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Safer prescribing of therapeutic norethisterone for women at risk of VTE

15 Jun, 12 | by shellraine, e-Media Editor

Latest Online First article

Norethisterone and VTE risk

Diana Mansour highlights a change in the Summary of Product Characteristics for Primolut N®, since data have emerged showing that, in high doses, norethisterone is partly metabolised to estradiol. This only applies to this particular progestogen, and only in high doses, not those used in contraceptive pills. Nevertheless, it could explain why studies have occasionally suggested an increased risk of venous thromboembolism with high-dose norethisterone, used therapeutically for the management of menorrhagia or dysfunctional uterine bleeding. from Anne Szarewski, Editor in Chief, JFPRHC

News items from April

4 May, 12 | by shellraine, e-Media Editor

Better access to birth control would reduce stress on global resources

as reported by Nigel Hawkes in the BMJ. The rich should consume less and the poor should procreate less, says the Royal Society in a new report. The report was produced by a working party chaired by John Sulston, who headed the UK part of the Human Genome Project, and took 21 months to research and write.

Morning after pill courier service launched

A new service allows women (living in London) to order emergency contraception on the internet, so it arrives within two hours, rather than having to see their GP to obtain the drugs. For £20, women can order the drug by filling out an online form through the internet medical practice DrEd.com. The forms, which ask users to confirm they are aged over 18, will be assessed by doctors before pills are dispatched by courier. Currently they only offer Levonelle®, which can also be purchased in advance and by buying 2 packets for £24.00 at a saving of 37%.

Pharmacists should provide oral contraceptive services, says NHS report

As reported by Jacqui Wise in the BMJ:
“A report from NHS South East London has recommended that trained community pharmacists provide oral contraceptive consultation services after a successful pilot scheme to widen access to contraception.  The part of the report that has received the most media coverage is a recommendation to “consider providing the service to women under 16 years where appropriate.” The report said that this may help reduce numbers of teenage pregnancies.”

Brook and fpa respond to proposal to introduce contraceptive pill in pharmacies

Responding to the proposal that the contraceptive pill should be available from pharmacies without a prescription to young people, including those under 16, the chief executives of Brook and FPA, Simon Blake and Julie Bentley said: “The majority of young people under 16 are not having sex, however we must ensure that those who are can access support and services when they need to. “Although Brook and FPA welcome proposals which could increase young people’s access to sexual health services and information, all the necessary safeguards must be in place to ensure young people can get the information and support they need. “This includes pharmacists having the appropriate clinical knowledge about contraception, being able to communicate effectively with young people, having the right type of environment including a confidential space, as well as the appropriate support and referral networks.”

Egg-Sharing in Fertility Treatment

Evaluating egg-sharing: new findings on old debates – as reported in BioNews
Egg-sharing refers to a scheme where a woman undergoing fertility treatment donates a portion of her eggs to an anonymously matched recipient in exchange for a reduction in treatment costs. As a very specific form of egg donation, egg-sharing has generated heated debate since its introduction in the UK in 1998. While proponents argue it provides a win-win solution, allowing two women to help each other conceive, critics talk of the potential ethical and psychological consequences. Until recently, there has been very little empirical data to inform these discussions. However, new research conducted by Gurtin and Golombok at the University of Cambridge Centre for Family Research, in collaboration with the London Women’s Clinic, hopes to redress this balance.

Men’s health expert presents to Members of European Parliament

A leading men’s health expert presented a report detailing the health challenges facing men across Europe MEPs and key European decision-makers at the European Parliament in Brussels.

Professor Alan White, Director of the Centre for Men’s Health at Leeds Metropolitan University was commissioned by the European Commission to produce a report which gives the first complete picture of the breadth of issues affecting men’s health across Europe.  Professor White brought together 36 leading researchers from 34 countries across Europe to undertake the research which highlights the state of men’s health in Europe as a serious public health concern. more info

Faculty Consultations

The CEU Guideline on “Barrier Methods-Contraception and STI prevention” is for consultation until 21st May. see FSRH website:

BASHH Mentoring Group is currently seeking new members:

BASHH would like new representatives to support coordination of mentors and mentees within North West regions and Wales. The successful candidates would also be involved in the activities that the Mentoring Group is currently taking forward nationally. Closing date for applications: 16th May 2012.  see BASHH website for more details

And finally – we hear reports that Virgin Care have obtained ‘preferred bidder’ status in the tender to run West Sussex sexual health services .

