BackgroundUK guidelines recommend routine HIV testing in healthcare settings if the local diagnosed HIV prevalence >2/1000 persons. This prospective study assessed the feasibility and acceptability, to patients and staff, of routinely offering HIV tests in four settings: Emergency Department, Acute Care Unit, Dermatology Outpatients and Primary Care. Modelling suggested the estimated prevalence of undiagnosed HIV infection in attendees would exceed 1/1000 persons. The prevalence identified prospectively was not a primary outcome.MethodsPermanent staff completed questionnaires assessing attitudes towards routine HIV testing in their workplace before testing began. Subsequently, over a three-month period, patients aged 16–65 were offered an HIV test by study staff. Demographics, uptake, results, and departmental activity were collected. Subsets of patients completed questionnaires. Analyses were conducted to identify factors associated with test uptake.FindingsQuestionnaires were received from 144 staff. 96% supported the expansion of HIV testing, but only 54% stated that they would feel comfortable delivering testing themselves, with 72% identifying a need for training. Of 6194 patients offered a test, 4105 (66·8%) accepted (61·8–75·4% across sites). Eight individuals were diagnosed with HIV (0–10/1000 across sites) and all transferred to care. Younger people, and males, were more likely to accept an HIV test. No significant associations were found between uptake and ethnicity, or clinical site. Questionnaires were returned from 1003 patients. The offer of an HIV test was acceptable to 92%. Of respondents, individuals who had never tested for HIV before were more likely to accept a test, but no association was found between test uptake and sexual orientation.ConclusionsHIV testing in these settings is acceptable, and operationally feasible. The strategy successfully identified, and transferred to care, HIV-positive individuals. However, if HIV testing is to be included as a routine part of patients’ care, additional staff training and infrastructural resources will be required.
callaboratrve placebo-controlled trial of dexamethasonc lor neonatdl chronic luns dlseaee: a 3 Year follow-L@ RoBamond A Jones, Elizabeth Wlncott, Diana Elbourne. Adrian Grant (opn. by Nell Mclntosh). National Perlnatal Epldemloloqy Unit. Oxford, UK 287 preterm b a b~e s from 31 European and North Amorlcan centrau who were oxygen-dependent aged 3 weeks or more were randomlred to dexamctl,asone or placebo.Active treatment was aeeoclated with reduced t m e on a s s~s t e d ventilstlon and no observed lncrease I n serious i m m c d~a t e sldeeffects. 62 infants dled.Survivors were followed up at 3 ycaro of age, using queetionna~res to CPs, health v~e~t o r s and parents. Data are available for 209 infante (93P of aurvlvore and 1001 of U K rsoidento)
In recent years, the sexual health of the nation has risen in profile. We face increasing demands and targets, in particular the 48-hour waiting time directive, and as a result clinic access has become a priority. eTriage is a novel, secure, web-based service designed specifically to increase access to our clinics. It has proved a popular booking method, providing access to 10% of all appointments across the Directorate within six months of introduction. KC60 analyses revealed that the majority of users (58%) underwent asymptomatic screening with the remainder having some degree of pathology. There was a greater percentage prevalence of human papilloma virus, chlamydia, non-specific urethritis, gonorrhoea, herpes and trichomonas in the eTriage population when compared with the general clinic population. A notes review illustrated a high degree of concordance between data entered on eTriage registration and clinical review (97%). A patient survey revealed high levels of patient satisfaction with the service. As an adjunct to our existing booking services, eTriage has served to increase patient choice and has proved itself to be a safe, efficient and effective means of improving patient access.
Data are presented for the speed of transmission of pulses of 2.5MHz ultrasound through fats and oils at temperatures in the range -50 to +llo"C. It is suggested that a measurement of the speed of ultrasound (V), which is greater in solid fats (V,) than in oils (V,), might be used to provide an estimate of the proportion of solid in a partially solidified fat. An acoustic parameter 4 is defined such that:and it is suggested that 4 might be used as a practical index for determination of the volume fraction of solid fat. This procedure might be useful under conditions unsuited to the established methods of dilatometry, calorimetry or nuclear magnetic resonance. As an example of a possible application, measurements are presented for the speed of ultrasound in pig adipose tissues selected to show a range of consistencies which, by subjective assessment and by penetrometer measurements, ranged from 'soft', and therefore unsuited for the manufacture of bacon, to 'hard'. After allowing for the contribution of the fat-free tissue, it was estimated that the lipid in the tissues ranged from about 20 to 88% (by volume) solid. The variation in 4 explained 88% of the variance in the penetrometer measurements.
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