A national audit on the management of pelvic inflammatory disease in UK genitourinary medicine clinics.

The prompt and effective treatment of pelvic inflammatory disease (PID) may reduce the risk of complications such as infertility, ectopic pregnancy and pelvic pain. We conducted a national audit to investigate the treatment of women diagnosed with PID and associated rates of partner notification in genitourinary (GU) medicine clinics during 2008 and compared our results with the British Association of Sexual Health and HIV (BASHH) 2005 national guideline. Among a total of 1,105,587 female attendees, national data showed 18,421 cases of PID diagnosed in GU medicine clinics, giving an incidence of 167 cases per 10,000 attendences. We audited a national sample of 1132 PID cases for review. Of those, 504 (44.5%) received a recommended treatment regimen and 447 (39%) of named male contacts were treated. Adherence to recommended treatment and partner notification did not reach national standards.

An audit of the contraception service offered to teenagers attending Scottish genitourinary medicine clinics in 2007.

An audit of contraception service offered to teenagers attending Scottish genitourinary (GU) medicine clinics in 2007 was carried out by collecting data from each main clinic of 11 Scottish health boards. The case notes of 579 women aged under 18 years were reviewed. In 553 (95.5%) cases, sufficient data were available to make an assessment regarding whether the women needed any advice on having a reliable method of contraception. Of these 553 women, 280 (50.6%) were assessed as requiring contraceptive advice. Of the 280 women who needed advice, 156 (56%) received it. Currently, there are some gaps in the provision of contraception services offered to teenagers attending GU medicine clinics, which could be improved by increasing awareness among staff and providing adequate resources.

Expedited partner therapy for Chlamydia trachomatis at the community pharmacy.

OBJECTIVE: Expedited partner treatment (EPT) for uncomplicated Chlamydia trachomatis at the pharmacy is an alternative approach to partner notification that has not yet been evaluated within the UK. The aim of this study was to evaluate EPT for partners using pharmacies in Lothian. DESIGN: A pilot study over 18 months. SETTING: Selected healthcare settings and community pharmacies in Lothian, Scotland, UK. POPULATION: Sexual partners of index cases with uncomplicated C. trachomatis. METHODS: Index cases with uncomplicated C. trachomatis were given a pharmacy voucher to pass onto sexual partners. Partners could redeem vouchers for free treatment (azithromycin) at one of 90 pharmacies in the area. MAIN OUTCOME MEASURES: The main outcome measure was the proportion of vouchers redeemed. Secondary outcomes included patient satisfaction, as determined at a telephone follow-up of a subgroup of female index cases from one study site, 1 month later. RESULTS: In total 577 vouchers were issued to chlamydia-positive index patients of mean age 22.9 years (range 15-47 years). A total of 231 vouchers were redeemed (40%), at a median of 2 days after issue. Only 4% of partners attended a clinic for treatment. Most index patients surveyed reported that partners were satisfied with this method of treatment (48 out of 55; 87%). CONCLUSIONS: Expedited partner treatment for uncomplicated chlamydia at a pharmacy is a popular choice, and increases options on where, when and how partners are treated.

An audit of the interval to treatment of anogenital Chlamydia trachomatis at Scottish genitourinary medicine clinics.

Timely treatment of sexually transmitted infections can reduce complications and prevent onward transmission. Several audit standards exist in this area. We audited the timeliness of treatment of 538 episodes of chlamydia at 12 Scottish genitourinary medicine clinics against a national standard and against a local best practice target. Three clinics treated 95% of patients within two weeks and 10 clinics treated 95% of patients within four weeks. All clinics treated 60% of patients within four weeks. Overall, all clinics performed well against published standards, but less well against the best practice target.

The basal ganglia in Parkinson's disease: current concepts and unexplained observations.

The pathophysiology of Parkinson's disease is reviewed in light of recent advances in the understanding of the functional organization of the basal ganglia (BG). Current emphasis is placed on the parallel interactions between corticostriatal and corticosubthalamic afferents on the one hand, and internal feedback circuits modulating BG output through the globus pallidus pars interna and substantia nigra pars reticulata on the other. In the normal BG network, the globus pallidus pars externa emerges as a main regulatory station of output activity. In the parkinsonian state, dopamine depletion shifts the BG toward inhibiting cortically generated movements by increasing the gain in the globus pallidus pars externa-subthalamic nucleus-globus pallidus pars interna network and reducing activity in "direct" cortico-putaminal-globus pallidus pars interna projections. Standard pharmacological treatments do not mimic the normal physiology of the dopaminergic system and, therefore, fail to restore a functional balance between corticostriatal afferents in the so-called direct and indirect pathways, leading to the development of motor complications. This review emphasizes the concept that the BG can no longer be understood as a "go-through" station in the control of movement, behavior, and emotions. The growing understanding of the complexity of the normal BG and the changes induced by DA depletion should guide the development of more efficacious therapies for Parkinson's disease.

Factors affecting time to treatment following diagnosis of genital Chlamydia trachomatis infection in Scottish genitourinary medicine clinics.

Early treatment of genital Chlamydia trachomatis can reduce complications and transmission. Guidelines have proposed standards for how soon people should be treated following a test. Data from an audit of Scottish genitourinary (GU) medicine clinics was analysed to identify factors associated with a short interval to treatment of chlamydia. A sample of 538 cases of chlamydia diagnosed at 12 Scottish GU medicine clinics between 1 April 2005 and 30 June 2005 was studied. Variables assessed included: age, sex, sexuality, whether a contact, symptoms, whether microscopy was performed, time to lab result and how the result was given. Earlier treatment was associated with: being a contact, having symptoms, being male, performing microscopy (male patients only) and giving the result at a follow-up appointment. Most of these variables (sex, symptoms, etc.) are without the influence of clinic policies and the ones which can be influenced (microscopy and follow-up appointments) are becoming less common. Time to treatment of genital chlamydia might therefore increase in the future.