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Biomedical subjects

S Madge

Publications and source records attributed to S Madge.

At least 37 records · Page 2Linked to original sources
PubMed1999

Changing treatment patterns among patients with HIV: Royal Free Hospital 1987-97.

OBJECTIVE: Following the publication of results of large-scale clinical trials, antiretroviral treatment for HIV has changed dramatically. The aim of this study was to describe changes in antiretroviral treatment and the way treatments were combined among 1806 patients with HIV seen at a single centre at the Royal Free Hospital, London, UK. DESIGN AND METHOD: Each calendar year was divided into quarters, and the number of patients receiving treatment and participating in clinical trials was determined. RESULTS: The proportion of patients on no therapy decreased from over 90% at the beginning of 1988 to under 15% at the end of 1997. Monotherapy was the only form of treatment available before 1992 but its use dropped to 2% by the end of 1997. The standard of care at the end of 1997 was triple combination therapy, used in over 40% of patients. There were dramatic changes in the use of individual agents; use of zidovudine decreased from 50% during 1989 to 25% during 1997, while use of lamivudine and stavudine saw an exponential rise in 1997. The protease inhibitors were used in equal proportions in this clinic population; the use of dual protease therapy began in 1997 and was rising rapidly by the end of the year. CONCLUSIONS: There have been major changes in the use of antiretroviral therapy at this centre, particularly during 1996 and 1997. The long-term cost implications and side-effects of intensive treatment regimens remain to be addressed.

Adult↗
PubMed1999

Do people attending a same day testing clinic discuss their need for a HIV test with their GP?

In the United Kingdom, people with HIV infection present with advanced disease and general practitioners (GPs) are currently an underused resource for HIV testing. We describe the reasons for using an open-access clinic rather than primary care for testing for HIV. People attending the clinic were asked to complete a questionnaire asking about GP registration, access, and whether HIV testing was discussed in primary care. Despite access to GPs, HIV testing in primary care was rarely discussed. If HIV testing is to move to a general practice setting, GPs could address the issues, such as the recording of sensitive information in notes, future life insurance, and confidentiality, which this report identifies as the main barriers for using primary care.

Family Practice↗
PubMed1998

Demographic, clinical and social factors associated with human immunodeficiency virus infection and other sexually transmitted diseases in a cohort of women from the United Kingdom and Ireland. MRC Collaborative Study of women with HIV.

BACKGROUND: Clinical experience suggests many women with HIV infection have experienced no other sexually transmitted diseases (STD). Our objective was to test the hypothesis that a substantial proportion of women with HIV infection in the United Kingdom and Ireland have experienced no other diagnosed STD and to describe the demographic, clinical and social factors associated with the occurrence of other STD in a cohort of HIV infected women. METHOD: Analysis of cross-sectional baseline data from a prospective study of 505 women with diagnosed HIV infection. The setting was 15 HIV treatment centres in the United Kingdom and Ireland. The main outcome measures were occurrence of other STD diagnosed for the first time before and after HIV diagnosis. Data were obtained from interview with women and clinic notes. We particularly focused on occurrence of gonorrhoea, chlamydia and trichomoniasis after HIV diagnosis, as these are the STD most likely to reflect recent unprotected sexual intercourse. RESULTS: The women were mainly infected via heterosexual sex (n = 304), and injection drug use (n = 174). 151 were black Africans. A total of 250 (49.5%) women reported never having been diagnosed with an STD apart from HIV, 255 (50.5%) women had ever experienced an STD besides HIV, including 109 (21.6%) who had their first other STD diagnosed after HIV. Twenty-five (5%) women reported having had chlamydia, gonorrhoea or trichomoniasis diagnosed for the first time after HIV diagnosis, possibly reflecting unprotected sexual intercourse since HIV diagnosis. In all 301 (60%) women reported having had sex with a man in the 6 months prior to entry to the study. Of these, 168 (58%) reported using condoms 'always', 66(23%) 'sometimes' and 56 (19%) 'never'. CONCLUSIONS: Half the women in this study reported having never experienced any other diagnosed STD besides HIV. However, after HIV diagnosis most women remain sexually active and at least 5% had an STD diagnosed which reflect unprotected sexual intercourse.

Adolescent↗
PubMed1998

Research bronchoscopies do not adversely affect HIV-infected individuals' future health-care decisions.

