AMPK and PGC-α following maximal and supramaximal exercise in men and women: a randomized cross-over study

We tested the hypothesis that AMPK activation and peroxisome proliferator gamma coactivator 1 alpha (PGC-1α) expression are not augmented as exercise intensity (power output) increases from maximal to supramaximal intensities and conducted an exploratory analysis comparing AMPK activation and PGC-1α expression in males and females. Seventeen (n = 9 males; n = 8 females) recreationally active, healthy, young individuals volunteered to participate in the current study. Participants completed work matched interval exercise at 100% (Max) and 133% (Supra) of peak work rate (WRpeak). Intervals were 1 min in duration and participants were prescribed 6 and 8 intervals of Max and Supra, respectively, to equate external work across protocols. PGC-1α mRNA expression and activation of AMPK (p-ACC) were examined in muscle biopsy samples. Interval WR (watts; W), intensity (%WRpeak) and average HR (bpm), blood lactate (mmol/L) and rating of perceived exertion were all higher (all p < 0.05) in Supra. Fatigue was greater (p < 0.05) in Supra. PGC-1α mRNA expression significantly increased after exercise in Max (p < 0.01) and Supra (p < 0.01), but was not significantly different (p = 0.71) between intensities. A main effect of time (Pre - 0 h) (p < 0.01) was observed for p-ACC; however, no effect of intensity (p = 0.08) or interaction (p = 0.97) was observed. No significant effects of time (p = 0.05) intensity (p = 0.42), or interaction (p = 0.97) were observed for p-AMPK (Thr172). Exploratory sex analysis demonstrated a main effect of sex for p-ACC (greater p-ACC in males; p < 0.05) but not for p-AMPK or PGC-1α expression. Our results confirm that AMPK-PGC-1α signalling is not augmented following supramaximal exercise and provide novel data demonstrating a decrease in AMPK activation (p-ACC) in females compared to men. Trial registration: https://doi.org/10.17605/OSF.IO/U7PX9.

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m 3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

The diabetes community exercise programme plus usual care versus usual care in patients with type 2 diabetes: A randomised, two-arm, parallel, open-label trial

BACKGROUND

Exercise is important in type 2 diabetes (T2D) management. Focussing on Māori and Pacific people and those from deprived circumstances, the Diabetes Community Exercise Programme (DCEP) was developed to engage people with T2D in exercise. We report the evaluation of whether being offered DCEP (plus usual care) was more effective than usual care in improving glycaemic control at 1-year.

METHODS

A randomised, two-arm, parallel, open-label trial with blinding of outcome assessor and data analyst. Adults (age ≥35 years) with T2D recruited from two New Zealand (NZ) communities were randomised, using opaque sealed envelopes and stratified by centre with random block lengths, to DCEP or usual care. DCEP comprises twice-weekly, two-hour sessions of exercise and education over 12-weeks, followed by a twice-weekly maintenance exercise class. The primary outcome was between-group differences in mean changes of glycated haemoglobin (HbA1c) from baseline to 1-year follow-up with intention-to treat analysis. This trial is registered with the Australian NZ Clinical Trials Registry (ANZCTR): ACTRN12617001624370p and is closed to new participants.

FINDINGS

From 2018 - 2019, of 294 people screened, 165 (mean age 63·8, SD16·2 years, 56% female, 78·5% European, 14% Māori, 6% Pacific, 27% most deprived) were baseline evaluated, randomised, and analysed at study end (DCEP = 83, control = 82). Multimorbidity (≥2) and polypharmacy (>5 medications) were high (82%, 69%). We found no statistically significant between-groups differences in HbA1c (mmol/mol) change at 15 months (mean 3% higher in DCEP, 95% CI 2% lower to 8% higher, p = 0·23). Twelve-week intervention adherence was good (41% attended >80% available sessions). No adverse events were reported.

INTERPRETATION

DCEP was not effective in improving glycaemic control, possibly due to insufficient exercise intensity. Our attendance demonstrated DCEP's cultural accessibility. DCEP might be good to engage in exercise marginalised people with high Hb1Ac levels, multimorbidity, and high polypharmacy.

FUNDING

Health Research Council of New Zealand.

