The history
Caroline J Rodgers in Helping Hands: An Introduction to Diagnostic Strategy and Clinical Reasoning, 2019
The history is an integral part of clinical diagnosis and arguably the most fundamental, determining the subsequent examination and appropriate investigations. The history usually comes from the patient but if this is not possible, other sources such as next of kin, carers, witnesses and allied health professionals may provide a valuable history. At medical school, the structured approach of presenting complaint, history of presenting complaint, past medical history, drug history, allergies, social history, family history and systems enquiry is usually taught. After qualification, the approach becomes increasingly tailored to the clinical context, knowledge and experience of the clinician. ‘Self-labelling’ is the term used to describe this strategy, in which a patient offers what they think the diagnosis may be. Thrush makes the point that history taking should be detective work rather than a mechanical task.
Sexually transmitted infections
Sarah Bekaert in Women's Health, 2018
This chapter covers the more common sexually transmitted infections (STIs), and outlines their symptoms, how they are transmitted and the treatment available. STIs can be transmitted by penetrative sex, oral sex and digitally. Anogenital warts are the commonest viral STI diagnosed at genitourinary medicine clinics. It usually takes 1 to 3 months from the time of infection for warts to appear. Genital chlamydial infection is an important reproductive health problem, because 10–30% of infected women develop pelvic inflammatory disease (PID), which if left untreated can cause fertility problems and chronic pain. Sexual intercourse can alter the pH of the vagina, which thrush and bacterial vaginosis may then colonise. Sexual activity can introduce bacteria to the urethra in both men and women, causing cystitis. Episodes of cystitis are often associated with the onset of sexual intercourse, and women who have regular intercourse have three to four times as many episodes of infection per year as women who are not having intercourse.
Safer sex
Dominic Upton in Student Nurse Health Promotion Survival Guide, 2014
This chapter explains the use of psychological theory within a nursing framework to guide them how to assess lifestyle behaviours of patients with Safer sex in day-to-day clinical practice. Safer sex practices go beyond just the use of condoms. By knowing about and practising safer sex, the risks of getting a sexually transmitted infection can be significantly reduced. Sexually transmitted infection symptoms such as, Chlamydia, Genital warts, Genital herpes, Gonorrhoea, Syphilis, Trichomoniasis, Thrush, and HIV. Safer sex refers to those sexual activities that do not involve the exchange of bodily fluids semen, pre-ejaculation fluid, vaginal fluid and blood between one person and another. Use of condoms during penetrative sex for vaginal and anal intercourse, latex condoms should be used with water-based lubricants. Perceived barrier and proposed intervention strategy such as, Decreases sexual pleasure or sensation, Decreases spontaneity of sexual activity, Embarrassing, juvenile, 'Unmanly' and Fear of breakage may lead to less vigorous sexual activity.
Colony morphologies, species, and biotypes of yeasts from thrush and denture stomatitis
Published in Acta Odontologica Scandinavica, 2009
Xiaobo Song, Jinglu Sun, Geir Støre, Bjørn Frode Hansen, Ingar Olsen
Objective. To study the species and phenotypic characteristics of yeasts, i.e. colony morphology, biotypes, and biotype relatedness, and the oral distribution of yeasts, in thrush and denture stomatitis.Material and Methods. Yeast colony morphology was observed under a stereo-microscope and photographed with a digital camera. Genus, species, and biotypes of the yeast isolates were identified by using a commercial kit, ID 32C. Yeast biotype dendrograms were generated by Spotfire software and SPSS 15.0 for Windows. Results. Multiple colony morphologies were observed among the yeasts from both thrush and denture stomatitis. One genus, 6 species, and 21 biotypes were identified among the yeasts from thrush, while 2 genera, 7 species, and 20 biotypes were identified among the yeasts from denture stomatitis. Considerable similarities in predominant species, biotypes, and biotype clustering profiles were shown among the yeasts from thrush and denture stomatitis. However, Candida dubliniensis was identified exclusively in subgingival areas and biotype 7347340215 of C. albicans was identified more frequently in palate and sulci in thrush. Conclusions. A diversity of species and phenotypes was found among the yeasts in thrush and denture stomatitis. Candidal commensals were predominant in thrush and denture stomatitis, but the observation of divergent Candida species and biotypes, constituting 23% of all the yeast isolates, should not be ignored.
Sexual function in diabetic women: A psychological perspective
Published in Sexual and Relationship Therapy, 2003
Claire Rockliffe-Fidler, Gundi Kiemle
Definitional inconsistencies and a narrow approach to assessing female sexual functioning have contributed to the conflicting literature on the impact of diabetes on women's sexual functioning. This study focused on psychological factors relevant to sexual functioning in subgroups of diabetic women aged 24 to 83 (18 type 1 and 25 type 2). Between-groups analysis indicated that when compared with type 1 diabetic women, type 2 women reported significantly less sexual preoccupation and lower overall sexual functioning scores, with significantly lower desire and enjoyment. These differences remained significant when age was controlled for. While psychological factors such as anxiety and adjustment to diabetes were significantly correlated with aspects of sexual functioning, only depression accounted for significant variance in overall sexual functioning scores. These findings are supported by data from semi-structured interviews with eight women. Factors including presence of diabetic complications, body mass index (BMI) and body satisfaction were not significantly correlated with sexual functioning. Interviews identified the experience of genitourinary infections (GUIs), such as thrush, as a particular concern to diabetic women that might interfere with their sexual functioning. The implications of these findings for future research and clinical practice are discussed.
An Evaluation of Patients' Willingness to Trade Symptom-Free Days for Asthma-Related Treatment Risks: A Discrete Choice Experiment
Published in Journal of Asthma, 2008
Helen M. McTaggart-Cowan, Peilin Shi, J. Mark FitzGerald, Aslam H. Anis, Jacek A. Kopec, Tony R. Bai, Judith A. Soon, Larry D. Lynd
Background. Not taking treatment preferences into account may lead to patients' inappropriate use of asthma treatments. The objective of this study was to quantify these preferences, in terms of risk-benefits trade-offs, for six asthma treatment attributes using a discrete choice experiment (DCE). Methods. Adult asthma patients (n = 157) participated in the study. The custom-designed DCE measured preferences for treatment effectiveness (symptom-free days), potential risk (oral thrush and tremor/heart palpitation), ease of use (frequency of daily administration and number of inhalers required), and cost. A nested logit model was used to determine the relative preferences of each attribute, from which the marginal rates of substitution were calculated. Segmented models were used to test for interactions between cost and treatment benefit with socioeconomic status and medication use. Results. Relationships between preferences and all attributes were in the hypothesized direction. On average, patients were willing to pay an additional $14 per month to receive one additional symptom-free day, and $26, $79, and $112 monthly to avoid one, two, and three annual episodes of oral thrush, respectively. Income and the magnitude of short-acting β -agonist use also affected treatment preferences. Conclusions. Overall, asthma patients desired treatments that offered more symptom-free days, but they were willing to trade days without symptoms in exchange for a reduction in adverse events and greater convenience.