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Clinical practice

Constructing Information Requests: Making The New Normal

1 Jan, 16 | by shaworth

When we collect information from our patients, we ask, often unthinkingly, for quite a lot of it. Some of it has obvious value to our consultations: how long has it been there, and where does it itch? Some of it has additional use in research, and in auditing our practice. Today, we’re going to take a look at how we ask for some of these basic demographics and what it says about our perception of society, and of our patients’ lives, when we do.

In the UK, we classify infants at birth by many characteristics, and sex is one of those. This is obvious to anyone who has tried to pick a gift, or a card, to congratulate new parents: we, as a society as a whole, treat sex as a dichotomy of male or female. This is referred to as the gender binary. If this were a fundamental truth, it makes collecting information regarding sex to be as simple as checking a box for either, and in turn, stored in a binary form digitally; however, the truth is more complex. Many countries allow for the legal recognition of a third gender, and this is a state welcomed by people who do not identify with either, or with aspects of both. This may due to an intersex condition diagnosed at birth, or a subjective lack of affiliation with either sex despite sexual organs and characteristics of one sex. One can argue that the reasons are academic, as it is the end state of requiring an option outside of the gender binary that matters.

For many people, the definition of the word “gender” is roughly interchangeable with “sex”, and both terms are taken to mean the reproductive organs existing within a person and associated secondary sexual characteristics; however, some people and organisations define gender as being the abstract social roles based on sex, and diverging the definition of “sex” to be the definition stated above, pertaining to sexual organs and characteristics. In this post, we’ll be using the latter.

One organisation which collects vast amounts of personal data: Facebook, has come into focus as it demonstrates how to handle information outside of the gender binary in an attempt to sensitively reflect the real life experiences of users; however, as a recent paper reviewing Facebook’s handling of this information shows, the way that Facebook deals with the information regarding sex is not new, but over time has been changed by user pressure. When Facebook began to collect user data on sex, it allowed options for male, female or other and subsequently used this information to provide gender based pronouns describing user activity. Over time, the use of “they” as a gender neutral pronoun created some translation difficulties and was derided as grammatically incorrect, so an attempt was made to force users to choose a pronoun on the basis of sex, and this overrode the original sex identity e.g. if you chose a female pronoun, your choice of “other” was changed to female.

Users self-organised to protest this, driving change by producing guides on amending the source code of the pages to allow reversion to the original “other” state, raising the question why this needed changed in the first place if the choice was not removed from the database itself. Over time, Facebook amended its policy and in 2014, allowed limited use of gender neutral pronouns and a greater range of non-binary identities; although the choice of a gender specific pronoun reverts the stored identity to a binary one.

The multiple options presented when signing up for Facebook with relation to sex is potentially confusing and, whilst presenting many options, remains restrictive if your choice is not offered, raising the question if there is a better way of working when requesting information. Web designer Sarah Dopp, who wrote an open letter to web designers and developers regarding this in 2010, and reminding us that the dangers of the gender binary, and the promotion of it as normal at the expense of all else, marginalises those who already feel marginalised, something that we, as healthcare professionals, should be striving to avoid.

So, the next time we sit down to ask a patient, or client, for their gender, we should take the time to reflect that whilst this may be a single question in a page of several, and perhaps just a tick in a box to us, that for them it may be a huge part of their identity that we are refusing to acknowledge through ignorance, and souring our relationship with them before we start.

For those of us who are doctors, we have benefited from the privilege of a free gender-neutral pronoun as a by-product of completion of a degree. If it’s important to us to use this title as an expression of professional identity, we could at least extend the courtesy to our patients to express, fundamentally, who they are.

Lost Boys: Universal HPV Vaccination

10 Dec, 15 | by shaworth

Last month, the government announced an extension of the national HPV vaccination campaign to include men who have sex with men who are aged less than forty. This was welcomed, as this group, particularly men who exclusively have sex with men, are excluded from the direct effects of the vaccination of women. Vaccination is offered when men come into contact with health services.