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

Randomized controlled trial of a new portable calf compression device (Venowave) for prevention of venous thrombosis in high-risk neurosurgical patients

BACKGROUND

Patients undergoing neurosurgical procedures are at risk of venous thromboembolism (VTE), but often have contraindications for anticoagulant prophylaxis.

OBJECTIVES

To assess the efficacy and tolerability of a new, lightweight, portable, battery-powered, intermittent calf compression device, Venowave, for the prevention of VTE in neurosurgical inpatients.

PATIENTS/METHODS

We performed an open randomized controlled trial comparing Venowave with control for the prevention of VTE in patients undergoing neurosurgery. The primary outcome was the composite of asymptomatic deep vein thrombosis (DVT) detected by screening venography or compression ultrasound performed on day 9 (± 2 days) and symptomatic VTE.

RESULTS

We randomized 75 patients to receive Venowave devices and 75 to the control group. All patients were prescribed graduated compression stockings and physiotherapy. VTE occurred in three patients randomized to Venowave and in 14 patients randomized to control (4.0% vs. 18.7%, relative risk 0.21; 95% confidence interval 0.05-0.75, P = 0.008). Similar reductions were seen for proximal DVT (2.7% vs. 8.0%) and symptomatic VTE (0% vs. 2.7%), and the results were consistent in all subgroups examined.

CONCLUSIONS

Venowave devices are effective in preventing VTE in high-risk neurosurgical patients.

Self-management education for adults with epilepsy

BACKGROUND

Self-management education has been shown to improve the quality of life of people with chronic illnesses. It has been suggested that self-management education may improve seizure control and other outcomes in people with epilepsy.

OBJECTIVES

To review systematically the research literature on the effectiveness of self-management education in improving health outcomes for adults with epilepsy.

SEARCH STRATEGY

We searched MEDLINE (Ovid) (1966 to April 2005), EMBASE (Ovid) (1980 to April 2005), CINAHL (Dialog) (1980 to April 2005), PsycINFO (Dialog) (1887 to April 2005), and the Cochrane Epilepsy Group's Specialised Register (April 2005). We also handsearched Epilepsia and conference abstracts and proceedings. Experts in the field were contacted to identify any additional trials. We did not impose any language restriction. We re-ran the searches in February 2007 and added the identified references to the 'Studies awaiting assessment' table.

SELECTION CRITERIA

Randomised trials of self-management education programmes for adults with epilepsy.

DATA COLLECTION AND ANALYSIS

At least two review authors independently assessed the quality of each study and extracted data.

MAIN RESULTS

Two trials evaluated the effect of self-management education for adults with epilepsy, neither of which assessed as being of high quality. In total, 483 adults with epilepsy were randomised. Both trials showed improvements in seizure frequency and other outcomes, such as knowledge. However, we were not able to estimate a summary effect for seizure frequency due to a lack of data.

AUTHORS' CONCLUSIONS

Self-management education programmes, based on increasing understanding through psychosocial methods, may improve knowledge about epilepsy, certain behavioural outcomes, and reduce seizure frequency. It is, however, not clear how effective self-management programmes of epilepsy would be in a more general population of adults with epilepsy, as both trials had higher proportions of people with partial seizures than would be expected in a community sample.

Self-management education for children with epilepsy

BACKGROUND

Self-management education has been shown to improve the quality of life of children and young people with chronic illnesses. It has been suggested that self-management education may improve seizure control and other outcomes in children and young people with epilepsy.

OBJECTIVES

To review systematically the research literature on the effectiveness of self-management education in improving health outcomes for children and young people with epilepsy.

SEARCH STRATEGY

We searched the Cochrane Epilepsy Group's Specialised Register (April 2007), MEDLINE (Ovid) (1966 to February 2007), EMBASE (Ovid) (1980 to February 2007), CINAHL (Dialog) (1980 to February 2007), and PsycINFO (Dialog) (1887 to February 2007). We also handsearched Epilepsia and conference abstracts and proceedings. Experts in the field were contacted to identify any additional trials. No language restriction was imposed.

SELECTION CRITERIA

Randomised trials of self-management education programmes for children or young people with epilepsy.

