Refocusing health promotion for syphilis prevention: results of a case-control study of men who have sex with men on England's south coast.

Background: Prevention interventions have had little impact on syphilis outbreaks among men who have sex with men (MSM) and diagnosis rates continue to rise rapidly. Detailed studies of the determinants of syphilis transmission are needed to inform new prevention interventions.

Objective: To investigate factors associated with recent syphilis diagnosis and recommend strategies for improved prevention interventions.

The role of invasive ventilation in exacerbations of chronic obstructive pulmonary disease causing respiratory failure.

Acute hypercapnic respiratory failure in chronic obstructive pulmonary disease can usually be managed initially with medical treatment and non- invasive ventilation. In circumstances where non- invasive ventilation cannot be used or has failed, intubation and invasive ventilation may be lifesaving. The outcome of patients with an exacerbation of COPD requiring invasive ventilation is better than often thought, with a hospital survival of 70-89%.

Community based syphilis screening: feasibility, acceptability, and effectiveness in case finding.

Objectives: To investigate the feasibility and acceptability of implementing community based syphilis screening using different sample collection techniques, and its effectiveness in screening at-risk populations and identifying new syphilis cases.

Methods: Two phases of syphilis screening were conducted in venues frequented by men who have sex with men (MSM). Phase 1 used venepuncture and phase 2 a validated saliva test.

Evaluation of warfarin dosing by pharmacists for elderly medical in-patients.

Objective: To compare the effectiveness of pharmacists dosing warfarin for in-patients, in comparison to that of junior doctors, in order to establish the value of a pharmacist-controlled in-patient anti-coagulation service.

Setting: Brighton and Sussex University Hospitals NHS Trust (BSUH).

Method: Two wards at Brighton General Hospital were under pharmacist-control of warfarin dosing and three wards remained under the care of doctors.

Evolutionary aspects of anxiety disorders.

DANGER AND HARM ARE AVOIDED BY STRATEGIC DECISIONS MADE AT ALL THREE LEVELS OF THE TRIUNE FOREBRAIN: rational (neomammalian), emotional (paleomammalian), and instinctive (reptilian). This applies also to potential harm from conspecifics, which leads to a choice between escalating and de-escalating strategies. Anxiety is a component of de-escalating strategies mediated by the paleomammalian and reptilian forebrains.

Predicting pressure ulcer risk.

The Braden scale is a widely used pressure risk assessment tool and it is, therefore, essential to ensure that the tool is reliable and valid. Several studies have questioned the predictive validity of the Braden scale (Nixon and McGough, 2001). Bergstrom et al (1998) used a quantitative research paradigm to evaluate the effectiveness of the Braden scale in predicting which patients who are at risk of developing pressure ulcers in three different clinical settings in the USA.

A podiatrist's view of community diabetic foot management.

The diabetic foot is an enormous burden to the patient, society and to the NHS. This article offers a podiatrist's view of the diabetic foot: the principles behind the disease process, the management of diabetic foot complications and how problems can be avoided. The major contributing factors of diabetic foot ulcers are discussed, the role of the podiatrist described, and the principles of screening and community-based management of ulcers outlined.

To operate or not to operate? The value of fine needle aspiration cytology in the assessment of thyroid swellings.

Aims: To evaluate all thyroid fine needle aspirations (FNA) done over a six year period to assess the accuracy and value of the technique.

Methods: There were 335 FNAs of which 184 had subsequent histology and 49 others had clinical follow up, providing 233 patients for analysis. All cytology and histology was reviewed with no significant alterations in diagnosis.

Induction of mutagenic DNA damage in human fibroblasts after exposure to artificial tanning lamps.

There is increasing concern about the adverse health effects associated with the use of sunbeds, particularly with respect to skin photocarcinogenesis. The induction of mutagenic DNA damage is a prerequisite for the development of skin tumours, and it is well established that direct types of damage such as cyclobutane pyrimidine dimers (CPDs) give rise to mutations in tumour suppressor genes and oncogenes. In addition, ultraviolet radiation may induce indirect types of DNA damage, including oxidative products, which are also potentially mutagenic.

Drug-related problems in older people.

This is the second of two articles looking at medication problems in older people. Here, the prevention and management of drug-related problems is discussed and a case study presented illustrating a problem in practice. The first article was published on July 2.

