LEARN: A multi-centre, cross-sectional evaluation of Urology teaching in UK medical schools

OBJECTIVE: To evaluate the status of UK undergraduate urology teaching against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology. Secondary objectives included evaluating the type and quantity of teaching provided, the reported performance rate of General Medical Council (GMC)-mandated urological procedures, and the proportion of undergraduates considering urology as a career. MATERIALS AND METHODS: LEARN was a national multicentre cross-sectional study. Year 2 to Year 5 medical students and FY1 doctors were invited to complete a survey between 3rd October and 20th December 2020, retrospectively assessing the urology teaching received to date. Results are reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). RESULTS: 7,063/8,346 (84.6%) responses from all 39 UK medical schools were included; 1,127/7,063 (16.0%) were from Foundation Year (FY) 1 doctors, who reported that the most frequently taught topics in undergraduate training were on urinary tract infection (96.5%), acute kidney injury (95.9%) and haematuria (94.4%). The most infrequently taught topics were male urinary incontinence (59.4%), male infertility (52.4%) and erectile dysfunction (43.8%). Male and female catheterisation on patients as undergraduates was performed by 92.1% and 73.0% of FY1 doctors respectively, and 16.9% had considered a career in urology. Theory based teaching was mainly prevalent in the early years of medical school, with clinical skills teaching, and clinical placements in the later years of medical school. 20.1% of FY1 doctors reported no undergraduate clinical attachment in urology. CONCLUSION: LEARN is the largest ever evaluation of undergraduate urology teaching. In the UK, teaching seemed satisfactory as evaluated by the BAUS undergraduate syllabus. However, many students report having no clinical attachments in Urology and some newly qualified doctors report never having inserted a catheter, which is a GMC mandated requirement. We recommend a greater emphasis on undergraduate clinical exposure to urology and stricter adherence to GMC mandated procedures

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Syphilis

The availability of penicillin gave hope that syphilis could be eradicated. However, syphilis still re1nains endemic in the developing world, while outbreaks continue in industrialised nations despite screening, available testing and effective treatment. While historically a sexually transmitted infection (STI) of the heterosexual community, the recent outbreaks in both Australia and New Zealand, as in other high-income communities, are almost entirely confined to homosexually active men. In developing nations, heterosexual spread and mother-to-child transmission continue to drive infection.2nd ed

Screening for sexually transmitted infections

Screening for STIs is worthwhile as it facilitates early detection and prompt treatment, and potentially minimises complications and long-term sequelae of infection. It also allows for the interruption of forward transmission, thereby reducing the risk of reinfection. Screening offers opportunities for patient education and counselling to effect behaviour change and, by decreasing prevalence rates, is of public health benefit. Screening is essential for detecting many STIs because of high rates of asymptomatic carriage. Here we consider common STIs, who to screen, and how to approach taking a sexual history

Managing sexually transmitted infections

TESTING for STIs should be guided by individual sexual risk assessment, local epidemiology, and whether the patient falls within a particular atrisk group. With the widespread availability of nucleic acid amplification tests (NAATs), more sampling options are available for patients, resulting in increased acceptability and allowing for limited screening in non-clinical situations. Clinicians need to be aware of sampling options, test limitations and associated window periods, and counsel patients appropriately. Similarly, clinicians need to be aware of first-line treatment modalities and local resistance patterns. STI testing and management is an ideal opportunity to effect behaviour change by way of education, safe-sex messages, and harm-minimisation counselling

Hyperaesthesia Following Genital Herpes: A Case Report

License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We report an adult female patient who presented with sacral radiculopathy as incapacitating dysthesias following primary genital herpes simplex, which later recurred. Despite use of systemic antiviral treatment, the painful syndrome in our patient persisted. The success in treatment was seen only after the addition of amitriptyline hydrochloride. The case is being presented here for its rare manifestation and novel use of amitriptyline hydrochloride. 1. Case Presentation We present the case of a 64-year-old female teacher who presented to the sexual health clinic in Newcastle, Australia. Six weeks previously, the patient had attended her primary care doctor (PCD) with dysuria and was treated for a urinary tract infection; however, symptoms persisted. Several days later she noticed acute onset of bilateral vulval blisters. She was clinically diagnosed with genital herpes and commenced on valacyclovir 500 mg bd for one week. Th

Sexual health care for sex workers

Background: The Australian STI Prevention Framework identifies sex workers as a priority group. The Hunter New England Sexual Health Unit, based at the Royal Newcastle Hospital (New South Wales) provides free sexual health care to sex industry workers. Objective: To assess current service delivery and barriers to accessing sexual health care by registered brothel based sex industry workers in the Hunter New England area. Method: An on site survey of 36 sex industry workers was conducted. Results: Seventy-four percent of participants sought sexual health advice from a general practitioner compared to 37% from the sexual health unit. Seventy-seven percent of participants reported having their sexual health screening carried out according to guidelines. The most frequently stated reason for not using the sexual health unit was the inconvenience of clinic opening times. Discussion: This study highlights the important role that GPs play in providing sexual health care to sex industry workers. It provides the impetus for future research, education and strategies to improve health service delivery to this important group of patients

Vulval Crohn's disease

We report a case of vulval Crohn’s disease, the diagnosis of which was complicated by the presence of sexually transmissible infections

So Much Is at Stake : Professional Views on Engaging Heterosexually Identified Men who Have Sex with Men with Sexual Health Care in Australia

Australian HIV prevention, testing, and treatment services are well-established for men who have sex with men (MSM) who identify as gay or bisexual. However, the sexual health needs of heterosexually identified MSM (hereafter called ¿straight MSM¿ as a shorthand) and opportunities to engage this sub-group with services and information are less clear. Semi-structured interviews were conducted in 2015¿2016 with 30 professionals working in the sexual health sector in the state of New South Wales, Australia. Participants viewed straight MSM as comprising multiple, intersecting sub-groups, but sharing a common preference for services which promise ¿discretion¿ and ¿confidentiality¿, and information which does not presume an alignment between gay identity and sex between men. Participants described these men as typically very concerned about keeping this aspect of their sexual lives secret and separate from their family, work, and community lives. Participants were keenly aware of both the benefits and the challenges of providing respectful and non-judgmental care. This exploratory study provides initial evidence of the complexities of engaging straight MSM with sexual health care and suggests a range of strategies for increasing cultural understanding of the diverse sexual practices that can be present in the lives of some heterosexually identified men