DATA COLLECTION AND ANALYSIS

At least two review authors independently assessed the quality of each study and extracted data.

MAIN RESULTS

Only one trial involving 167 children was identified that evaluated the effect of a child-centred model of training for the self-management of two chronic illnesses, asthma and epilepsy. The trial was not assessed as being of high quality and the methods used to analyse and report the data did not enable us to precisely determine the effect of the intervention. However, improvements were seen in seizure frequency and other outcomes, such as knowledge and behaviour.

AUTHORS' CONCLUSIONS

Self-management education programmes that deliver a child-centred model of training, may improve knowledge about epilepsy, certain behavioural outcomes, and reduce seizure frequency in children and young people with epilepsy. However, based on the evidence reviewed, we are not able to determine how effective it is, or what the key components of the programme should be.

Models of the medical consultation: opportunities and limitations of a game theory perspective

The medical consultation is best understood as a two-way social interaction involving interactive decision making. Game theory--a theory based on assumptions of rational choice and focusing on interactive decision making--has the potential to provide models of the consultation that can be used to generate empirically testable predictions about the factors that promote quality of care. Three different game structures--the Prisoner's Dilemma game, the Assurance game, and the Centipede game--all provide insights into the possible underlying dynamics of the doctor-patient interaction. Further empirical work is needed to uncover the underlying game structures that occur most commonly in medical consultations. Game theory has the potential to provide a new conceptual and theoretical basis for future empirical work on the interaction between doctors and their patients.

Models of the medical consultation: opportunities and limitations of a game theory perspective

The medical consultation is best understood as a two-way social interaction involving interactive decision making. Game theory--a theory based on assumptions of rational choice and focusing on interactive decision making--has the potential to provide models of the consultation that can be used to generate empirically testable predictions about the factors that promote quality of care. Three different game structures--the Prisoner's Dilemma game, the Assurance game, and the Centipede game--all provide insights into the possible underlying dynamics of the doctor-patient interaction. Further empirical work is needed to uncover the underlying game structures that occur most commonly in medical consultations. Game theory has the potential to provide a new conceptual and theoretical basis for future empirical work on the interaction between doctors and their patients.

Management Of Marine Mammal Tours On The Great Barrier Reef

Of the more than 30 species of marine mammal occurring within the Great Barrier Reef Marine Park (GBRMP), three are the focus of wildlife-based tours: humpback whales (Megaptera novaeangliae), dwarf minke whales (Balaenoptera acutorostrata) and dugongs (Dugong dugon). Currently (April 2001), 19 permits, comprising 31 ships and two aircraft, allow whalewatching in the GBRMP. The combined passenger capacity of these craft is 3,238 at any one time (e.g., per day). However, fewer than 15,000 persons were recorded in ?dedicated? whalewatching tours each month during the May - October ?whale-watching? season between 1998 and 2000. Watching M. novaeangliae occurs primarily in the Central and Cairns Sections of the GBRMP, with most activity focused in the Whitsundays. Permitted levels of whale-watching are capped at eight permits in the Cairns Area, and at 11 permits in the Whitsundays. Other tours include: a specialised form of whale-watching involving swimming with B. acutorostrata which is being brought within a limited-entry management regime; one dolphin-watching tour in the Central Section of the GBRMP north of the Whitsundays; and one dugong-watching tour in the Hinchinbrook Region. Because of reported declines in the number of D. dugon on the Great Barrier Reef, this activity is being monitored closely before further permits are granted. Marine mammal watching activities in the GBRMP are managed through a combination of best practices guidelines, codes of conduct, regulations, zoning, wildlife protection areas and permits. The potential for the commercial whale-watching industry to become self-regulating is acknowledged.

Choosing and using services for sexual health: a qualitative study of women's views

OBJECTIVE

To explore women's accounts of choosing and using specialist services for sexual health.

METHODS

A qualitative study involving semistructured interviews with 37 women screened for Chlamydia trachomatis attending genitourinary medicine and family planning clinics in an East Midlands health authority.

