Comprehensive Patient History Research Articles

Societal implications of herpes simplex virus (HSV) in semen donors.

Objective: To determine seroprevalence and markers of infectivity for HSV-1 and HSV-2 in semen donors and donor candidates. Design: The study group consisted of 24 healthy semen donors and donor candidates being evaluated at a national sperm bank. Following a comprehensive patient history interview, all subjects received a complete physical examination and screen for sexually transmitted diseases (STDs). After obtaining informed consent, donor sera were tested for type-specific antibodies to HSV-1 and HSV-2 and semen specimens were cultured and PCR amplified for HSV. Materials/Methods: Semen and sera specimens collected at the sperm bank were shipped to a university clinical microbiology laboratory in liquid nitrogen vapors for the HSV testing. Specimens were allowed to thaw and were thoroughly mixed prior to analysis. Culture and PCR for HSV were performed on all donor and candidate semen specimens and all sera were tested for antibodies to HSV-1 and HSV-2. Semen specimens were cultured for HSV using a tube MRC-5 fibroblast cell line and read for cytopathic effect until 21 days. DNA was extracted from the semen of all culture-negative specimens using the MasterPure™ rapid desalting technique and amplified with HSV-1 and HSV-2 specific primers using buffer L in the FailSafe PCR system. Sera were tested by type specific EIA using the MRL IgG Immunoblot test kit, permitting simultaneous assessment of serostatus to both HSV-1 and HSV-2. Results: Fourteen of the 24 (58.3%) specimens had antibodies to neither HSV subtype, 6 of the 24 (25%) specimens had only HSV-1 type-specific antibodies and 4 of the 24 specimens (16.7%) had type-specific antibodies for both HSV-1 and HSV-2. None of the 24 (0%) specimens had only HSV-2 type-specific antibodies. All semen specimens were negative by both culture and Polymerase Chain Reaction for HSV. Conclusions: Although 16.7% of the study group had type-specific antibodies to both HSV-1 and HSV-2, and 25.0% had antibodies to HSV-1 only, none demonstrated actual semen infectivity by PCR or culture. Although most cases of HSV-2 represent genital herpes, most cases of HSV-1 do not. Our preliminary data demonstrate that neither herpes virus was detected in the semen of the donors suggesting that patient history, physical examination and STD screening are sufficient in eliminating potentially infectious individuals from the donor pool. However, HSV-1 and HSV-2 seropositivity should initiate discussion regarding symptoms of subclinical HSV genitalis and all symptomatic donors should be cultured to eliminate the risk of collecting HSV contaminated semen Supported by: Women’s Health Initiative of the Chandler Medical Center Research Fund, the University of Kentucky, Lexington, KY 40536.

Computerization of Obstetric Antenatal Histories

EDITORIAL COMMENT: We accepted this paper for publication because it explains the basic facts of life concerning computerization of obstetric antenatal histories. The editorial committee is convinced that such a system should now be introduced into all obstetric hospitals at least for the purposes of prompt production of a discharge summary and letter to the referring practitioner. This system is easily adapted to the coding requirements for clinical audit and Diagnostic Related Group (DRG) coding now required for funding of Public Hospitals in Victoria. We encourage all readers to seek more information about these systems and to request that the administrators in the hospitals where they work at least introduce them for generation of discharge summaries and letters. The rest will follow. Summary: Computers have existed for over 40 years. Their evolution has transformed them from being merely big calculators into versatile user-friendly machines with the possibility to interact with the operator. Within their clinical capacity one of their main benefits is within the area of quality assurance. When applied in an appropriate way in obstetrics, they can actually lead to improved antenatal care. This can be achieved through obtaining a more standardized and comprehensive patient history and the use of management suggestions, made by the computer, in response to specific items in the patient history. These suggestions are titled ‘action prompts’. Other quality assurance advantages exist within the areas of legibility and availability of individual patient files, while within a general setting they lend themselves easily to research and education. All these advantages will make computer generated antenatal histories and summaries more likely to be widely implemented in the future.

A subjective approach to the treatment of dry eye syndrome.

This International Meeting has dealt mainly with scientific studies of the lacrimal gland. I’d like to discuss the treatment of Dry Eye Syndrome, a product of the lacrimal glands, as well as the treatment of the secondary symptoms of Dry Eye Syndrome involving the nose, throat and sinus, by following a subjective diagnosis and treatment plan. Several speakers have referenced the need for objective clinical studies in the diagnosis and treatment of lacrimal gland dysfunction. I agree that we need this highly scientific approach, but strongly believe in applying practical experience to the study of the diagnosis and treatment of lacrimal gland dysfunction, specifically in the area of Dry Eye Syndrome. This involves: 1. Obtaining an adequate and comprehensive patient history, using a ‘Symptoms Checklist’ 1. Obtaining an adequate and comprehensive patient history, using a ‘Symptoms Checklist’ 2. Initial examination specifically looking for landmarks of Dry Eye Syndrome. 3. Dependable, diagnostic testing to see if the patient experiences temporary symptomatic improvement regarding the cross-reference of subjective complaints. 4. Simple, practical, effective treatment — only if the patient has responded favorably to the testing and has significant improvement in the cross-reference of the unstimulated tear. 5. Consistent reversibility — in case there is resultant epiphora from too much retention of the unstimulated tear.

Preoperative evaluation of the cardiac patient for noncardiac surgery

In summary, obtaining a comprehensive patient history is a critical part of the diagnostic and risk stratification process of the patient with cardiac disease undergoing non-cardiac surgery. Many of the factors associated with perioperative cardiac morbidity are treatable and early and aggressive management appears to have beneficial effects on morbidity and mortality rates.

Influence of occupation and living habits on semen quality in men (scrotal insulation and semen quality)

Fifty-six males from infertile couples were categorised into two different groups and their semen quality examined. Patients in which there was no evidence of interference with normal testicular thermoregulation either during the day or the night were classified as ‘cool workers’ and ‘cool sleepers’ (Group I, n = 26). In the other group (II), ‘warm workers’/‘ warm sleepers’ (n = 30), there was evidence for scrotal insulation. The number of good moving spermatozoa per ejaculate as well as this number per ml was greater in ‘cool workers’/‘cool sleepers’ than in ‘warm workers’/‘warm sleepers’ (p < 0.001). These results emphasize the need for comprehensive patient history when evaluating infertility problems. Similarly, living habits may play a role in human male infertility and treatment.

Burning Mouth Syndrome

<h3>To the Editor.—</h3> In regard to Dr Grushka's letter (1983;249:1151), she makes a suggestive argument for the presence of collagen vascular disease in about 50% of patients with the "burning mouth syndrome." A more comprehensive patient history is needed to help substantiate her claims: how many patients have signs or symptoms of arthritis, serositis, nephritis, cutaneous involvement, Raynaud's phenomenon, and muscle or CNS disorders? More specifically, with a female-to-male ratio of 2.4:1, all patients having intraoral burning, and 44% of patients having dry mouth, we would like to know what percentage of the patients had dry eyes, dry skin, and parotid enlargement. Sjogren's syndrome is the second most common of the autoimmune diseases, following only rheumatoid arthritis.¹It should be considered in all patients with symptoms of dry mouth. A more complete history and an examination by an ophthalmologist including a Schirmer tear test and a rose bengal dye