 

Around 20% of 16-20 year old men who have sex with men (MSM) are HPV positive, Whilst the age at which gay men identify as gay appears to be decreasing with increasing acceptance of non-hetrosexual identities, the targeted vaccination campaign towards MSM makes the presumption that all MSM wish to identify as such to their health provider, at an age at which they will still be seronegative. We have the opportunity to offer to vaccinate MSM where we find them, but this will not be a great deal of comfort to those who have already been exposed to HPV and already suffer from the disease burden, usually in the form of genital warts. Australian data after the introduction of the quadrivalent vaccine to women showed that significant declines could be achieved by vaccinating women and heterosexual men, but the rates in MSM remained static.

 

The estimated cost of rolling out vaccination to all children is estimated to be around £20 million pounds. Some good analysis of the cost of anal cancers, a disease that disproportionately affects MSM has has already been done, the cost effectiveness of the additional protection from vaccinating boys on HPV related disease has already been done. The JCVI will convene in two years to decide whether universal vaccination of children is cost-effective.

 

Cost effectiveness is the ultimate outcome measure for a healthcare system that is government funded, as we as taxpayers want to see the most value for our money, but in focusing the entire argument on the basis of cost, do we effectively say that the lives of MSM are not worth enough?

 

Review of Glow: A Reproductive Health App

25 Aug, 15 | by shaworth

Glow is a reproductive health app for Android and iOS, developed and released this year. It forms part of a triad of apps including Glow Nurture, which allows logging of pregnancy data, and Ruby (currently only available for iOS) which logs and advises on contraceptive use.

The purpose of Glow is to centralise fertility awareness measures for either optimisation of fertility, or for use as part of family planning through fertility awareness methods. Users can log their cycle length, body temperature and cervical mucus consistency to determine ovulation periods. After logging data, the app generates “insights” based on the data supplied i.e. short snippets of advice for improving fertility, or managing symptoms. In addition, Glow collects data on weight, stress levels, alcohol intake and exercise. Users are advised to enter a daily health log, and set reminders about user dependent contraceptive methods and pre-natal supplementation.

For all the data entry that is required, Glow is remarkably streamlined. It took very little time to enter a daily log, largely because the user interface to do so is excellent. Once the data is logged, the app returns to its home screen where the day of the cycle is demonstrated, alternating with the risk of conception (unless you’re using LARC, where it does not show this and is a nice touch). From here, it’s possible to navigate to all other areas of the app.

Glow’s user interface is exceptionally well designed, and using it feels intuitive. There are no flashy trimmings: the interface is streamlined, which is is probably why it comes in at around 24MB on your device. It can also synch with some fitness accounts with other providers.

Glow is free to download and use, and during my short time using it, I did not notice the presence of intrusive ads; although Glow’s ToCs do stipulate that advertised content is provided. Glow’s privacy statement says that personally identifiably data is not shared with third parties; although aggregate data is, which might explain where some of the profit comes from.

The main drawback to using Glow is that it is US-centric, and as such, its advice is based on US healthcare advice and guidelines. This said, the app can be used by people in other countries without feeling disconnected from the user’s personal experience.

Overall verdict: a powerful tool which can give women the tools to optimise fertility without taking up valuable baby-making time.

Sue Capstick – Queens Nurse.

26 Mar, 15 | by shellraine, e-Media Editor

One of the first sexual health nurses in the country to be given the prestigious title of Queen’s Nurse (QN) by community nursing charity The Queen’s Nursing Institute (QNI) hails from Lancaster.

Sue C

As reported in the Lancaster Guardian, Sue Capstick is service manager for Lancashire Care NHS Foundation Trust’s Contraception and Sexual Health (CaSH) Service. Sue said:

“It was an honour to find out I had been awarded the title of a Queen’s Nurse. “The CaSH service is committed to providing excellent care to the people in Lancashire.“The team work together to continually develop new and innovative ways to ensure people receive the highest quality of care. I am proud to be part of such a dedicated and compassionate team and look forward to continuing to improve the sexual health for people in the future.”