RESULTS

In making the decision to seek help, women act on a range of specific prompts, including lay ideas about the significance of symptoms; their own behaviour; their partner's symptoms or behaviour; contact tracing; and health promotion. Some women do not seek help specifically in relation to sexual health but are identified as being at risk of sexually transmitted infections (STIs) during routine consultations. Important influences on women's choice of services include the lay referral system, "insider" knowledge of health services, referral by health professionals, and need to have alternatives to general practice care. Women's willingness to access services is mediated by psychosocial factors such as embarrassment. They may use smear tests as a legitimate opportunity to raise questions about sexual health. Women's priorities for services are that their feelings of stigma and embarrassment are managed appropriately; that staff communicate well and are sensitive to their emotions and comfort during tests and procedures; that they are "in control" when obtaining test results; and that confidentiality is preserved.

CONCLUSIONS

A detailed understanding of both lay people's response to symptoms or behaviour that indicates risk of an STI and their needs when using services should inform interventions aimed at encouraging secondary prevention of STIs.

Production efficiency of loblolly pine and sweetgum in response to four years of intensive management

We tested the hypothesis that productivity of intensively managed loblolly pine (Pinus taeda L.) and sweetgum (Liquidambar styraciflua L.) stands is dependent not only on leaf area, but also on foliar photosynthetic rate. Effects of irrigation (irrigation treatment), irrigation with a fertilizer solution (fertigation treatment), and fertigation + pest control (loblolly pine only; fertigation + pest control treatment) on leaf physiology and growth were compared with control plots during the third and fourth growing seasons. Complete weed control was maintained on all plots. Aboveground net primary productivity of loblolly pine and sweetgum increased from 16.3 to 40.5 Mg ha(-1) and from 4.2 to 23.9 Mg ha(-1), respectively, in response to the most intensive treatment. Relative to the control treatment, neither fertigation of sweetgum nor fertigation + pest control of loblolly pine had a significant or consistent influence on foliar N concentration, quantum yield, carboxylation efficiency, net photosynthesis, stomatal conductance, or production efficiency (increment in woody biomass per unit leaf area). Irrigation increased predawn leaf water potential and photosynthesis of loblolly pine, but it had no effect on production efficiency. Leaf area was the predominant determinant of maximum productivity in these rapidly growing plantations.

Sexual health and the practice nurse: a survey of reported practice and attitudes

BACKGROUND

Practice nurses have an important role in the provision of sexual health services in general practice.

AIM

This study set out to determine practice nurses' reported practice and training in sexual health, attitudes towards sexual health, barriers to discussing sexual health with patients, and training needs.

METHOD

A confidential self-administered postal questionnaire survey was sent to all 298 practice nurses in one English health district (Leicestershire).

RESULTS

Completed questionnaires were returned by 234 practice nurses (response rate 79%). Most nurses routinely offered well-person checks (90%), cervical smears (89%), travel clinics (83%), saw women with genito-urinary symptoms (77%) and offered family planning advice (54%). Only a minority of nurses (13%) offered specific teenage health clinics. Sexual health issues were always discussed in a majority of consultations when giving family planning advice (65%) and in women with genito-urinary symptoms (58%). Most practice nurses (62%) had undertaken at least one course dealing with sexual health issues in the last 5 years. Uptake of training was, however, significantly lower in certain groups of nurses. An analysis of the attitude statements suggested that nurses were more comfortable discussing sexual health issues with female patients and teenagers than with male patients and those of different sexual orientations. Nurses who had received training reported more positive attitudes towards discussing sexual health issues with patients.

CONCLUSION

Practice nurses offer a wide range of services in which the need to be able to take a sexual history and offer appropriate advice is important. There is scope to improve the provision of sexual health services by nurses in general practice, particularly in relation to services for teenagers.

