Porter Brook Medical Centre

BackgroundOveruse of antimicrobials and the threats posed by resistance are concerning. Most patients in primary care with respiratory tract symptoms are prescribed antibiotics, amounting between 80–90% of all prescriptions. The National Institute for Health and Care Excellence (NICE) recommends point-of-care (POC) testing of C-reactive protein (CRP) where there is uncertainty about prescribing antibiotics. Studies evaluating the use of POC CRP to reduce antibiotic prescribing for self-limiting respiratory illness in primary care have demonstrated heterogeneity in their results.AimTo evaluate the impact of POC CRP testing on antibiotic prescribing.MethodA retrospective case analysis was undertaken at a GP practice. Alere Afinion AS100 was used for POC CRP testing. Data were collected on patients presenting with cough or sore throat who had POC CRP testing used in their clinical decision making. Eighty-four cases were selected for inclusion. NICE clinical guideline CG191 was used as a standard comparator for antibiotic prescribing and patients were followed up over a 2-month period.ResultsPatients presented with cough (n = 56) and sore throat (n = 28). At initial presentation 23/84 (27.4%) of patients were prescribed antibiotics. Over the 2-month follow-up period 15/84 (17.8%) of patients had at least one further consultation related to their initial respiratory complaint with 6/84 (7.1%) being prescribed antibiotics. The overall effect was a reduction of antibiotic prescriptions by 65.5%.ConclusionThe use of POC CRP testing helped GPs reduce the rate of antibiotic prescription and improve antimicrobial stewardship by being an addition to their diagnostic armoury. It has also shown potential role in patient reassurance and modifying health seeking behaviour.

The human female orgasm bestows the greatest pleasure without recourse to drugs. Despite numerous studies there are many aspects of the activity that are poorly understood. These include its neurophysiology and pharmacology, while even its typology, induction, and function(s) are contentious issues. It can be induced by a variety of agencies that include genital and non‐genital sites and even by exercise. While there are similarities with the male orgasm, there are a few differences, the major one being that women can have repeated multiple orgasms while males cannot. Despite recurrent speculative claims in the literature, it does not mediate or facilitate sperm transport through its uterine contractions. Brain imaging that measures cerebral regional blood flow has revealed that there is no single orgasm center, but rather specific areas are either activated, inhibited, or unaffected during orgasm. However, no consensus has yet been achieved due to experimental procedural differences and data handling by researchers.

Psychological, interpersonal, and sociocultural factors play a significant role in making one vulnerable to developing a sexual concern, in triggering the onset of a sexual difficulty, and in maintaining sexual dysfunction in the long term. To focus on psychological and interpersonal aspects of sexual functioning in women and men after a critical review of the literature from 2010 to the present. This report is part 1 of 2 of our collaborative work during the 2015 International Consultation on Sexual Medicine for Committee2. Systematic review of the literature with a focus on publications since 2010. Our work as sexual medicine clinicians is essentially transdisciplinary, which involves not only the collaboration of multidisciplinary professionals but also the integration and application of new knowledge and evaluation and subsequent revision of our practices to ensure the highest level of care provided. There is scant literature on gender non-conforming children and adolescents to clarify specific developmental factors that shape the development of gender identity, orientation, and sexuality. Conversely, studies consistently have demonstrated the interdependence of sexual function between partners, with dysfunction in one partner often contributing to problems in sexual functioning and/or sexual satisfaction for the other. We recommend that clinicians explore attachment styles of patients, childhood experiences (including sexual abuse), onset of sexual activity, personality, cognitive schemas, infertility concerns, and sexual expectations. Assessment of depression, anxiety, stress, substance use and post-traumatic stress (and their medical treatments) should be carried out as part of the initial evaluation. Clinicians should attempt to ascertain whether the anxiety and/or depression is a consequence or a cause of the sexual complaint, and treatment should be administered accordingly. Cognitive distraction is a significant contributor to sexual response problems in men and women and is observed more consistently for genital arousal than for subjective arousal. Assessment of physical and mental illnesses that commonly occur in later life should be included as part of the initial evaluation in middle-aged and older persons presenting with sexual complaints. Menopausal status has an independent effect on reported changes in sex life and difficulties with intercourse. There is strong support for the use of psychological treatment for sexual desire and orgasm difficulties in women (but not in men). Combination therapies should be provided to men, whenever possible. Overall, research strongly supports the routine clinical investigation of psychological factors, partner-related factors, context, and life stressors. A biopsychosocial model to understand how these factors predispose to sexual dysfunction is recommended.

“The twin concepts of innocence and ignorance are vehicles for adult double standard. A child is ignorant if she doesn't know what adults want her to know, but innocent if she doesn't know what adu...

Disclosures by patients related to infidelity produce a variety of reactions in clinicians, and can also lead to ethical and other clinical dilemmas. These need to be appropriately managed in order to offer effective help to couples or individuals in such situations. Having an understanding of the diversity and complexity of current couple relationship arrangements can help the clinician to manage these reactions and think clearly through any clinical dilemmas. It is also necessary to have a clear theoretical basis for understanding infidelity and making therapeutic interventions around this issue.

The recently developed SIS/SES scales, measuring propensity for sexual inhibition (SIS1 and SIS2) and for sexual excitation (SES), shown to be related to erectile problems in non-clinical samples, were explored in 171 men attending sexual problem clinics [n = 146 with erectile dysfunction (ED)] and compared with an age matched non-clinical sample (n = 446). SES and SIS1 scores in the clinic group with ED were very similar to those reporting ED in the non-clinical sample, but were not related to reporting of premature ejaculation (PE) in either group. In the clinic group, SIS/SES scores were related to features of the sexual history of potential aetiological relevance. SES was higher in men with normal waking erections, with erections better during masturbation than during sexual intercourse and lower in men with marked performance anxiety. SIS1 was higher in men with low sexual desire, and SIS2 higher in men with fear of rejection by their partners. These preliminary findings raise more questions than answers, but do provide a theoretical model for further research into male sexual dysfunction, in which erectile dysfunction can be seen as resulting from either impaired arousability (low SES), high inhibition proneness (high SIS1) or a combination of the two.