STUDY OBJECTIVES: Asymptomatic HIV-infected individuals are increasingly recruited for studies involving invasive procedures such as bronchoscopy. We sought to determine the response to and outcome of a request for a research bronchoscopy in HIV-positive individuals with no respiratory disease, and whether this would adversely affect future decisions to have a medically indicated bronchoscopy. DESIGN AND SETTING: Prospective, semistructured, questionnaire-based study in a London teaching hospital HIV outpatient clinic. PARTICIPANTS: One hundred and seven consecutive HIV-infected eligible individuals. Thirty-one healthy volunteers served as a control group for the subjective response to bronchoscopy. MAIN OUTCOME MEASURES: Subjects' attitudes and responses to requests for bronchoscopy and subsequent behavior when they required medically indicated bronchoscopy. RESULTS: Seventy-five patients (70%) agreed to the procedure in principle, predominantly for altruistic reasons. Thirty-nine subjects underwent bronchoscopy. Five percent found it worse than expected; and 79% agreed to another research bronchoscopy (performed in 11 subjects approximately 2 years later). All patients said they would undergo bronchoscopy again for diagnostic purposes (required in seven during the study). When compared to a healthy volunteer population within the same study, postbronchoscopy symptoms were similar in frequency although somewhat different in nature. Subjects felt that a clear explanation of what was involved enhanced their participation in this research. CONCLUSIONS: Invasive research procedures such as bronchoscopy can be performed and are repeatable in a healthy HIV-infected population. Performance of procedures for research purposes does not appear to adversely affect future health-care decisions.

Adolescent↗
PubMed1998

HIV.

Explore the source record for details and available documents.

Family Practice↗
PubMed1998

Do women with HIV infection consult with their GPs?

In a cohort of 106 HIV-positive women, 86 (81%) were registered with a general practitioner (GP) and 71 (83%) had a GP who was aware of their HIV status. GPs were primarily consulted for perceived non-HIV-related problems and prescriptions. This is encouraging. However, primary and secondary care services should aim to increase the proportions of HIV-positive individuals with access to primary care.

Adult↗
PubMed1997

Access to medical care one year prior to diagnosis in 100 HIV-positive women.

BACKGROUND: Anonymous antenatal testing for HIV antibodies suggests that the majority of HIV-positive women in the UK remain undiagnosed. Primary care reaches the majority of the population and women present more often than men. Sexual health matters are frequently raised, so there is an opportunity to discuss concerns with respect to HIV. Women often present with advanced HIV disease and with antiviral treatments proving to be more effective, there is now an even greater incentive to diagnose HIV early. OBJECTIVE: We aimed to look at access to medical care 1 year prior to HIV diagnosis in 100 HIV-positive women and to establish whether a discussion regarding HIV was recalled. METHOD: The setting was an established clinic for HIV-positive women in the Royal Free Hospital, London. In a 6-month period a questionnaire was completed by 100 women with their clinic doctor. RESULTS: Women were young (mean age 31). Most (84%) were infected by heterosexual sex. Forty-six per cent of the women presented with symptomatic HIV or AIDS and 50% were black Africans, hence there is a large ethnic bias in this sample. General practice was accessed by 65% of the women 1 year prior to HIV diagnosis. Few (14%) women recalled a discussion concerning HIV. Secondary care settings such as gynaecology and general outpatients were also frequently attended, but again HIV was apparently rarely discussed. There was no significant difference when variables such as time since diagnosis, health care setting, or ethnic group were concerned with respect to recall of a discussion concerning HIV. CONCLUSIONS: Despite coming from 'high risk' groups or presenting with symptomatic disease in the year prior to HIV diagnosis, few women recalled discussing HIV in either primary or secondary care settings. As these sites were commonly accessed, we feel that doctors and other health care workers should be encouraged and trained to raise HIV more routinely in their consultations.

Adult↗
PubMed1996

Infertility among human immunodeficiency virus-positive women: incidence and treatment dilemmas.

