Objectives to direct the training of emergency medicine residents on off-service rotations: Surgery, part 2

This is the 35th article in a continuing series of objectives to direct emergency medicine resident experiences on off-service rotations. Vascular and urological complaints are common problems in the emergency department and often lead to consultation with a surgeon. Because an understanding of the principles of surgical diagnosis and treatment is an essential component of the practice of emergency medicine, emergency medicine residents rotating on surgical services require specific goals and objectives to emphasize early patient assessment, identification of the possible need for surgery, and a basic understanding of definitive management. Unique aspects of pediatric surgery are also addressed in this segment.     

Roles and challenges of outreach workers in HIV clinical and support programs serving young racial/ethnic minority men who have sex with men

The federal government has established rapid identification, linkage, and engagement in medical care of HIV-positive individuals as a high priority. Outreach workers and other linkage coordinators are identified as key personnel in implementing this policy. Young racial/ethnic minority men who have sex with men (MSM) have relatively high and growing rates of HIV infection and would benefit from the services of outreach workers. In this article, we describe the characteristics of outreach workers employed by eight demonstration sites participating in the federal Special Projects of National Significance (SPNS) Young MSM of Color Initiative, the linkage and retention models used by the sites, and the number of outreach/ linkage contacts and individuals referred to HIV care. We summarize rates of retention of outreach workers in employment, factors associated with worker turnover, and costs associated with their replacement. We also summarize the experiences of demonstration sites in employing and retaining outreach workers and improving their performance. The insights of outreach workers are reported regarding the challenges they experienced while conducting outreach. Recommendations from demonstration site project managers and outreach workers are offered to improve workplace performance and job retention. Outreach and retention strategies, as well as lessons learned in employing outreach workers, are useful to programs serving young racial/ethnic minority MSM and other HIV-positive groups.     

The Effect of an Iranian Herbal Drug on Primary Dysmenorrhea: A Clinical Controlled Trial

Our objective was to examine the effect of an Iranian herbal drug in the treatment of primary dysmenorrhea. A randomized, double‐blind, placebo‐controlled pilot trial among 180 female students at Isfahan University dormitory aged 18 to 27 who suffered from primary dysmenorrhea was undertaken. The participants were randomly divided into three groups: herbal drug, mefenamic acid, and placebo. The herbal drug group was given 500 mg of highly purified saffron, celery seed, and anise (SCA) extracts three times a day for three days, starting from the onset of bleeding or pain. Participants were followed for two to three cycles from the beginning of menstruation through the three days of bleeding. Main outcome measures were the severity and duration of pain at 2 and 3 months. A visual analogue scale was used to record pain. There were statistically significant reductions in pain scores and pain duration scores in the groups that took SCA (P < .001) and mefenamic acid (P < .01). The decrease in pain score was reflected by a significant reduction in other drug use among the treatment groups compared with the women in the placebo group. The magnitude of the reduction was significantly greater in the SCA group than in the mefenamic acid and placebo groups. Both drugs effectively relieved menstrual pain as compared with the placebo. More clinical trials are needed to establish the efficacy of this herbal drug.     

Does the recent increase in HIV diagnoses among men who have sex with men in the UK reflect a rise in HIV incidence or increased uptake of HIV testing?

OBJECTIVES: To determine whether the increase in HIV diagnoses since 1997 among men who have sex with men (MSM) in the UK reflects a rise in HIV incidence or an increase in HIV testing. METHODS: Estimates of HIV incidence were derived using data from UK HIV surveillance systems (HIV diagnoses; CD4 surveillance; unlinked anonymous surveys) for 1997-2004. Data on HIV testing were provided by KC60 statutory returns, voluntary testing and unlinked anonymous surveys in sentinel genitourinary medicine (GUM) clinics. RESULTS: HIV diagnoses among MSM in the UK rose by 54% between 1997 and 2004 (from 1382 to 2124), with variation by age and geographical location. The number of HIV diagnoses among MSM <35 years of age in London showed no increase, but in all other groups it increased. Throughout the UK, uptake of HIV testing increased significantly among MSM attending GUM clinics between 1997 and 2004, including "at-risk" MSM (p<0.001). Direct incidence estimates (serological testing algorithm for recent HIV seroconversion assay) provided no evidence of a statistically significant increase or decrease in HIV incidence. Indirect estimates suggested that there may have been a rise in HIV incidence, but these estimates were influenced by the increased uptake of HIV testing. CONCLUSIONS: The number of HIV diagnoses increased among MSM in the UK between 1997 and 2004, except among younger MSM in London, in whom there was no change. The increase in HIV diagnoses among MSM in the UK since 1997 seems to reflect an increase in HIV testing rather than a rise in HIV incidence.