All Party Parliamentary Group launches enquiry into restrictions in access to contraceptive services.

20 Apr, 12 | by shellraine, e-Media Editor

The All-Party Parliamentary Group on Sexual and Reproductive Health in the UK (APPGSRH) has launched an inquiry and call for evidence into restrictions in access to contraceptive services.

Examples have already been seen of commissioners cutting prescribing budgets for contraceptive methods to meet targets for savings, with consequences for choice and public health outcomes. In addition the Public Health Minister, Anne Milton MP, in a response to a parliamentary question tabled on contraceptive services, has recently confirmed that the Department of Health has received “representations from clinicians and voluntary sector organisations on the current commissioning of contraception by primary care trusts (PCTs) and access to certain types of contraception by certain age groups”.

On Monday 6 February, the APPGSRH held a meeting to discuss possible restrictions in access to sexual health services to residents-only and to people under 25 years old.  During the meeting members of the Advisory Group on Contraception (AGC) presented the initial findings from a Freedom of Information audit which had found variations in access to contraceptive services and methods.

The APPGSRH expressed concerns at the findings from the audit, in particular:

  • Evidence of commissioners restricting access to contraceptive services on the basis of age or place of residence
  • The impact that the drive for efficiency savings is having on women’s choice of the full range of contraceptive methods
  • Some methods of contraception only being made available with a GP referral
  • The impact of changes to the commissioning structures on the continuity and quality of contraceptive care

The APPGSRH is launching this inquiry in the belief that its work can contribute to the debate about how high quality contraceptive services can be delivered in the context of the healthcare reforms; and how access to the full range of contraceptive services and methods can be improved for women of all ages.

The inquiry will bring together further evidence and understanding to the current provision of contraceptive services across the country. It will also look at uncovering examples of good practice in relation to the availability of contraceptive services which can be shared amongst new and emerging commissioners of services.  We are therefore encouraging stakeholders – including commissioners, healthcare professionals and service user representatives – to submit written evidence which will help feed into the inquiry’s discussions.

Call for written evidence

The deadline for written evidence is 5pm on Friday 18 May and submissions should be sent to appg@fpa.org.uk. Submissions should be no more than 2,500 words. For more information click here.


 

What is The Course of 5?

13 Apr, 12 | by shellraine, e-Media Editor

The Course of 5 (C5) is the 2nd stage of the new DFSRH blended learning training package – it provides a link between the theory element (e-SRH) and the practical, clinical assessments (ACP).

What is involved in C5? 5 one-hour, assessed workshops in groups of no more than 4 per facilitator. These are usually offered as a one-day or 2 half day package organised locally by Faculty Registered Trainers. They can also be done as 5 individual sessions.

When can I do thisC5 cannot be undertaken until you have registered for the diploma and e-portfolio and have completed the e-SRH sessions. It must be passed before moving on to clinical practice.

What is covered? The content is fixed by the Faculty and covers:
Session 1 – Taking a Sexual History and HIV pre test discussion and testing
Session 2 – STI Screening and Testing and Teaching the use of Condoms
Session 3 – Practical Aspects of Contraception – including diaphragm and implant fitting
Session 4 – Young people; Consent, Confidentiality, Fraser Guidelines and Safeguarding children
Session 5 – Managing Sensitive Scenarios – dealing with unwanted pregnancy, psycho sexual problems and referral for sterilisation.

How is it assessed? There are 9 assessment criteria in which you must demonstrate active and appropriate participation in all the sessions.

How do I access a C5? A list of local contact details is available from the Faculty website.

How much does it cost? The courses are costed locally and will vary according to set up.

