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Edelstein M, Iyanger N, Hennessy N, Mesher D, Checchi M, Soldan K, McCall M, Nugent J, Crofts J, Lo J, Gilson R, Powell K, Ramsay M, Yarwood J. Implementation and evaluation of the human papillomavirus (HPV) vaccination pilot for men who have sex with men (MSM), England, April 2016 to March 2017. ACTA ACUST UNITED AC 2020; 24. [PMID: 30808443 PMCID: PMC6446955 DOI: 10.2807/1560-7917.es.2019.24.8.1800055] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: Opportunistic human papillomavirus (HPV) vaccination for men who have sex with men (MSM) was piloted in sexual health clinics (SHC) in England between 2016 and 2018. Aim: to evaluate the pilot’s first year (April 2016–March 2017) in terms of feasibility, acceptability, uptake, impact and equity and interpret the outcome in the context of wide HPV vaccination policy. Methods: Attendance and uptake data from routine SHC surveillance datasets and a cross-sectional survey administered to individuals receiving the vaccine were analysed. Results: Among 18,875 eligible MSM, 8,580 (45.5%) were recorded as having received one HPV vaccine dose, decreasing slightly with increasing age, and uptake was higher in rural than urban areas. Survey results suggested that of those receiving the first dose of HPV vaccine, 8% were new attendees and that among those, less than 11% attended just to receive the vaccine. Of those having their first HPV vaccination, 95% indicated they would like to receive the next vaccine doses at the same clinic and 85% of patients reported accessing other services when visiting SHC for the first dose of vaccine. Conclusion: An opportunistic HPV vaccination programme for MSM can be delivered in an acceptable and, as far as can be evaluated, equitable manner, without major disruption to SHC and HIV clinics.
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Affiliation(s)
- Michael Edelstein
- Immunisation and countermeasures division, National Infection Service, Public Health England, London, United Kingdom
| | - Nalini Iyanger
- Immunisation and countermeasures division, National Infection Service, Public Health England, London, United Kingdom
| | - Nicola Hennessy
- Immunisation and countermeasures division, National Infection Service, Public Health England, London, United Kingdom
| | - David Mesher
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV service, National Infection Service, Public Health England, London, United Kingdom
| | - Marta Checchi
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV service, National Infection Service, Public Health England, London, United Kingdom
| | - Kate Soldan
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV service, National Infection Service, Public Health England, London, United Kingdom
| | - Mark McCall
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV service, National Infection Service, Public Health England, London, United Kingdom
| | - Julie Nugent
- Immunisation and countermeasures division, National Infection Service, Public Health England, London, United Kingdom
| | - Jonathan Crofts
- Immunisation and countermeasures division, National Infection Service, Public Health England, London, United Kingdom
| | - Janice Lo
- Immunisation and countermeasures division, National Infection Service, Public Health England, London, United Kingdom
| | - Richard Gilson
- Mortimer Market Sexual Health Clinic, London, United Kingdom
| | - Karen Powell
- Immunisation and countermeasures division, National Infection Service, Public Health England, London, United Kingdom
| | - Mary Ramsay
- Immunisation and countermeasures division, National Infection Service, Public Health England, London, United Kingdom
| | - Joanne Yarwood
- Immunisation and countermeasures division, National Infection Service, Public Health England, London, United Kingdom
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Abstract
Ten healthy volunteers were placed in three different surgical prone positions (knee-chest, Eschmann frame and two supports, one each for the thorax and pelvis); the normal prone position without any supports was used as a control. Lung volumes using helium dilution and spirometry were calculated for each volunteer in each position. Compared with the control position, functional residual capacity, expiratory reserve volume, residual volume and total lung capacity were significantly higher in the knee-chest position. Functional residual capacity and expiratory reserve volume were significantly higher in the frame position. No advantage was gained with the use of the two supports position. We conclude that, of these three prone positions in awake volunteers, the knee-chest position causes least respiratory restriction.
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Affiliation(s)
- R P Mahajan
- University Department of Anaesthesia, Queen's Medical Centre, Nottingham
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Abstract
We questioned whether the side effects outweighed the advantages of priming doses of nondepolarizing neuromuscular relaxants in awake patients. We have assessed lung function and clinical evidence of muscle weakness in 10 elderly patients, eight women and two men, aged 67-78 yr, ASA grade I or II, before and 3 min after a priming dose (0.01 mg/kg) of vecuronium. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), maximum midexpiratory flow rate (MMEF), peak expiratory flow rate (PEFR), inspiratory capacity (IC), functional residual capacity (FRC), expiratory reserve volume (ERV), residual volume (RV), slow vital capacity (SVC), and total lung capacity (TLC) were measured by using a Morgan transfer test machine and oxygen saturation (SpO2) was measured by pulse oximetry. All the patients developed ptosis, six had diplopia and were unable to perform the Valsalva maneuver for 10s, and four were unable to swallow or lift their head for > 4s, demonstrating significant muscle weakness. Significant reductions occurred in FVC, FEV1, FRC, ERV, SVC, and TLC. SpO2 decreased in 8 of 10 patients, and in 4 the decrease exceeded 4%. We conclude that priming with vecuronium 0.01 mg/kg in elderly patients causes significant impairment of lung function and a significant decrease in oxygen saturation.
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Affiliation(s)
- R P Mahajan
- University Department of Anaesthesia, Queen's Medical Centre, Nottingham, United Kingdom
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Hennessy N, Harrison DA, Aitkenhead AR. The effect of the anaesthetist's attire on patient attitudes. The influence of dress on patient perception of the anaesthetist's prestige. Anaesthesia 1993; 48:219-22. [PMID: 8460799 DOI: 10.1111/j.1365-2044.1993.tb06905.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Two groups of adult patients (55 each) were visited pre-operatively by an anaesthetist who was dressed either formally or casually. Their response to this visit, their opinions regarding anaesthetists and their knowledge of anaesthetic work were elicited afterwards by means of a questionnaire. Patients' satisfaction with the anaesthetist and his/her visit was not influenced by dress. The anaesthetist was awarded a high level of prestige and the length of his/her training was recognised to be comparable to that of other professionals; 81.8% of patients thought that anaesthetists held a medical degree but only 35.4% thought that they worked in the intensive care unit. Patients expressed a preference for doctors to wear name tags, white coats and short hair but disapproved of clogs, jeans, trainers and earrings.
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Affiliation(s)
- N Hennessy
- University Department of Anaesthesia, University Hospital, Queen's Medical Centre, Nottingham
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