Fas (CD95) expression is up-regulated on papillary thyroid carcinoma

Thyrocyte apoptosis signaled through the Fas receptor has been proposed as a mechanism for the cytotoxicity observed in thyroiditis, but the role the Fas pathway plays in thyroid cancer is not known. We examined Fas expression in thyroid tissue derived from patients with papillary carcinoma and follicular cancer. More intense immunohistological staining for the Fas protein was observed on papillary cancer cells as compared with adjacent normal follicles. To further characterize the expression of Fas in papillary cancer, paired normal and cancerous thyroid tissues were obtained at thyroidectomy from several donors, digested, and placed into cell culture. Messenger RNA was analyzed by ribonuclease protection assays, and protein was identified by flow cytometry. Fas expression was detected at levels up to 3-fold higher in cancerous thyrocytes compared with paired normal cells. To determine whether the expressed Fas antigen was functional, thyrocytes were treated with a monoclonal IgM anti-Fas antibody (clone CH11; Upstate Biotechnology, Inc., Lake Placid, NY) in the presence of interferon-gamma and cycloheximide. Whereas both normal and cancerous thyrocytes were induced to die after this treatment, the cancerous thyrocytes were more sensitive to anti-Fas antibody. This work demonstrates that the Fas antigen is expressed and functional on papillary thyroid cancer cells and this may have potential therapeutic significance.

Evidence-based guidelines for the management of genital chlamydial infection in general practice. (Leicestershire Chlamydia Guidelines Group)

BACKGROUND

Valid clinical guidelines can be effective in improving patient care. Genital Chlamydia trachomatis infection is the commonest curable sexually transmitted disease (STD) in England and Wales and is an important cause of pelvic inflammatory disease (PID), tubal infertility and ectopic pregnancy. No published guidelines exist on managing genital chlamydial infection in British general practice.

OBJECTIVE

We aimed to develop valid guidelines for the management of genital chlamydial infection for use in British general practice.

METHODS

A district-wide postal questionnaire survey was used to document current clinical practice. A critical review of the evidence concerning the management of genital chlamydial infection as it relates to British general practice was performed. The information gained from the critical review and survey was used to develop evidence-based guidelines within a multidisciplinary guideline recommendation group.

RESULTS

The guidelines covered the diagnosis, investigation, drug treatment and referral of adult male and female patients with genital chlamydial infection in general practice.

CONCLUSION

Valid guidelines for the management of genital chlamydial infection have been developed for use in British general practice. Appropriate dissemination and implementation of the guidelines should lead to earlier detection and treatment of men and women with chlamydial infection and thereby reduce the incidence of PID, tubal infertility and ectopic pregnancy in women.

A survey of contact tracing practice for sexually transmitted diseases in GUM clinics in England and Wales

We set out to determine current policy and practice in relation to contact tracing (partner notification) for sexually transmitted diseases (STDs) within genitourinary medicine (GUM) clinics in England and Wales. A confidential postal questionnaire survey of all GUM clinics in England and Wales was undertaken. Completed questionnaires were returned by 105 GUM clinics (a response rate of 65%). All respondents undertook routine contact tracing for gonorrhoea and chlamydia. The most popular method of contact tracing used was patient referral. The majority of contact tracing was undertaken by health advisers. Information on the time period over which contact tracing was undertaken showed wide variation. Audit data on the effectiveness of contact tracing in terms of the proportion of sexual contacts seen were available from only a minority of GUM clinics (33/79, 42%). Only chlamydia (24/79, 30%) and gonorrhoea (22/79, 28%) were the subject of any appreciable audit activity. There is wide variation in contact tracing policy and practice in GUM clinics in England and Wales. Audit of contact tracing effectiveness appears to be a minority activity. Further research is needed before an evidence-based approach to contact tracing can be implemented.

Hospital readmission after cardiac surgery. Does "fast track" cardiac surgery result in cost saving or cost shifting?

BACKGROUND

Intense medical and economic pressures have created "fast track" cardiac surgery in which clinical services are streamlined and early discharge is encouraged. Does this strategy promote significant cost saving or merely cost shifting? In a global system of reimbursement, the economic benefit of decreasing patient length of stay may be offset by high rates of patient readmission. This study was undertaken to determine the 30-day readmission rate after cardiac surgery and to analyze trends of readmission diagnoses.

METHODS AND RESULTS

From October 1, 1996 to July 31, 1997, 460 consecutive cardiac surgical operations were performed at 1 institution. There were 25 deaths and 8 patients who remained as inpatients at the 30-day postoperative deadline for readmission. Two patients had 2 operations. Therefore, 527 operations were performed on 525 patients. There were 110 readmissions after 527 operations for a readmission rate of 20.9%. A significant number of readmissions (49%) were to outside hospitals. Readmission diagnoses were: atrial fibrillation (23%); angina, congestive heart failure, or ventricular tachycardia (20%); leg wound (15%); sternal wound (5%); pneumonia (5%); gastrointestinal complaints (5%); neurologic event (2%); and miscellaneous (25%). Patients discharged > or = 7 days postoperatively were twice as likely to be readmitted as those discharged on postoperative days 4, 5, or 6.

