Effects of intravitreal conbercept before panretinal photocoagulation on lipid exudates in diabetic macular documented by optical coherence tomography

AIM: To determine whether ophthalmic photographers can conduct virtual clinics in medical retina appropriately and whether this increases clinic capacity. METHODS: Three ophthalmic photographers underwent a training programme to learn how to assess and manage macular edema secondary to diabetes or retinal vein occlusion. The 300 consecutive patients over a 7-month observation period in 2018 were assessed in virtual clinics by both ophthalmic photographers and medical retina consultants. The degree of agreement in treatment decisions between doctors and photographers, as well as adverse events, was recorded. The change in number of patients seen in virtual clinics over two years was also measured. RESULTS: There was 100% agreement in management decisions between doctors and photographers during the 300-patient observation period. No adverse events were recorded. In 2017, 517 patients were seen in virtual clinics by doctors. After ophthalmic photographer clinics were introduced in 2018, this number increased by 24% to 709 patients seen by both photographers and doctors. There was a significant increase in mean number of patients seen per month between 2017 (47.7?11.7) and 2018 (59.1?14.4) (P=0.045, 95%CI -22.5 to -0.296). CONCLUSION: Ophthalmic photographers can manage medical retina patients in virtual clinics appropriately and can increase clinic capacity significantly in particular conditions.     

上海市性病门诊医务人员服务能力现况调查

目的 了解上海市性病门诊医务人员服务能力，以发现服务过程中存在的问题，提出建议，为有关决策者提供科学依据。方法 对上海市三家性病门诊医务人员进行问卷调查及小组深入访谈。结果 门诊医务人员性病艾滋病防治知识得分和优质服务评分较低，分别仅为69．17～76．67分和80．70～85．09分。多因素Logistic回归分析显示：年龄越小、培训次数越多，知识得分和优质服务评分越高；性病门诊工作年限越长，优质服务评分越高。定性研究显示：在病史采集、体检、促进安全套使用、性伴通知及健康教育等方面存在较大问题。结论 被调查的3家公立性病门诊健康教育力度低、内容少，而且许多医务人员的性病艾滋病防治知识和咨询技巧严重不足，部分医师优质服务意识较差，须加强对门诊医务人员的优质服务培训，尤其要加强安全套使用技巧、注意事项、咨询技巧、医患交流方面的培训。     

Knowledge and willingness to use pre-exposure prophylaxis among men who have sex with men in Northeastern Brazil

Few studies evaluate knowledge and willingness to use pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in middle-income countries. Brazil added PrEP to public drug formularies in December 2017, but little is known about local knowledge and attitudes about PrEP among MSM outside metropolitan areas in Southern Brazil. The cross-sectional HIV Surveillance Survey Project in Brazil estimates HIV and STD prevalence among MSM in 12 state capitals. Among 32 participants at the Salvador, Bahia study site, we used qualitative interviews to assess knowledge, willingness, and barriers to PrEP use among MSM; few MSM had previous knowledge of PrEP and were willing to use PrEP. Clinical, behavioural, social, and structural factors influencing participants’ knowledge and willingness to take PrEP included concerns about efficacy and side effects, access to culturally congruent services for MSM, and stigma. Some participants reported that learning about PrEP online positively influenced their willingness to use PrEP. Participants’ opinions about PrEP’s contribution to risk compensation varied. Interventions to provide culturally congruent care and destigmatise PrEP for MSM at high risk for HIV acquisition, particularly those conducted collaboratively with Brazil’s civil society movement, may enhance the public health effort to expand access to PrEP in Brazil.     

提高社区诊所为集贸市场商贩性病卫生服务满意度研究

目的鼓励有可疑性病症状的集贸市场商贩及时就诊,避免性病的传播。方法采用描述性分析、χ2检验、Logistic回归等分析方法,对集贸市场商贩具有的高危性态度和性行为,开展以提高疑似性病患者满意度为主要内容的卫生服务研究。结果具有疑似性病症状的集贸市场商贩的就诊意识得到加强,出现症状后的就诊率干预前为43.7%,干预后提高到57.9%(P<0.05);在诊所中开展的性病卫生服务营销方式,使患者的满意度由干预前的84.8%提高到干预后的93.0%(P<0.05)。结论提高社区诊所性病卫生服务满意度是集贸市场内进行性病防治的可行方法,对在相似人群中的性病预防控制工作有重要的参考价值。     

Use of antigen mimics to produce specific antibodies to anti-coccidial drugs

A range of polyclonal antibodies was successfully produced to the coccidiostatic drugs diclazuril and robenidine. Initial attempts to make immunogenic complexes of both drugs were ineffective due to difficulties encountered while trying to couple the compounds to large carrier proteins. Structural mimics, which could act as haptens for each drug, were sought and identified. The compounds identified were more open to chemical manipulation and were conjugated to carrier proteins to produce effective immunogens. The most sensitive antisera produced displayed IC50s of 1.5 ng/ml and 13 ng/ml for diclazuril and robenidine respectively. The antibody for diclazuril was shown to be specific, cross-reacting only with clazuril by 15%. The robenidine antibody displayed a low cross-reactivity of 1.2% to the compound used to produce the antibody.     