A Queen’s Nurse is someone who is committed to high standards of practice and patient-centred care and Sue’s career demonstrates her dedication to the field of sexual health nursing.

She began her nursing career in 1980 and has worked as a sexual health nurse for over 30 years. In that time she has worked in Africa developing sexual health and HIV programmes as well as being a member of a sexual health nursing advisory panel at the Department of Health, developing the competencies required to work in this specialty.

For the past few years Sue has been leading a piece of work in Blackburn which is focused on providing information to women about the various contraception methods available to make informed choices and as a result avoid unwanted pregnancies. The title is not an award for past service, but indicates a commitment to high standards of patient care, learning and leadership.

Nurses who hold the title benefit from developmental workshops, bursaries, networking opportunities, and a shared professional identity.

Sue is the third member of staff at the Trust to be awarded the title . A ceremony will be held later this year in London for the Queen’s Nurses to be presented with their awards.

Many, many congratulations for a well-deserved award.

Review: The Menopause Exchange

9 Jun, 14 | by shaworth

The Menopause Exchange is an independent organisation founded by Norma Goldman, a pharmacist with a special interest in health promotion, to provide impartial information for patients and health professionals about the menopause. Information is circulated largely through the quarterly newsletters, which are free and through the Menopause Exchange blog. They are also present on Twitter and Facebook. Unlike some other magazines aimed at patients, they are not supported by advertising, and take no funding from sponsors; although there are no conflict of interest decelerations from the writers.

I read the Spring 2014 issue of Menopause Exchange which covers a diverse range of issues from irregular peri and post menopausal bleeding to the NHS screening programs available for women who are going through the menopause. There is also an “ask the experts” section where questions can be posed to those writing for the newsletter which explore fairly diverse subjects such as the length of time HRT can be used, to complementary and alternative therapies.Although Menopause Exchange states that it is for both patients and health professionals, the articles seem to be mainly aimed at the former rather than the latter. This is no bad thing, as patient support and resources are valuable to those experiencing menopause. The articles communicate the concepts they explore well, without jargon.

Whilst the information produced is good quality, the format of the newsletter could be improved. Digital media has leveled the playing field for communicating information, and high quality printers to produce slick and effective print media are available for home use, but Menopause Exchange isn’t taking maximum advantage of this and I felt that the look of the newsletter was dated. Back issues of the newsletter are available by post, paid by cheque (there is an option to pay digitally, but this doesn’t seem like the first choice), which seems absurd in 2014; although perhaps demand has produced this need.

Overall, I’d say that Menopause Exchange has a lot to offer your patients, and mine. If it took full advantage of technological advances, it would find itself a unique and valuable resource.

FSRH Welcomes Nurses at a one day conference

24 May, 14 | by shellraine, e-Media Editor

 

The FSRH is delighted that from January 2014 nurses are Eligible to become members of the FSRH and to undertake training for the Nurse Diploma in Sexual and Reproductive Health Care (NDFSRH), the Letters of Competence in both intrauterine devices and subdermal implants and the postgraduate qualification in medical education. The organising committee has planned this ‘one off’ meeting to update delegates on FSRH qualifications and to provide a general update on contraception, together with a motivational speaker on communication skills. This event is aimed at all nurses working in sexual and reproductive health in any setting, service managers and lecture practitioners.

Venue

Royal College of Obstetricians and Gynaecologists

27 Sussex Place, London, NW1 4RG

 Course Fee £130.