Where can I get more information? For full details visit the Faculty website training section

I am a nurse – can I do the Course? The simple answer is yes, but it may depend where you live and who is organising C5 in your area. Nurses cannot gain the Faculty diploma but can do the e-SRH sessions and C5. In some areas nurses are using this to access training in SRH and some clinics may then be happy to offer clinical assessment too.

Journal highlights – April issue

30 Mar, 12 | by shellraine, e-Media Editor

This quarter’s Journal includes the following:

Redefinition of women’s health care

Last year the Royal College of Obstetricians and Gynaecologists published ‘High Quality Women’s Health Care: a Proposal for Change’ that proposed a radical change to the structure of UK women’s health services. Andrew Horne and Johannes Bitzer discuss this exciting document from both a UK and a European perspective, commenting on its implications for sexual health provision. See page 68

Multidrug-resistant gonorrhoea

Gonorrhoea infection is increasing in the UK with a 3% increase in cases between 2009 and 2010. Last year there was a report of a ceftriaxone-resistant isolate; there is a growing concern that gonorrhoea may become incurable. The commentary by Taylor and Bignell is timely. It reviews the current position and provides clear guidelines on screening and treatment, which may prove challenging for some community services that rely exclusively on the use of nucleic acid amplification tests. See page 70

At last, a COC licensed for use in a flexible extended regimen

Data are presented from Phase III studies of a 20 µg ethinylestradiol/3 mg drospirenone combined pill, designed to be used in a flexible regimen. The studies evaluated the efficacy of the regimen, bleeding patterns, safety (ie, metabolic and endometrial parameters) and effect on dysmenorrhoea. Comparisons were with a fixed extended regimen and the conventional 24-day regimen. Results show good efficacy, tolerability and safety with the flexible regimen, and a significant reduction in both bleeding and dysmenorrhoea. See pages 73, 84, 94

Does hormone replacement therapy cause breast cancer? Part 4. The Million Women Study

Shapiro et al. continue their review of breast cancer and hormone replacement therapy papers, this time focusing on the Million Women Study. They conclude that despite its massive size, this study did not satisfy causal criteria. The online version of this paper has already been the focus of a great deal of media publicity and both a news piece and an editorial in the BMJ. Readers should also look at the Letters section for related correspondence that the Journal has received as a result. See page 102

A new aid to diagnosis

Ultrasound imaging has been of value to our specialty for over two decades and skills and equipment have steadily become more available within sexual and reproductive health clinics. In their article on hysterosonography using a local anaesthetic gel, Pillai and Shefras present their experience with a simple and effective new technique that takes imaging a step further, allowing clear diagnosis of intrauterine abnormalities, particularly causes of abnormal bleeding or failed intrauterine device/system (IUD/IUS) insertion, as well as aiding location and easier retrieval of IUDs with missing threads. Many readers will be familiar with the use of lidocaine gel to aid IUD insertion: not surprisingly, uterine instrumentation in conjunction with scanning was reported to be less painful with this technique. This is a promising approach to simplifying and improving the cost-effectiveness of care for women presenting with some complex contraception problems. See page 110

Abortion legislation in a changed world

In his latest Legal Opinion article, Sam Rowlands reviews legislation governing early medical abortion (EMA) and the licensing of EMA drugs in the UK and in other jurisdictions. He then looks at the ways in which such legislation has been used – or in some cases circumvented. EMA has helped to fulfil the crucial need for safe abortion worldwide, but in the author’s view the laws governing abortion in most countries are out of step with scientific advances. Readers may find the author’s conclusions and suggestions for future changes to our own abortion laws thought-provoking. See page 117

Role of doulas in abortion care

Doulas, or lay support persons, have had a longstanding role in supporting women in labour. Chor et al. argue that their role should be extended to caring for women having abortions, where they can help women relax and provide information. They suggest that engagement of the medical community will be instrumental in successfully expanding the role of abortion doula programmes within abortion provision. See page 123

Abortion in the classical world

Lesley Smith continues her series on the history of contraception and reproductive health with a look at attitudes to and practices of abortion in ancient times. It appears that even then, abortion was at the heart of much medical ethical debate. See page 125

