Background Sexually transmitted infections (STIs) in low- and middle-income countries (LMICs) are predominantly managed by syndromic management. However, most STIs are asymptomatic. These untreated STIs cause individual morbidity, and lead to high STI prevalences. There is increasing interest in the use of point-of-care tests (POCTs) for STIs in LMICs, which could facilitate same day testing and treatment. To best utilise these tests, we must understand the facilitators and barriers to their implementation. The aim of this review is to explore how point-of-care testing for STIs has been implemented into healthcare systems in LMIC and the facilitators and barriers to doing so. Methods A scoping review was conducted by searching MEDLINE, Embase, Emcare, CINAHL, Scopus, LILACS, the Cochrane Library, and ProQuest Dissertations and Theses for studies published between 1st January 1998 and 5th June 2020. Abstracts and full articles were screened independently by two reviewers. Studies were considered for inclusion if they assessed the acceptability, feasibility, facilitators, or barriers to implementation of point-of-care testing for chlamydia, gonorrhoea, trichomoniasis or syphilis in LMICs. Thematic analysis was used to analyse and present the facilitators and barriers to point-of-care STI testing. Results The literature search revealed 82 articles suitable for inclusion; 44 (53.7%) from sub-Saharan Africa; 21 (25.6%) from Latin American and the Caribbean; 10 (12.2%) from East Asia and the Pacific; 6 (7.3%) from South Asia; and one (1.2%) multi-regional study. Thematic analysis revealed seven overarching themes related to the implementation of POCTs in LMICs, namely (i) Ideal test characteristics, (ii) Client factors, (iii) Healthcare provision factors, (iv) Policy, infrastructure and health system factors, (v) Training, audit, and feedback, (vi) Reaching new testing environments, and (vii) Dual testing. Conclusion Implementation of POCTs in LMICs is complex, with many of the barriers due to wider health system weakness. In addition to pressing for broader structural change to facilitate basic healthcare delivery, these themes may also be used as a basis on which to develop future interventions. The literature was heavily skewed towards syphilis testing, and so more research needs to be conducted assessing chlamydia, gonorrhoea, and trichomoniasis testing, as well as home or self-testing.

BackgroundThe global prevalence of autism is reported to be at least 1% and is rising. Autistic people have a range of comorbidities resulting in a high use of health services. Doctors of nearly all specialties are likely to encounter autistic people in their practice. Autistic people report dissatisfactory care and encounter disproportionately worse health-related outcomes than non-autistic people, which in part has been attributed to a lack of skill and awareness in the medical workforce. At present, autism education is not always included in undergraduate medical curricula. In England, the Department of Health and Social Care has mandated that autism education should be included in all undergraduate medical curricula but current evidence relating to the delivery and receipt of autism education is poor. A greater understanding of medical student perceptions of autism education is required to inform curriculum development. This qualitative study sought to explore the perceptions of autism education in final year medical students at a medical school in South-East England by 1) assessing their perceived preparedness to care for autistic people once they have graduated from medical school and 2) determining their perceived acceptability of a new undergraduate education programme, Time for Autism (TfA).Materials and methodsA purposeful sample of ten final-year medical students were recruited. Students completed in-depth, individual interviews. Data was analysed using thematic analysis.ResultsFour key themes were identified: Learning environment, Exposure, Relevance and Curricular priority. The findings of this study indicate that medical students perceived greatest value in autism education when it was directly relevant to developing preparedness for practice. Value was influenced by the perceived curricular priority attached to autism education. The new autism programme, Time for Autism was perceived to add relevance and priority to autism education in the existing curriculum in this medical school setting.DiscussionThe study findings shed new light on medical education literature, emphasising the importance of congruence between the provision of autism education and the prioritisation of autism education within the curriculum. Consideration of relevance and curricular priority can be used to support the development of autism education in future medical curricula.

Introduction: Coronary bifurcation lesions (CBL) are one fifth of all coronary lesions and they do not have an optimal strategy for stenting yet. Bioresorbable scaffolds (BRS) are novel invention that is proposed to be the optimal solution. The aim of this systematic review was to assess the role of BRS in treating CBL by comparing it to dedicated bifurcation stents (DBS). Methods: A systematic review was conducted following the PRISMA guidelines, searching databases such as ScienceDirect, EMBASE, MEDLINE, NIH, TRIP, PUBMED, and ClinicalTrials.gov. Risk of bias was assessed by MINORS and modified Cowley’s criteria. Q statistic was used for heterogeneity testing and a meta-analysis was conducted using the “meta” package in the R software application. Results: Fourteen studies were included with an average follow-up period of twelve months. almost 80% of the participants were male (p-value= 0.148) and around two-thirds were smokers. Meta-analysis was performed for myocardial infarction (MI), target lesion revascularisation (TLR) , major adverse cardiac events (MACE), and stent thrombosis (ST). These showed statistically non-significant differences with a slight trend favouring BRS except with stent thrombosis. Conclusion:: There is a lack of randomised trials on the topic which may be an area for further research. But the results showed favourable, yet statistically insignificant outcomes for BRS except for ST; an issue that can be addressed with technological advancement.

Aims Burns are usually associated with significant morbidity and mortality due to dysfunction and disfigurement. Non-fatal burns usually contribute to morbidity via burn wound infection, systemic sepsis, multiple organ failure, pneumonia etc. leading to prolonged hospitalization. The objective of this study is to present a systematic review of the role of enzymatic debridement in healing outcomes compared to standard of care (debridement and skin grafting) in adult patients with burns. Methods A systematic review of randomized controlled and case-control studies reporting and comparing healing outcomes of Nexobrid with the standard of care, published on Embase, Medline, PubMed, Google Scholar and Cochrane databases in the period from 1946 until August 2021 was performed. Relevant studies were extracted and analysed with the help of Review Manager. Results The database search identified thirteen articles that met inclusion criteria. A combined number of 441 patients were included. Nexobrid application average time was one day. The combined mean of total body treated mean surface was 6.5%. Studies investigating Nexobrid mention the combine average success of debridement of 82.8%. The forest plots favour the current evidence of Nexobrid shortens time from injury to intervention, reducing the need for surgery, hence shortening the length of hospital stay. Conclusions This systematic review provides the current results of Nexobrid usage for enzymatic debridement of partial thickness to deep dermal burns. Further randomized controlled trials or feasibility studies are warranted to open new horizons for this modality of burns treatment.