The effects of multiple medication in the elderly.

This article is the first of two looking at medication-related problems in the elderly. The processes through which drugs are handled by the body are briefly described and common problems associated with medication and the elderly are discussed. A case study is presented to illustrate some of these issues.

A prospective randomized trial of interstitial radiofrequency therapy versus transurethral resection for the treatment of benign prostatic hyperplasia.

Objective: To carry out a prospective randomized trial comparing interstitial radiofrequency therapy (IRFT) with transurethral resection of the prostate (TURP) in the treatment of bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia.

Patients And Methods: The change in detrusor pressure at maximum flow (PdetQmax) was chosen as the primary measure of outcome but the symptom score, Qmax and residual volume were also measured. Patients with urodynamic evidence of BOO were randomized to receive IRFT (n = 25) or TURP (n = 25); the urodynamics were repeated 6 months after treatment.

Phaeohyphomycosis caused by Exophiala dermatitidis following intra-articular steroid injection.

A patient with long-standing rheumatoid arthritis presented with a painful pigmented chronic nodule on the dorsum of the right hand, at the site of intra-articular steroid injections undertaken 5 years previously. Histology showed pigmented fungal elements consistent with phaeohyphomycosis. Cultures yielded black yeast-like colonies, identified as Exophiala dermatitidis and sensitive to itraconazole and amphotericin.

Interstitial radiofrequency therapy of the prostate: results of a pilot study.

Purpose: We assessed the feasibility of using interstitial radiofrequency therapy for benign prostatic hyperplasia (BPH) in 50 patients.

Materials And Methods: Therapy was given using a standard diathermy unit as the radiofrequency generator and a disposable needle electrode. The main outcome measure was improvement in symptoms assessed by symptom scores.

Role of re-screening of cervical smears in internal quality control.

Aims: To investigate the use of rapid re-screening as a quality control method for previously screened cervical slides; to compare this method with 10% random re-screening and clinically indicated double screening.

Methods: Between June 1990 and December 1994, 117,890 negative smears were subjected to rapid re-screening.

Results: This study shows that rapid re-screening detects far greater numbers of false negative cases when compared with both 10% random re-screening and clinically indicated double screening, with no additional demand on human resources.

Urethral anaesthesia with topical bupivacaine. A role for a longer-acting agent.

Objective: To assess the efficacy and toxicity of bupivacaine as a topical urethral anaesthetic.

Patients And Methods: This prospective two-part study comprised a pilot study of 10 men (mean age 73 years, range 39-86), to determine the toxicology, pharmocokinetics and suitable preparation of bupivacaine gel, and a study of 40 men (mean age 76 years, range 59-92) to compare the efficacy of bupivacaine with lignocaine gel. All patients were undergoing treatment for benign prostatic hyperplasia by transurethral radiofrequency heating using the Direx Thermex II system.

Successful surgical treatment of severe pretibial myxoedema.

We report a 46-year-old man with severe and long-standing pretibial myxoedema, who responded well to local surgical treatment. This improvement has been maintained over a 12-month period, perhaps because of concomitant treatment with octreotide.

Primary systemic amyloid with nail dystrophy.

We report a patient with the classical cutaneous findings of primary systemic amyloidosis, due to myeloma. He had developed a nail dystrophy, which is a recognized, but rare, feature in systemic amyloid.

Comedonal Darier's disease.

Darier's disease is an inherited disorder with well-recognized patterns of presentation. Lesions commonly affect the trunk and flexures. The diagnosis is based on the typical clinical appearance and histology showing acantholytic dyskeratosis.

The use of cytology in the diagnosis of basal cell carcinoma.

Two hundred and forty patients with basal cell carcinomas (BCCs) on the head or neck were studied. Scrapings of the lesions were taken for cytological examination, and a 3-mm punch biopsy was performed for histopathological study. The accuracy of diagnosis by each method was compared.

Use of a pro forma for head injuries in the accident and emergency department--the way forward.

The aim of this study was to assess the quality of documentation of head-injured patients seen in three accident and emergency (A&E) departments using a specially designed head injury pro forma. A 4-week prospective study of a single head injury pro forma was followed by a second similar study with an improved version (two head injury pro formas, one for young children and babies, the other for older children and adults). The main outcome measures were the degree of completion of the pro forma and questionnaire responses from receptionists, nurses and doctors.