Status of health professionals in the 21st century

Has the status of health professionals in society today fallen? If so, why? And is it a good or a bad thing? The Journal’s Consumer Correspondent, Susan Quilliam, explores the issue in her latest article. See page 127

Twenty-five years on: HIV remains a concern

In his latest ‘Then and Now’ article, Lindsay Edouard looks at topics covered by this Journal in 1987. New approaches to contraception were emerging. But was there a threat to community family planning services and would litigation faced by USA manufacturers restrict contraceptive choice? However, the major concern was the emergence of HIV/AIDS, with reinforcement of the advice that barriers should be used in addition to hormonal methods. In 2012, in the light of controversial research suggesting a possible association between hormonal contraception and increased HIV risk in some settings, Edouard draws our attention to the WHO very recent guidance regarding dual protection: 25 years on, advice has not changed. See page 131

Plus – Online Poll

Will the recent article on hormone replacement therapy and breast cancer alter your prescribing practice with regard to HRT?

Faculty News

The latest edition of FSRH News is available on the website.

 

 

 

CQC visits to Abortion clinics announced to media ahead of providers

23 Mar, 12 | by shellraine, e-Media Editor

This report from Jennie Bristow (editor, Abortion Review)

23 March 2012

UK: Health Secretary launches shock wave of inspections on abortion clinics

The Health Secretary, Andrew Lansley, yesterday announced to the UK media that the Care Quality Commission (CQC) would be carrying out a series of ‘unannounced inspections’ on abortion clinics throughout the UK to ensure that doctors are complying with the ‘spirit and the letter’ of the 1967 Abortion Act. Jennie Bristow reports.

This action, which Lansley confirmed in a statement to Parliament today, 23 March, is allegedly a response to concerns that doctors are ‘pre-signing’ the HSA1 abortion forms. ‘The process of pre-signing certificates where the doctor does not know who the woman is for whom that certificate may be used in relation to that abortion is in itself illegal. I am not prepared to tolerate a failure to respect the law,’ Lansley said in a press statement yesterday.

He further stated: ‘The CQC has agreed to undertake unannounced inspections to identify the scale of this problem and we will set up a special team comprising of all the necessary regulators… to look at how we stamp out bad practice in abortion clinics.’

The BBC gives a more measured explanation of the law regarding the HSA1 form. ‘Except in emergencies, the law says two doctors must certify an abortion. However, there is no requirement for them to have actually seen the woman – only that they should have seen and assessed the necessary clinical information about her case, which could have been taken by another doctor or nurse.’

Lansley’s concern is that this ‘second signature’ is being provided before the doctor has reviewed the relevant notes. This is not the practice of most abortion providers, including British Pregnancy Advisory Service (BPAS). However, launching a wave of CQC inspections on the basis of forms potentially being pre-signed in some other clinics is a strange and heavy-handed action, for three reasons.

First, the second doctor’s signature has been long understood to be a legal, rather than a clinical, safeguard; arising from attempts in the 1960s to pass a controversial new law in the form of the Abortion Act. As such, many politicians – including Lansley himself – have questioned whether it is necessary to retain this cumbersome and clinically irrelevant requirement in the 21st century.

As the BBC explains, ‘The requirement for two doctors’ signatures was criticised as long ago as 2007, when a report by MPs on the Commons science and technology committee recommended it be removed because of the potential for abortions to be unnecessarily delayed.’ And Andrew Lansley himself, during the debate about the abortion law that took place in 2008, said:

‘If a woman needs an abortion in terms sanctioned by the Abortion Act 1967, it must surely be better for it to be an early, medical abortion than a later, surgical one. I therefore hope that the House will consider whether the requirement for two doctors to consent to an abortion being performed, and the restrictions on nurses providing medical abortions, need to be maintained.’

So it is strange indeed that the Health Secretary, busily engaged as he is in controversial reforms of the entire health service, should now view strict adherence to the ‘two doctors’ requirement as a sudden issue of major clinical concern. His quote in yesterday’s press statement could not be more different from the temperate approach that he took four years ago. On 22 March 2012, Lansley argued:

‘I am shocked and appalled to learn that some clinics – which look after women in what are often difficult circumstances – may be allowing doctors to pre-sign abortion certificates. This is contrary to the spirit of the Abortion Act. The rules in the Abortion Act are there for a reason – to ensure there are safeguards for women before an abortion can be carried out.’

