Involving consumers in healthcare decisions is important for high quality care. We previously tested a brief, consumer-led intervention consisting of three questions in a trial employing trained, standardized patients. The intervention enhanced discussion of evidence and increased patient involvement. We now report a research translation study which tested implementation with real patients at a reproductive and sexual health clinic.
We worked with clinic staff to build a website with video clips demonstrating the questions in action, and produced supporting materials (pamphlet, consultation summary sheet, fridge magnet). Before their consultation, patients were invited to view a 4-minute video-clip on a supplied tablet and given the other materials and access to the website (www.askshareknow.com.au). They completed questionnaires at baseline (T1), immediately post-consultation (T2) and two weeks later (T3). 195 patients agreed to participate and provided baseline data. 155 watched the video clip; 121 and 95 completed post-consultation questions at T2 and T3 respectively. 84/121 (69%) asked at least one of the questions in their consultation, and 29% asked all three questions.
Question asking was strongly associated with decision making. Among those who made a treatment decision, 87% asked at least one question and 43% asked all three questions, compared with 50% and 14% respectively of those who did not make a decision (P<0.0001). 84% of those who made a decision rated the questions as very (53%) or somewhat helpful (31%) for decision making. 95% of all patients reported they would definitely (72%) or probably (22%) recommend the questions to others. Two weeks later 82% could recall Question 1, 47% could recall all three questions, and 83% reported they would ask the questions again. Implementation of this brief, effective and cheap intervention was feasible within routine clinical practice, and supports evidence-based, patient-centred care.
The case is of a 30 year-old HIV positive Zimbabwean woman (UK resident) who arrived in Australia in January 2011 on a one-year working visa. She was diagnosed with HIV in 2003 in the UK and commenced on Atripla® in 2005. She was first seen in Adelaide in May 2011, requesting a script for Atripla.®.
Background: Liquid based anal Papanicolaou smears, followed by High Resolution Anoscopy (HRA) guided biopsies are increasingly being advocated to identify areas of High Grade Anal Intraepithelial Neoplasia (HGAIN). We hypothesized that the ability to identify HGAIN would increase with experience of the anoscopist, and that comparison with contemporary Papanicolaou smears might yield insights into technical abilities.
Indigenous Australians experience a greater burden of sexually transmitted infections, however are less likely than the general population to access sexual health services. We examined the effectiveness of an Indigenous cultural appropriateness audit in assessing a sexual health clinic with low rates of Indigenous clients.
Despite the high proportion of young people annually accessing general practices, including Aboriginal Medical Services (AMS), testing for Chlamydia trachomatis remains relatively low in urban areas. A project officer was employed within the Institute of Urban Indigenous Health (IUIH) to serve a mentoring and facilitation role for the SE Queensland network of AMS and their sexual health workers, with a view to improving testing, management and follow-up of chlamydia and other STIs by community controlled medical services.
Monocytes are a heterogeneous cell population having specialised functions and differing phenotype. They are a link between innate immune system and adaptive immune system therefore, to identify if immune activation exists in HIV-1 individuals with controlled virema and recovered CD4 T cell counts, we assessed cell surface monocyte activation markers (MAM) within the monocyte subsets.
Case presentation: A 27 year-old Vietnamese man was diagnosed with HIV in April 2012 when he presented with cerebrospinal fluid (CSF)-culture positive Cryptococcus neoformans meningitis. CD4 count was 4 cells/µL and HIV viral load 228827 copies/mL. He was treated with two weeks of amphotericin B (0.7mg/kg/day) and 5-fluorocytosine (25mg/kg/QID), followed by consolidation and secondary prophylaxis with fluconazole. CSF cultures were negative at two weeks. A ventriculo-peritoneal shunt was inserted to manage persistently raised intracranial pressure and had to be replaced two weeks later due to bacterial shunt infection. Antiretroviral therapy (ART) was commenced after four weeks of treatment, and by September 2012, CD4 count was 107 cells/L and viral load 150 copies/mL.