Time-Line in HFEA Developments and Regulatory Challenges: 20 Years of Overseeing Fertility Practices and Research in the UK.

In the wake of political upheaval, the Human Fertilisation and Embryo Authority (HFEA) has faced increasing insecurity over its future as a pivotal regulatory body of fertility practices in the UK. HFEA regulates activities by means of licensing, audit, and inspection of fertility centers and maintaining the Code of Practice, which ensures the optimum undertaking of licensed activities by fertility centers. In 2009, amendments to the 1990 Act came into force representing an amalgamation of cumulative proposals, debates, and changes in legislation, which have shaped the world of reproductive medicine.

Temporal trends in the associations between age, sex and socioeconomic status after death from motor vehicle collisions in England and Wales: 1960-2009.

Objective: To determine the trend in the associations between socioeconomic status and gender with median age at death in England and Wales, from 1960 to 2009.

Methods: Annual cross-sectional studies of all registered deaths from a motor vehicle collision in England and Wales, 1960-2009.

Results: There were 1647 deaths from a motor vehicle collision in 1960 and 964 deaths in 2009.

Radiological evidence of subcutaneous emphysema leading to a diagnosis of retroperitoneal perforated diverticulum.

Introduction: This case report outlines the investigation and management of a young patient presenting with left iliac fossa pain and sepsis. A CT was performed which was initially reported as not showing a perforation, however closer analysis provided evidence of subcutaneous emphysema in the anterior abdominal wall. This evidence justified urgent operative intervention.

Management of non-muscle-invasive (superficial) bladder cancer.

Non-muscle-invasive (superficial) bladder cancer (NMIBC) represents 80% of incident cases of bladder cancer, and is characterized by a generally good prognosis, with a tendency to remain localized. Only 10%-20% of cases progress to invasion and/or metastasis. The biggest problem in management is the potential for local recurrence, and this will occur with relatively predictable prognostic determinants.

Giant mesenteric cyst: a rare cause of abdominal distension diagnosed with CT and managed with ultrasound-guided drainage.

This rare cystic lesion has an approximate incidence of 1 in 200,000. This patient complained of abdominal distension and was diagnosed with a giant mesenteric cyst measuring 26 cm in height using CT imaging. She underwent a successful ultrasound-guided drainage, which is not previously reported in the literature.

Testing the fathers: carrying out HIV and STI tests on partners of pregnant women.

Objectives: Opt out antenatal HIV testing has significantly reduced mother to child transmission of HIV, but seroconversion during pregnancy from undiagnosed HIV positive male partners remains a risk. The authors report on a pilot initiative for sexual health and HIV screening for male partners of women attending antenatal ultrasound examination at Homerton Hospital, London.

Methods: Men attending with their female partners for routine ultrasound examination between 1 August 2010 and 31 January 2011 were offered on-site serology for HIV, syphilis, hepatitis B and hepatitis C and urine testing for Neiserria gonorrhoeae and Chlamydia trachomatis.

Postnatal pelvic floor dysfunction: conservative treatment and management options.

Thirty per cent of postnatal women will suffer with one or more symptoms of pelvic floor dysfunction. Left untreated, symptoms can lead to social isolation and embarrassment. Long-term co-morbidity is increased in women who have symptoms of pelvic floor dysfunction postnatally, therefore assessing and treating these symptoms when they develop is crucia for the wellbeing of women.

The 'straight to test' initiative reduces both diagnostic and treatment waiting times for colorectal cancer: outcomes after 2 years.

Aim: This study aimed to determine whether a 'straight to test'(STT) strategy for 2-week wait (2 wk) referrals for suspected colorectal cancer (CRC) reduced the time to diagnosis and treatment for patients with CRC.

Method: Consecutive 2-week referrals for suspected CRC over a period of 2 years from February 2007 were analysed. The times to the first diagnostic test and treatment and the cancers identified were analysed for those going to STT or the outpatient clinic.

Preventing pelvic floor dysfunction: childbearing women deserve better care.

Pregnancy and childbirth are a major cause of pelvic floor dysfunction in women. Historically, symptoms of pelvic floor dysfunction have attracted little attention from government policies, either in funding or targets, when compared with other conditions such as diabetes or cancer. With more than 30% of women in the childbearing years suffering from this debilitating and embarrassing condition, this article looks at National Institute of Health and Clinical Excellence (NICE) and other guidelines that justify spending time and money on managing this group of women.

The evolution of an integrated sexual health service.

The objective of the study was to assess the contributions of different providers across an integrated sexual health-care network to the diagnosis of sexually transmitted infections (STIs). The method employed was retrospective cross-sectional survey of laboratory tests for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis between 01 April 2004 and 31 March 2007. The total number of STI screens in all venues rose from 17,126 to 23,679.

Trust in the patient's history: cough and eels.

A 54-year-old ex-smoker was referred to the respiratory clinic for breathlessness and wheeze. His symptoms started while eating jellied eels when he felt something stick in his throat. The following day, his general practitioner heard a wheeze in his right lower chest.

The impact of establishing a local-enhanced service for treating sexually transmitted infections in primary care.

Objectives: To consider whether a local-enhanced service in sexual health in City and Hackney, London, added to the services already provided within the borough and to compare the cost to the Primary Care Trust of diagnosing sexually transmitted infections (STI) in general practice and in the genitourinary medicine clinic.

Method: An observational study describing the local-enhanced service in primary care, including a quantitative analysis of swabs taken for chlamydial and gonorrhoeal infections at different venues before and after the introduction of the local-enhanced service.

Results: 32 out of 51 general practices (63%) within City and Hackney joined the local-enhanced service.

Straight to test. Results of a pilot study in a hospital serving an inner city population.

Objective: The main aims of the study were to determine the frequency with which two-week wait (2ww) referrals for colorectal cancer (CRC) could proceed directly to straight to test (STT), and the potential improvement in time to diagnosis.

Method: A telephone interview was attempted in all 2ww referrals not requiring an advocate and under 80 years. Data were assessed according to a test protocol, and where indicated a potential slot for the appropriate investigation was recorded (virtual test).

Transgastric endoscopy--a new fashion, a new excitement!

Current flexible gastrointestinal endoscopy has been enriched by a new technique, transluminal endoscopic surgery, which has recently attracted an explosion of interest. To date, the established applications are few, but this review attempts to provide an overview of the present status of the procedures and of the development of the technical devices. The possible risks will be addressed as well as the potential benefits.

Uptake of screening for breast cancer in patients with mental health problems.

Objectives: Mental illness is associated with physical illness and mortality from a variety of causes including cancer. There is little information on screening attendance among the mentally ill population. An audit was conducted of a breast screening service in inner London to determine uptake rates in women with mental illness.