Connecting The Dots: When the Risks of HIV/STD Infection Appear High But the Burden of Infection Is Not Known—The Case of Male Latino Migrants in the Southern United States

Between 1990 and 2000, the number of Latinos in Alabama, Arkansas, Georgia, North Carolina, South Carolina, and Tennessee, states that had no or small Latino populations in 1990, increased by more than 300% on average. Several of these states (referred to as rapid growth states) have high AIDS/STD case rates. Compared to Latinos in states with well-established Latino populations and Latinos nationwide, those in rapid growth states are more often males, young, foreign-born, and recent arrivals who travel without females. The typical Latino in rapid growth states is a young male migrant. Although these migrants may be at risk of HIV/STD infection, little is known about the risk factors that affect them. To clarify this picture, a database search was conducted to identify studies of HIV/STD infection and/or risk factors among rural and urban-based Latino migrants in the six rapid growth states. This qualitative review examines ten studies that were conducted in Alabama, Georgia, North Carolina, and South Carolina. Five of the studies screened for HIV and/or syphilis infection and provide some information on risk factors; five studies describe risk factors only. Most of those studies that describe risk factors provide evidence that male Latino migrants in rural and urban settings of rapid growth states are vulnerable to HIV/STD infection through heterosexual contacts. However, many of the studies fail to provide sufficient information on other risk factors, and all but one of the studies that screened migrants for HIV or STD infection were conducted between 1988 and 1991. There is an urgent need for updated information on HIV/STD infection and the social-behavioral and situational risk factors that affect male Latino migrants in rapid growth states of the South. Electronic Supplementary Material The online version of this article (doi:) contains supplementary material, which is available to authorized users. The findings reported here were presented in part at the 16th International AIDS Conference in Toronto, Canada (13–18 August 2006), abstract number TUPE0641, and the 19th Annual East Coast Migrant Stream Forum in Myrtle Beach, South Carolina (19–21 October 2006). The findings and conclusions in this report are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.     

Two-year follow-up of a randomized controlled trial of a clinical nurse specialist intervention,inpatient, and day patient team care in rheumatoid arthritis

AIM: To compare the long-term effectiveness of care delivered by a clinical nurse specialist (CNS) with inpatient team care and day patient team care in patients with rheumatoid arthritis and increasing functional limitations. Background. The role of CNSs in the management of patients with rheumatoid arthritis (RA) is evolving, and their effectiveness in comparison with care provided by a rheumatologist alone has been established. However, long-term controlled studies showing how the effectiveness of CNSs compares with that of other forms of co-ordinated care, such as multidisciplinary team care, are lacking. METHODS: Two hundred and ten patients rheumatoid arthritis patients were randomized to care delivered by a CNS in a rheumatology outpatient clinic (12 weeks), inpatient team care (2 weeks) and day patient team care (3 weeks). Clinical assessments recorded on study entry, weeks 12, 26, 52, 78 and 104 comprised the health assessment questionnaire (HAQ) and MacMaster Toronto Arthritis (MACTAR) patient preference interview as primary outcome measures. Grip strength, walk test, RAND-36, Rheumatoid Arthritis Quality of Life questionnaire and disease activity score (DAS) were applied as secondary outcome measures. RESULTS: No significant differences in medical treatment, use of services of other health professionals, introduction of adaptive equipment or number of hospitalizations were observed between the three treatment groups during 2 year follow-up, except that visits to nurse specialists were more frequent and home help was less frequent in the CNS group. A comparison of clinical outcomes among the three groups and a comparison between the nurse specialist and inpatient and day patient care groups together did not show any significant differences. Within all three groups functional status, quality of life and disease activity improved significantly (P < 0.05). In general, the results obtained after 12 weeks remained stable until 104 weeks after the start of the study. CONCLUSION: Care provided by a CNS in an outpatient rheumatology clinic has a similar long-term clinical outcome to inpatient and day patient team care in patients with rheumatoid arthritis. A CNS intervention appears to be an effective innovation in the care for patients with rheumatoid arthritis.     

Characteristics of COPD Patients Managed in Respiratory Medicine Departments in Spain,According to GOLD Groups and GesEPOC Clinical Phenotypes

Introduction

The objective of this study was to analyze the clinical characteristics of COPD patients attending general respiratory clinics, adherence to clinical guidelines, classification accuracy, and therapeutic management.