The increasing demand for fertility advice among human immunodeficiency virus (HIV)-positive women under our care led us to review the incidence of infertility and the ethical problems associated with its management. All HIV-positive women who attended the HIV outpatients clinic from October 1990 to the end of January 1996 were studied. The main outcome measures were: the number of women undergoing infertility investigations before and after HIV diagnosis, their demographic and social details, and the outcome of these investigations. Most of the 183 women studied were in their reproductive years (mean age 32.7 +/- 6.7 years). Nine women had undergone infertility investigations, and/or treatment before HIV diagnosis, three of whom were diagnosed with HIV during routine testing prior to IVF treatment. Six declined further infertility treatment after discovering their HIV status. Eight women have undergone infertility investigations after HIV diagnosis but none have achieved pregnancy to date. Management decisions may have been hampered by ethical uncertainties in several cases. In conclusion therefore, as requests for infertility treatment from HIV-infected women occur and may become more common as the prevalence of HIV infection in women continues to rise, the ethical issues associated with the management of this problem demand urgent attention so that clear guidelines are available to aid treatment decisions.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Screening for sexually transmitted diseases in an HIV testing clinic; uptake and prevalence.

OBJECTIVE: To estimate the prevalence of sexually transmitted diseases (STDs) and the acceptability of STD screening among people seeking an HIV antibody test in an established free standing HIV testing clinic. DESIGN: A 9 month period prevalence study conducted between August 1993 and April 1994. SETTING: The Same Day Testing Clinic (SDTC) for HIV antibodies at the Royal Free Hampstead NHS Trust Hospital, London. SUBJECTS: 242 males and 160 females attending the Same Day Testing Clinic. OUTCOME MEASURES: The prevalence of STDs including gonorrhoea, chlamydia, syphilis and hepatitis B and the percentage of clinic attenders accepting an STD screen. RESULTS: Of those invited to take part in the study 69% of the males (242/350) and 59% (160/269) of the females agreed to be screened although for a variety of reasons not everyone agreed to a full screen. Two cases of untreated syphilis, no cases of gonorrhoea and six cases of chlamydia were detected. Four people had active, previously undiagnosed herpes while three had genital warts. Evidence of previously unknown hepatitis B infection was found in 26 people. Despite a high level of previous contact with genitourinary medicine services, uptake of hepatitis B vaccination among those homosexual men eligible for immunisation was low (28%; 23/83). Nine (4%) of the males, but none of the females screened for STD were found to be HIV antibody positive. CONCLUSION: Among people seeking an HIV antibody test in an established free standing HIV testing clinic, the prevalence of acute STDs was low. However, evidence of previously undiagnosed hepatitis B infection was found in a number of subjects and uptake of vaccination among those most at risk had been low. While opportunistic screening for STD was acceptable to almost two thirds of HIV testing clinic attenders, a substantial minority nonetheless declined this offer. Selective STD screening could be offered to those people seeking an HIV test who report never having been screened before, as both cases of positive syphilis serology and all those of chlamydia were in people who had not previously been screened. All those at risk for hepatitis B infection should be encouraged to establish their infection status and be immunised where appropriate.

Ambulatory Care↗
PubMed1995

Testing carrier status in siblings of patients with cystic fibrosis.

Altogether 114 parents of patients attending a cystic fibrosis clinic and 27 regional genetics units were surveyed for their views on whether healthy siblings should be tested for carrier status during childhood. Most parents wanted to know their child's carrier status and felt it was their right; almost all would tell the children if they were carriers. However, 37% of the units never tested siblings and 40% said the parents had no right to this knowledge. Furthermore, 60% would withhold the information from parents.

Adolescent↗
PubMed1993

High dose Nutrizym 22 in cystic fibrosis.

New high dose pancreatic enzyme preparations could be potentially helpful to cystic fibrosis (CF) patients. The purpose of this study was to compare the efficacy of the new high dose pancreatic enzyme preparation, Nutrizym 22 with the standard preparation Nutrizym GR. Twenty-five CF children (aged 7-16 years) entered the study and 22 completed it; 3 did not, due to non-compliance. All were taking Nutrizym GR for at least 2 weeks before entering the study. A randomised double blind, crossover method using standard Nutrizym GR or double strength Nutrizym 22 capsules was carried out over two consecutive 14-day periods. Crossover analyses of variance showed no statistically significant differences in actual weight gain, appetite, abdominal pain, stool consistency or faecal fat during the prestudy and study periods. It is concluded that half the capsule numbers of the high strength preparation are just as effective as the standard capsule dosage.

Adolescent↗