The management of vaginal discharge: diagnosis in a community setting

Melville, Catriona Roberta Stuart (2004) The management of vaginal discharge: diagnosis in a community setting. MSc(R) thesis, University of Glasgow.

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Women with abnormal vaginal discharge may seek treatment at a Family Planning (FP) or Genitourinary Medicine (GUM) clinic. This common problem may also be managed in Primary Care or at a gynaecology clinic. There is no accepted standard strategy in the United Kingdom (UK) for management of this condition. Protocols for care have evolved mainly by custom and practice rather than from a firm evidence base. Although in the UK the specialities of GUM and FP have traditionally been organised separately, recently these services have become more integrated in order to provide an efficient, patient-orientated approach. In some centres, such as the Sandyford Initiative in Glasgow, FP and GUM services are now housed under the one roof This has highlighted the difference in approaches to the management of vaginal discharge. The GUM strategy utilises near-patient microscopy of the genital specimens and offers an immediate microscopy-based diagnosis. Specimens from the FP strategy however, are transferred to the local laboratory for analysis. Using this strategy, the clinician will make a presumptive initial diagnosis based on the clinical signs and symptoms. Integration of services at the Sandyford Initiative allowed us the opportunity to perform a study comparing the FP and GUM strategies for the management of vaginal discharge in terms of diagnostic accuracy. 200 women (100 each from FP and GUM) were recruited to, and completed this randomised controlled cross-over study. The FP and GUM strategies were performed on all participants. The sequence in which the strategies were performed was randomised to avoid sampling bias. The initial FP diagnosis based on clinical symptoms and signs and the GUM microscopy diagnosis were compared with the reference standard of both strategies combined, In addition, the final results from both strategies were compared with the reference standard. The researcher administered four clinical case scenarios. Each participant had to make a diagnosis based on the patient history and clinical photographs, which were provided. Following attendance at the STIF course, the participants were re-tested with the initial scenarios. The pre- and post-course scores were compared. Statistical analysis was performed using one and two sample t-tests and confidence intervals for the difference of two means. There was a mean increase of 2.5 points in all participants' scores. Comparison of pre- and post-course scores revealed a statistically significant improvement (p = 0.001). In summary the studies presented in this thesis were performed in response to the changing remit of sexual health services in the UK. The findings of these studies have been used to modify and influence practice at the Sandyford Initiative, and could be used to implement change in departments offering a similar service.

Item Type: Thesis (MSc(R))
Qualification Level: Masters
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Colleges/Schools: College of Medical Veterinary and Life Sciences
Supervisor's Name: Bigrigg, Dr. Alison and Nandwani, Dr. Rak and Lumsden, Dr. Mary Ann
Date of Award: 2004
Depositing User: Mrs Marie Cairney
Unique ID: glathesis:2004-40930
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 14 Jan 2019 08:49
Last Modified: 16 Aug 2021 13:21
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