CONCLUSIONS

Readmission after cardiac surgery is common and frequently (49%) to outside institutions. Patients discharged > or = 7 days postoperatively represent the patients at greatest risk of readmission and, therefore, warrant closer scrutiny before discharge.

A model for the development of evidence-based clinical guidelines at local level--the Leicestershire Genital Chlamydia Guidelines Project

Clinical guidelines can be effective in achieving health gain when they are validly developed, disseminated and implemented appropriately. There is, however, a potential conflict between the need for validity through use of expert resources available at a national level, and implementation, which is undertaken at local level and depends on the local relevance of the guideline. This paper presents a model by which valid guidelines for the management of a given disease (genital chlamydial infection) by general practitioners can be developed at local level using the resources available to a district health authority department of public health. The model has three elements. First, a district-wide postal questionnaire survey was used to document current clinical practice. Secondly, a critical review of the evidence relating to the management of genital chlamydial infection as it relates to British general practice was performed. Thirdly, the information gained from the critical review and survey was used by a multidisciplinary group to develop evidence-based guideline recommendations. It is argued that the Leicestershire Genital Chlamydia Guidelines compare favourably with other recently published national guidelines in terms of their development and content. Local guideline development of guidelines for selected topics can be practical and appropriate.

GP's management of genital Chlamydia: a survey of reported practice

BACKGROUND

Genital chlamydial infection is the commonest curable sexually transmitted disease in the industrialized world. Little is known about how GPs manage this condition.

OBJECTIVES

We aimed to determine current knowledge concerning genital chlamydia among GPs and to establish how patients with this infection are managed in primary care.

METHODS

A confidential self-administered postal questionnaire survey was sent to all 494 GPs in one English health district (Leicestershire).

RESULTS

Completed questionnaires were returned by 290 GPs (a response rate of 59%). A much higher proportion of GPs had tested and/or treated female patients for chlamydia [70%, 95% confidence interval (CI) 64-75%] as opposed to male patients (20%, CI 15-25%). Female patients (70%, CI 64-75%) were also more likely to be managed in general practice than male patients (56%, CI 50-62%). A majority of GPs (66%, CI 60-72%) routinely used an appropriate method of testing for chlamydia although a high vaginal swab, an inappropriate method of testing, was used by a fifth of GPs (19%, CI 15-24%). A large number of different treatment regimes were used by GPs. The majority of GPs (85%, CI 79-89%) prescribed an appropriate antibiotic although few GPs (19%, CI 14-25%) specified a chlamydia treatment regime in accordance with accepted international guidelines with respect to drug, dosage and duration of therapy.

CONCLUSIONS

Female patients with known or suspected genital chlamydial infection are commonly managed in UK general practice. There is scope to improve the management of this infection in general practice.

Screening for Chlamydia in general practice: a literature review and summary of the evidence

Genital Chlamydia trachomatis infection is the commonest curable sexually transmitted disease (STD) in England and Wales and is one of the chief causes of pelvic inflammatory disease (PID) in women. Infection in women is complicated by the fact that the majority of women with this infection are asymptomatic. It is feasible for general practitioners (GPs) to test for this infection, and there has been debate as to which is the most appropriate screening strategy. In the absence of any national UK guidelines, the purpose of this systematic literature review is to appraise critically and summarize the evidence for screening for genital chlamydia infection in sexually active women attending UK general practice. The four areas to be reviewed are: prevalence of genital chlamydia infection in women attending UK general practice; evidence for routine screening of women attending general practice; evidence for selective screening of women attending general practice; evidence for screening women requesting termination of pregnancy (TOP) or intrauterine device (IUD) insertion. This review should allow GPs and public health practitioners to become aware of the quality of evidence underlying various screening strategies and inform any local guideline development.