For Nurse Diplomate & Associate members £120

Please make cheques payable to FSRH and send to

Faculty of Sexual and Reproductive Healthcare, 27 Sussex Place, London, NW1 4RG

Full programme

 

 

 

Historic News for Nurse Training in SRH

26 Nov, 13 | by shellraine, e-Media Editor

Members of the Faculty of Sexual & Reproductive Healthcare (FSRH) have voted overwhelmingly to widen membership to include nurses, paving the way for the development of a new nationally recognised qualification for nurses working in sexual health. This happened last Thursday at an extraordinary general meeting before the Current Choices Conference in London, after which Dr Chris Wilkinson made a formal announcement it in his President’s opening address to the conference. This brought forth spontaneous applause and positive comments from Minister for Public Health, Jane Ellison MP, who said:

“This announcement is a groundbreaking moment for multi-disciplinary working in the health service. I am delighted to see the Faculty of Sexual and Reproductive Healthcare leading the way in opening up their membership to nurses, ensuring that doctors and nurses work together to set standards and improve patient care. I hope this will act as an example for all services.”

and Director of Nursing for Public Health England, Professor Viv Bennett, who added:

“Effective accessible sexual health services need highly skilled teams. It is fantastic that the Faculty is valuing the key roles of nurses in the multi-disciplinary team, providing the opportunity for nurses in sexual health to gain a nationally recognised qualification and through membership to the Faculty ensuring nurses play a national strategic role in developing sexual health services as well as providing high quality services to people locally”

The FSRH becomes one of the very few medical Colleges and Faculties to include nurses within its membership, reflecting the key role that nurses play in the delivery of sexual health care, and the organisation’s desire to promote and develop multi-disciplinary working in sexual health.

What this means in practice is that from January 2014 nurses will be able to become full members of the FSRH by following the same route as doctors and completing the Nurse Diploma. Within the new training structure (for doctors and nurses) there will be a new online knowledge assessment (eKA) which will test the theoretical knowledge gained from the e-SRH or elsewhere. Those who wish to go on to complete a diploma will (after passing the eKA) complete the Course of 5 workshops followed by the ACPs (assessments of clinical practice) as doctors currently do. All of these will be logged via an online e-portfolio. An additional change is that doctors and nurses will, in future, be able to undertake the LoCs (Letters of Competence) for either SDIs or IUTs without first having to complete the diploma – they will, however, have to pass the eKA first.

Further information will be posted on the FSRH website nearer the time of launch.

NICE PGDs – Template & Baseline assessment tool

1 Oct, 13 | by shellraine, e-Media Editor

Two implementation tools have now been published to support the patient group directions NICE good practice guidance. These are available from the NICE website at the links below:

GPG 2 Patient group directions: baseline assessment tool

GPG 2 Patient group directions: template

Azithromycin, PGDs and Peanuts.

30 Sep, 13 | by shellraine, e-Media Editor

peanut

Did you know that peanuts are not nuts but are part of the soya family?

Some formulations of azithromycin contain soya as an excipient.

Some services that have drugs supplied by local pharmacies may get different formulations of drugs delivered on different occasions.

Does your azithromycin PGD have peanut/soya allergy as a warning, exclusion criteria?

Nominations open for the UK Sexual Health Awards 2014

30 Sep, 13 | by shellraine, e-Media Editor

The UK Sexual Health Awards recognise outstanding work in and around sexual health. If you know of any incredible people, projects, services, campaigns, storyline or article – we want to hear about them.

Whether you’re nominating yourself, the organisation you work for, someone you work with, or something that has been done by someone else; if you think it deserves to be recognised and celebrated – make a nomination now!

There are seven categories open for nomination:

  • Sexual health professional of the year
  • Young person of the year
  • Adult sexual health service/project of the year
  • Young people’s sexual health service/project of the year
  • The Pamela Sheridan sex and relationships education award – recognising good practice in education in schools
  • Sexual health media campaign/storyline of the year
  • Rosemary Goodchild Award for excellence in sexual health journalism.

All shortlisted finalists get a free ticket to the glittering awards dinner and ceremony on Friday 14 March 2014 at 8 Northumberland Avenue – a stunning venue in the centre of London, Trafalgar Square.

Visit the Awards website to find out more or contact awards@brook.org.uk

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