Martin Talbot

A prospective, randomized, double-blind trial to evaluate the role of a short reducing course of oral corticosteroid therapy in the treatment of chronic prostatitis/chronic pelvic pain syndrome.

To assess the validity of our observational experience that a short course of oral prednisolone therapy might be of value in the management of symptoms of chronic pelvic pain syndrome (CPPS) in men.

Short course oral prednisolone therapy in chronic abacterial prostatitis and prostatodynia: case reports of three responders and one non-responder

Objective: To report on a small group of patients with chronic abacterial prostatitis/chronic pelvic pain syndrome treated with oral corticosteroids in order to suggest a hypothesis for a future randomised controlled trial. Design: A retrospective, observational report. Results: Three out of the four patients reported improvement in symptoms following steroid treatment. Conclusions: These reports suggest that there is scope for conducting a randomised, placebo controlled study to investigate the role of oral corticosteroids in patients with chronic abacterial prostatitis/chronic pelvic pain syndrome who have failed on conventional therapy.

Microbiological Flora in Men with Non-Gonococcal Urethritis with Particular Reference to Anaerobic Bacteria

In a microbiological study of the urethral flora in men with non-gonococcal urethritis (NGU), Chlamydia trachomatis (isolated from 30% of men) was the only organism isolated significantly more often from men with NGU than controls (P<0.01). Bacteroids species, especially of the melaninogenicus-oralis group, were the predominant anaerobic bacterial isolate from both men with NGU (isolated from 24%) and controls (isolated from 30%). There was no evidence that aerobic bacteria, anaerobic bacteria or herpes simplex virus made a significant contribution as primary pathogens in non-chlamydial NGU. Gram-positive cocci were the only anaerobic organism isolated more often from chlamydia-positive men (29%) than chlamydia-negative men (16%) with NGU (P<0.01). The significance of this remains unclear.

The characterisation of a recent syphilis outbreak in Sheffield, UK and an evaluation of contact tracing as a method of control.

Objective: To explore the factors around and the success of contact-tracing in a recent major outbreak of infectious syphilis in Sheffield, and to evaluate the effectiveness of it, our hitherto standard strategy of control. Method: Retrospective chart review Results: Over a period of 18 months, an outbreak of 21 cases was, on closer inspection, the result of several, discrete “micro” outbreaks in different groups. Two major patterns emerged, a relatively straightforward and more accessible cluster in heterosexual persons (a “spread” network), and more sporadic, “starburst” networks in men who have sex with men. Conclusion: Our traditional method of control, contact-tracing, was seen to be most effective in the spread network in heterosexuals. In the face of an apparent outbreak, clinicians should explore the nature and parameters of their local epidemic and engage a mixture of control methods. These may include, but not excusively so, contact-tracing to interrupt transmission by case-finding and by treatment.

Progressive symptoms and signs following institution of highly active antiretroviral therapy and subsequent antituberculosis therapy: immune reconstitution syndrome or infection?

A 36 year old man presented with weight loss, cough, fever, and exertional dyspnoea shortly after a diagnosis of HIV infection. Symptoms and initial radiological abnormalities worsened after highly active antiretroviral therapy was started. An eventual diagnosis was established but multiple problems occurred throughout the treatment period. Differentiation between immune reconstitution inflammatory syndrome and an infective cause was problematic.

Variability of the Symptoms of Chronic Abacterial Prostatitis/Chronic Pelvic Pain Syndrome during Intermittent Therapy with Rectal Prednisolone Foam for Ulcerative Colitis

We describe the response of symptoms of chronic abacterial prostatitis/chronic pelvic pain syndrome (CAP/PPS) in a man treated with rectal prednisolone for concomitant ulcerative colitis. The temporal relationship of the symptoms of CAP/PPS to starting and stopping the topical corticosteroid over 2 treatment cycles lends further anecdotal support to our hypothesis that treatment of the immune-mediated response in this chronic condition has a beneficial effect upon symptomatic outcome.