The second peculiarity of this shock wave of inspections is that the ‘evidence’ upon which they have been launched seems remarkably thin. It seems to have come out of police investigations launched on the back on the Daily Telegraph’s investigation into ‘sex selection’ abortions last month, which itself found little evidence that such abortions were carried out.

There may be more basis Lansley’s concerns than a flimsy newspaper investigation – but we do not know. And this is the third and most striking peculiarity of today’s Parliamentary statement: that the media were briefed about it before any of the clinics whose work it might concern.

Ann Furedi, chief executive of BPAS, said: ‘Abortion doctors provide an important service to women who are often in difficult circumstances. Their work is already intensely scrutinised, with clinics regularly inspected by the CQC.

‘Mr Lansley says he is shocked and appalled by the practices he has uncovered. BPAS is shocked and appalled that Mr Lansley has found it necessary to inform journalists of alleged breaches of the abortion law before he has informed those responsible for providing the services that have been investigated, and before the investigation is concluded.’

The UK Sexual Health Awards 2012 winners announced

16 Mar, 12 | by shellraine, e-Media Editor

The celebration, hosted by Nitin Ganatra (Eastenders), to mark the hard work and dedication of people involved in sexual health across the UK took place at Troxy, London. Celebrities, including Janet Ellis, Zoe Margolis, Sharon Marshall, Johnny Partridge and our own Susan Quilliam and Alison Hadley were in attendance to show support and present awards to:

Sexual health professional of the year: Kay Elmy, Peterborough Contraceptive and Sexual Health Service.
JLS young person of the year: Azizi Kosoko, Terrence Higgins Trust.
Rosemary Goodchild Award for excellence in sexual health journalism: Sophie Goodchild for her article ‘Free love: what happened to AIDS?’  Men’s Health magazine.
Adult sexual health service/project of the year: ‘Morning-after-pill in the post’ campaign, bpas.
Young people’s sexual health service/project of the year: Sheffield Open Doors, Sheffield Contraception and Sexual Health Service, School Nursing Service and the Young People’s Drug and Alcohol Service.
Pamela Sheridan Award for Innovation in SRE: Shropshire Respect Yourself Relationship and Sex Education Programme.
Lifetime Achievement in sexual health award presented to Professor Michael Adler CBE.

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Research highlights risks with current tests for Chlamydia trachomatis

“Researchers, from the University of Southampton and the Wellcome Trust Sanger Institute, have discovered that Chlamydia is much more diverse than was previously thought. Using whole genome sequencing, the researchers show that the exchange of DNA between different strains of Chlamydia to form new strains is much more common than expected.”  Current clinical tests only give a positive or negative result and can not identify different strains.  In clinical practice those found to be chlamydia positive after treatment were assumed to have been re-infected but this may not be the case.  Up until now antibiotic resistance has not been seen in humans only in the laboratory but current tests would be unable to demonstrate this if it did occur.

New BASSH Patient Information Leaflets

The BASSH Clinical Effectiveness Group (CEG) has produced new patient leaflets on Safer Sex, Epididymo-orchitis and Gonorrhoea. These are available from their website along with details about up-coming events as well as news and other guidelines.

GMC seeks views on proposed changes to the way doctors are assessed for GP or specialist registration through the ‘equivalence’ or CESR/CEGPR route to registration

Information and access to consultations are via the GMC e-consultation website.

 

Celebrating International Women’s Day

9 Mar, 12 | by shellraine, e-Media Editor

“This International Women’s Day, the world’s women have much to celebrate: maternal mortality rates are declining after years of stagnation; the importance of maternal health is receiving unprecedented attention; and one solution in our efforts to save women’s lives during childbirth, misoprostol, is gaining significant traction globally. But we have further to go for the world’s women.”  IWD website has links to a number of events happening around the globe and asks supporters to publish and share their initiatives

fpa and Brook join forces with Durex

Two of the country’s leading sexual health charities and the biggest condom brand in the UK have announced a major collaboration with a three year programme to deliver a number of sexual health initiatives; information events, public awareness campaigns and learning materials.

