2013 was conducted. Information from patient charts on the diagnostic criteria, investigations performed and management was retrieved and compared with the QSHCMG. Results: A total of 47 charts was identified with patient age range of 16-48 years. There was insufficient documentation of many features that were deemed as risk factors for PID by the QSHCMG, such as having multiple partners, concurrent bacterial vaginosis, previous sexually transmitted disease, vaginal douching, post-partum endometriosis and recent uterine instrumentation. Minimal diagnostic criteria were met by 37 (79%) patients. Documentation of investigations and management plan was complete in all patients. The antibiotic regimen prescribed (ceftriaxone 500 mg IMI stat, metronidazole 400 mg BD for two weeks and azithromycin 1 g stat (plus repeat in one week) matched that in the QSHCMG in all patients. Symptom improvement was documented in 33 of 40 patients (83%). Seven patients (15%) were lost to follow-up. Conclusion: Improvements could be made in the documentation of important parts of the history and clinical features that identify those patients diagnosed with PID

Exploring the costs and outcomes of sexually transmitted infection (STI) screening interventions targeting men in football club settings: preliminary cost-consequence analysis of the SPORTSMART pilot randomised controlled trial

Background: The objective of this study was to compare the costs and outcomes of two sexually transmitted infection (STI) screening interventions targeted at men in football club settings in England, including screening promoted by team captains. Methods: A comparison of costs and outcomes was undertaken alongside a pilot cluster randomised control trial involving three trial arms: (1) captain-led and poster STI screening promotion; (2) sexual health advisor-led and poster STI screening promotion and (3) poster-only STI screening promotion (control/comparator). For all study arms, resource use and cost data were collected prospectively. Results: There was considerable variation in uptake rates between clubs, but results were broadly comparable across study arms with 50% of men accepting the screening offer in the captain-led arm, 67% in the sexual health advisor-led arm and 61% in the poster-only control arm. The overall costs associated with the intervention arms were similar. The average cost per player tested was comparable, with the average cost per player tested for the captain-led promotion estimated to be £88.99 compared with £88.33 for the sexual health advisor-led promotion and £81.87 for the poster-only (control) arm. Conclusions: Costs and outcomes were similar across intervention arms. The target sample size was not achieved, and we found a greater than anticipated variability between clubs in the acceptability of screening, which limited our ability to estimate acceptability for intervention arms. Further evidence is needed about the public health benefits associated with screening interventions in non-clinical settings so that their cost-effectiveness can be fully evaluated

Home-based chlamydia testing of young people attending a music festival - who will pee and post?

<p>Abstract</p> <p>Background</p> <p>Chlamydia is most common among young people, but only a small proportion of Australian young people are tested annually. Home-based chlamydia testing has been piloted in several countries to increase testing rates, but uptake has been low. We aimed to identify predictors of uptake of home-based chlamydia testing to inform future testing programs.</p> <p>Methods</p> <p>We offered home-based chlamydia testing kits to participants in a sexual behaviour cross-sectional survey conducted at a music festival in Melbourne, Australia. Those who consented received a testing kit and were asked to return their urine or vaginal swab sample via post.</p> <p>Results</p> <p>Nine hundred and two sexually active music festival attendees aged 16-29 completed the survey; 313 (35%) opted to receive chlamydia testing kits, and 67 of 313 (21%) returned a specimen for testing. One participant was infected with chlamydia (1% prevalence). Independent predictors of consenting to receive a testing kit included older age, knowing that chlamydia can make women infertile, reporting more than three lifetime sexual partners and inconsistent condom use. Independent predictors of returning a sample to the laboratory included knowing that chlamydia can be asymptomatic, not having had an STI test in the past six months and not living with parents.</p> <p>Conclusions</p> <p>A low proportion of participants returned their chlamydia test, suggesting that this model is not ideal for reaching young people. Home-based chlamydia testing is most attractive to those who report engaging in sexual risk behaviours and are aware of the often asymptomatic nature and potential sequelae of chlamydia infection.</p

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Diagnosis and management of pelvic inflammatory disease at an outpatient sexual health clinic: a chart audit

Background/Aims: To compare the management of pelvic inflammatory disease (PID) at the Townsville Sexual Health Services (TNSHS) with the Queensland Sexual Health Clinical Management Guidelines (QSHCMG), and identify areas of discrepancy. Methods: A retrospective chart audit of patients diagnosed with PID between January 2012 and December 2013 was conducted. Information from patient charts on the diagnostic criteria, investigations performed and management was retrieved and compared with the QSHCMG. Results: A total of 47 charts was identified with patient age range of 16-48 years. There was insufficient documentation of many features that were deemed as risk factors for PID by the QSHCMG, such as\ud having multiple partners, concurrent bacterial vaginosis, previous sexually transmitted disease, vaginal douching, post-partum endometriosis and recent uterine instrumentation. Minimal diagnostic criteria were met by 37 (79%) patients. Documentation of investigations and management plan was complete in all patients. The antibiotic regimen prescribed (ceftriaxone 500 mg IMI stat, metronidazole 400 mg BD for two weeks and azithromycin 1 g stat (plus repeat in one week) matched that in the QSHCMG in all patients. Symptom improvement was documented in 33 of 40 patients (83%). Seven\ud patients (15%) were lost to follow-up. Conclusion: Improvements could be made in the documentation of important parts of the history and clinical features that identify those patients diagnosed with PID

Novel approach to an effective community-based chlamydia screening program within the routine operation of a primary healthcare service

Background: A prospective study was undertaken to develop an evidence-based outreach chlamydia screening program and to assess the viability and efficiency of this complementary approach to chlamydia testing within the routine operations of a primary healthcare service. \ud \ud Methods: A primary healthcare service based in Townsville, Queensland, Australia, identified high-prevalence groups for chlamydia in the community. Subsequently, a series of outreach clinics were established and conducted between August 2004 and November 2005 at a defence force unit, a university, high school leavers’ festivities, a high school catering for Indigenous students, youth service programs, and backpacker accommodations. \ud \ud Results: All target groups were easily accessible and yielded high participation. Chlamydia prevalence ranged between 5 and 15% for five of the six groups; high school leavers had no chlamydia. All participants were notified of their results and all positive cases were treated (median treatment interval 7 days). Five of the six assessed groups were identified as viable for screening and form the basis for the ongoing outreach chlamydia screening program. \ud \ud Conclusion: The present study developed an evidence-based outreach chlamydia screening program and demonstrated its viability as a complementary approach to chlamydia testing within the routine operations of the primary healthcare service, i.e. without the need for additional funding. It contributes to the evidence base necessary for a viable and efficient chlamydia management program. Although the presented particulars may not be directly transferable to other communities or health systems, the general two-step approach of identifying local high-risk populations and then collaborating with community groups to access these populations is

Genital Chlamydia trachomatis infection: a study of general practice management in northern Queensland

Background Most diagnoses of genital Chlamydia trachomatis infection in Queensland are made by general practitioners. This study aimed to describe GP knowledge of recommended guidelines for chlamydia management and ascertain GPs' preferred model for contact tracing. Method A questionnaire completed by 35 GPs in northern Queensland in January 2011. Results Although the majority of GPs reported treating uncomplicated chlamydia infection correctly with azithromycin, very few (26%) used empirical treatment. Most reported testing for re-infection within 6 weeks of initial positive results, earlier than recommended. The GPs preferred the notifiable disease register to refer the patient directly to a specialist contact tracer. Conclusion General practitioners in this regional location and probably elsewhere would benefit from education around the timing of re-testing. Public health units and sexual health services should consider ways of providing a contact tracing service for patients with positive chlamydia results in general practice