Evaluation, using two assessment instruments, of the American and British national guidelines for the management of sexually transmissible and genital infections

BACKGROUND The objective of the present study was to compare, utilising two guideline assessment instruments, six corresponding clinical practice guidelines of the British Association for Sexual Health and HIV and the Centres for Disease Control. METHODS Three raters independently assessed the recently published guidelines for gonorrhoea, chlamydial infection, early syphilis, pelvic inflammatory disease, bacterial vaginosis and HIV testing using two instruments, the Cluzeau and the AGREE (Appraisal of Guidelines for Research and Evaluation instrument). The Cluzeau scores were a simple percentage comparison; the AGREE scores were a standardised score for each guideline development domain. Differences were assessed using the Wilcoxson signed ranks test. Inter-rater variability was calculated on the Cluzeau instrument utilising the intragroup correlation method. RESULTS The British Association for Sexual Health and HIV guidelines scored higher than the Centres for Disease Control guidelines in many of the assessed domains. There were significant differences between the two in many of the scores (P = 0.026-0.028). Inter-rater concordance was high to very high at 0.70-0.83. CONCLUSIONS There were often major differences in scores between the two guideline groups. It is necessary for wider discussion within the profession to consider the significance of these findings.

The elephant in the room: Modernising Medical Careers – an educational critique

1. Modernising Medical Careers (MMC) training in the UK has been introduced with haste. The pilot schemes were concerned merely with feasibility.

Experience in Sheffield: Follow-Up of Abnormal Cervical Cytology

Failure to re-attend for follow-up is a significant problem in patients attending genitourinary clinics. In this study, despite the efforts made to trace patients with cervical cytological abnormalities, adequate follow-up or further investigation was achieved in only 15.3% of women with inflammatory changes on initial cytology, 38.5% with herpes simplex virus changes, 34.5% with human papillomavirus changes, 60.8% with mild dyskaryosis, 79.9% with moderate dyskaryosis and 97% with severe dyskaryosis. Until the natural history of the minimal atypias is more fully understood, it may be that more vigorous surveillance in such women should be considered.

Ethics committee review of medical audit: a personal view from the United Kingdom

Until now, medical practice in the United Kingdom has, unlike in medical research, largely resisted ethics committee scrutiny of clinical audit. I support this position. On what grounds do I do so? Are there sufficient differences between medical research and medical audit to reliably sustain this thesis? I shall argue that research ethics committees may be operating under philosophical constraints which, in the main, go unrecognised; they therefore have no, as it were, prima facie rights and their potential involvement in medical audit raises serious questions, not least because audit is a creature of an entirely different nature from research. For me, the situation is straightforward but others, of course, are welcome to refute my assertions. Sex Transm Inf2001;77:69–72 [OpenUrl][1][FREE Full Text][2] It is said that research is finding out how one should be doing something, and audit whether one is actually doing it, or, as Rawlins says, “Research discovers the right thing to do: audit ensures that it is done right.”1 He explains the view of the British Medical Associations clinical audit committee and calls for a scrutiny of proposed audit projects by audit ethics committees, rather than ethics research committees. But he rather begs the question of the validity of this position by suggesting that, otherwise, ethics research committees would be overburdened by work. Taking the contrary view, the Royal College of Physicians clearly states that medical audit (among other activities such as epidemiological surveillance and morbidity and mortality reviews) is medical practice and, as such, does not require ethical review.2 Kinn disagrees with most definitions of medical audit, believing that the purpose of audit is to “raise general clinical standards” (and thus, I interpret her to say, has more in common with research) yet refers only to specific instances where audit must be based on sound ethical principles.3 I suggest … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DTalbot%26rft.auinit1%253DD%26rft.volume%253D315%26rft.issue%253D7120%26rft.spage%253D1464%26rft.epage%253D1464%26rft.atitle%253DLocal%2Bresearch%2Bethics%2Bcommittees%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.315.7120.1464%26rft_id%253Dinfo%253Apmid%252F9418110%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=FULL&journalCode=bmj&resid=315/7120/1464&atom=%2Fsextrans%2F77%2F1%2F69.atom