Media Reaction to Abortion – gender selection and legal issues

in the ongoing debate around gender-selection abortion an Open letter of support for doctors who provide abortion services was published by Reproductive Health Matters, the international journal for sexual and reproductive health and rights, signed by members of Voice for Choice, leaders in womens’ health and abortion care. The letter clarifies many of the misinterpretations of legal issues that have been voiced in much of the ‘popular’ press.

Sexual Health Trainersnew PGA Med Ed (SRH)

The FSRH website has details of the planned changes to ‘training the trainers’.  The current letter of competence (Loc MEd) will be replaced by the new Post Graduate Award in Medical Education (Sexual and Reproductive Health).  In collaboration with Keele University the course is aimed at doctors working in CASH, GP’s, those in GUM and nurses who wish to gain a recognised teachers qualification in sexual health. This PGA will, for doctors, be accepted as appropriate for Primary Trainers for DFSRH purposes.

The GMC Education Update (Feb 2012) includes notification of a consultation on the recognition and approval of trainers.

New Clinical Guidance – Management of Vaginal Discharge in Non-Genitourinary Medicine Settings

The FSRH Clinical Effectiveness Unit (CEU) have published their latest clinical guidance document which updates previous guidance from 2006. Changes include: new tests for gonorrhoea and chlamydia; changes to treatments available for vulvovaginal candidiasis (VVC) & bacterial vaginosis (BV); and new advice on combined hormonal contraception (CHC) and antibiotics.

BPAS website hacked

The British Pregnancy Advisory Service website has been the subject of attempted hacking.  A 27 yr old man has been arrested on suspicion of offences under the Computer Misuse Act.  In a statement issued today BPAS say that:

“Around 26,000 attempts to break into our website were made over a six hour period, but the hacker was unable to access any medical or personal information relating to women who had received treatment at bpas.”

Faculty News

10 Feb, 12 | by shellraine, e-Media Editor

Amendments to FSRH Guidance Documents: Drug Interactions and Emergency Contraception
Drug Interactions (2011): Page 9 of the original version of this CEU Guidance Document (issued in January 2011) incorrectly stated that the interaction between lamotrigine and combined hormonal contraception (CHC) only applies to lamotrigine monotherapy. CHC also reduces lamotrigine levels when lamotrigine is combined with antiepileptic drugs that
do not alter its metabolism.

Emergency Contraception (2011): The original version of this CEU Guidance Document (issued in August 2011) contained some inconsistencies that the CEU has corrected in this version. These amendments are as follows: additional recommendation regarding offering a Cu-IUD to eligible women presenting between 0 and 120 hours of UPSI or within 5 days of expected ovulation added (pages ii and 8); references 12 and 13 updated (page 11); and acknowledgement of chart designer added to Appendix 2 (page 15).

New Examiners for the Multiple Choice Question Paper (MCQ)
The Examination Committee invites applications to join the MCQ Examiner Group of the MFSRH Panel of Examiners. Applicants should be accredited Members of the Faculty and active clinically in the sphere of the Faculty or, to be Clinicians, of equivalent status, with an interest in Sexual and Reproductive Healthcare but whose speciality is GUM, Public Health Medicine, Gynaecology or Primary Care. Further information and application forms from the Faculty website, closing date 29th February.

Committee Vacancies

  • Clinical Standards: for a doctor and a nurse
  • Workforce Planning: for an Associate member and a Fellow/Member/Diplomate

Information and details of how to apply are available from the committee’s page of the Faculty website

and in other news

Oral Ulipristal Proves Highly Effective for Uterine Fibroids
According to 2 studies published this week in the New England Journal of Medicine the oral selective progesterone receptor modulator, ulipristal, proved highly effective as a treatment for symptomatic uterine fibroids rapidly reducing excessive bleeding and reducing the size of uterine fibroids, and was well tolerated. The drug was approved for emergency contraception in 2010. Known as ella (HRA Pharma) in the United States and ellaOne in Europe, ulipristal works by interrupting ovulation. For emergency contraception, a 30-mg dose is used. By contrast, the newly-published studies tested 5-mg and 10-mg daily doses for fibroid treatment. In one of the studies (placebo-controlled) the drug controlled excess menstrual bleeding in over 90% of cases with a high incidence of amenorrhoea. If and when a product becomes available in the UK (Esmya is already approved and licensed in other countries) the issue of contraception will need to be highlighted to those that might use it because of the interaction with hormonal contraception.

Journal: January 2012 and News

3 Feb, 12 | by shellraine, e-Media Editor

The January edition of the Journal of Family Planning and Reproductive Health Care includes a number of articles previously available at Online First (the Dinger/Shapiro VTE commentary, Advances in IUD training by Connolly & Rybowski and Brown’s study looking at young mens’ views on contraception) as well as:

  • a thought-provoking commentary by Raine-Fenning et al on pregnancy of unknown location (PUL) which points out that a recent recommendation from CMACE to abandon the term is at odds with current scientific evidence and clinical experience;
  • a commentary by Wilkins of the Men’s Health Forum on men and sexual health;
  • a study by Draper et al on 525 GP fittings over a period of 30 years confirms that routine IUD checks confer no benefit.  The paper suggested that current guidelines recommend annual checks though this is based on a statement from Australia dated 2007 and USA advice from 2000 and ignores more up to date FSRH and WHO guidance;
  • a questionnaire study of clinic attendees and staff about what we should call ‘attendees’. This appears to show that there is a preference to retain the term ‘patient’ but was based on the respondents picking from only 4 options (‘patient’, ‘client’, ‘user’ or ‘customer’ – ie didn’t include ‘women’ and ‘men’) or asking them what they would prefer to be called;
  • Kipp et al highlight the unmet need for effective methods of FP in HIV+ individuals in rural Uganda;
  • womens’ views of the use of their leftover LBC samples for research purposes (Cooper et al);
  • an important restrospective audit comparing unscheduled reattendance among women having EMA (early medical abortion) at home vs hospital (Astle et al);
  • a review of appropriate use of Co-cyprindiol in a general practice (Tandy);
  • a review of Clomifene use for ovulation induction in general practice (Wilkes & Murdoch)

Plus at Online First on 31 January 2012: Encouraging IUD uptake after medical TOP [Cameron et al.] 

Sharon Cameron and her colleagues in Edinburgh created a fast-track referral service so that women who had undergone early medical abortion who wished to use intrauterine contraception afterwards could be seen promptly for IUD/IUS fitting. However, only about half the women who were given appointments actually attended. In their article they analyse the differences between the attenders and the non-attenders and suggest ways to enhance the uptake of these effective methods for the prevention of further unwanted pregnancies. While some women would benefit from IUD/IUS insertion at the place of abortion, provision of a fast-track service to the family planning clinic may yet remain the best strategy for maximising uptake of intrauterine contraception in this specific client group. from David Horwell, Advisory Editor, JFPRHC

Journal Fiction Book Reviews for April 2012:
The fiction book that has been reviewed for the next Journal is:
“Sense of an Ending” by Julian Barnes.  Read this and see if your views coincide with our reviewer.  If anyone has read “The Marriage Plot” by Jeffrey Eugenides and would like to review it and see their review in print in the April issue please submit a maximum of 400 words to journal@fsrh.org by 12 February at the latest.  In addition, let us know if there are any other books you have read recently that you feel would be of interest to readers.

New GMC Guidance
Two new documents have been published by the GMC: Raising concerns about patient safety and Leadership and management for all doctors 2012 which they “hope will contribute to a culture change within the health service – where raising and acting on concerns becomes part of every day practise in the UK.”

New mobile website for Brook
Brook, the young people’s sexual health charity, have launched a version of their website optimised for viewing on a mobile phone, funded by the JLS Foundation. See a screenshot of the new site below:

Latest from JFPRHC

Latest from JFPRHC