Background Due to the COVID-19 pandemic, sexual health clinics across Australia have switched from clinician-collected to self-collected swabs for oropharyngeal STI screening. The study aimed to determine the acceptability of self-collected throat swabs among 200 gay, bisexual and other men who have sex with men (GBMSM) attending a sexual health service. Methods GBMSM aged ≥16 years old, had a throat swab taken at the Melbourne Sexual Health Centre (MSHC), and provided consent to participate in research, were invited to take this online survey by SMS. The survey collected data on how easy or difficult men found collecting their own throat swab. Results 273 GBMSM completed the survey; 218 (79.9%) self-collected their throat swab and were included in the final analysis. Most participants found collecting their own throat swabs very easy, easy, or were neutral (190; 87.2%; 95% confidence interval [95%CI]: 82.0% to 91.3%) and 28 (12.8%; 95%CI: 8.7% to 18.0%) found it difficult or very difficult. There were 85 (39.0%) who reported taking the swab by themselves was worse than previous experiences of clinician-collected swabs, compared to 110 (50.5%) who reported it was better taking the swab by themselves or found no difference to previous clinician-collected swabs. The two most commonly reported experiences during self-collection were gagging (155; 71.1%) and being worried they had not done it correctly (46 out of 95 who were asked this; 48.4%). Almost half of participants preferred to have a clinician take their throat swab (103; 47.5%; 95%CI: 40.5% to 54.1%); 66 (30.4%; CI: 24.3% to 36.8%) did not have a preference and 48 (22.1%; 95%CI: 16.7% to 28.1%) preferred to take the swab themselves. Conclusion Most GBMSM did not find self-collecting throat swabs difficult, however almost half of participants preferred to have a clinician take the swab.

Objective: We describe our experience of performing bipolar transurethral resection in saline (Olympus Medical) as a day-case procedure over an initial five-year period. Patients and methods: All procedures coded as transurethral resection of the prostate over a 60-month period were analysed to determine whether the procedure was planned as a day-case or as an inpatient admission, and whether post-operative discharge proceeded as intended. Re-admission rates, reasons for re-admission and transfusion rates were also recorded. Results: Of the 1035 operations, 689 (66.57%) were planned as a day-case procedure (mean age 70.5 years) with 176 (25.5%) requiring inpatient admission, and 346 (33.43%) were planned for inpatient admission (mean age 73.6) but 58 (16.8%) were discharged the same day. Overall 571 (55.17%) procedures were performed as day cases. Readmission rates for day-case and inpatient procedures were 7.4%, and 6.3% respectively (p=0.48). Transfusion rates were lower in the day-case group (0.7% vs 3.7%, p<0.05). Day-case rates improved from 48.70% in 2011 to 75.22% in 2016. Conversion from day case to inpatient fell from 34.6% in 2011 to 14.8% in 2016. Conclusions: Our experience indicates that day-case transurethral resection of the prostate can be performed safely in appropriately selected patients, without increased rates of re-admission or complications. Level of evidence: 4 (Oxford Centre for Evidence-Based Medicine (CEBM)).

Lidocaine has been used to treat neuropathic pain by virtue of its ability to block sodium channels and thus block neuropathic pain signaling. On the theory that migraines or other pain syndromes may also be neuropathically mediated, we tried treatment of refractory migraines and pain with this agent in the clinic. 64 patients were treated (49 female/15 male) [average age 40.8 yrs] for refractory headaches and pain in the clinic. An IV line was started with pulse oximetry monitoring. Patients had failed at-home treatment for their pain/migraines. 97 IV infusions were given in this series for all clinical problems including neck and back radicular pain, TN, nerve entrapment, CRPS, anesthesia dolorosa, TMD and migraine. The beginning severity for migraines and pain was 6.93/10 in severity before treatment and this was reduced to 3.27/10 in severity after treatment. This resulted in a significant decrease in pain and headache severity (p value of <.001) for treatment. 15 of 97 IV treatments [15%] of patients had complete abolishment of their migraines or pain. Average time of lidocaine infusion was 98.5 minutes and average dose was 256 mg of lidocaine. There were 4 patients with transient nausea and dizziness during infusion, easily arrested by stopping or slowing the infusion rate. No other side effects were seen with treatment. We conclude that IV lidocaine can be used in the clinic for treatment of refractory migraines as well as pain and that sodium channel over-activity may be playing a role in the maintenance or perpetuation of migraine headaches, as well as neuropathic pain syndromes. Successful treatment permits choice of a sodium channel-active agent for oral prophylaxis of migraines or pain. The study also raises questions about mechanisms of aberrant neurotransmitter activity involving sodium channels playing a role in refractory migraine.

Ketamine is a antagonist of NMDA-subtype glutamate receptors, thought to play a role in pain transmission. Remarkably little information exists on this receptor subtype and any potential role in migraine pathophysiology, although central sensitization and allodynia play a part in the migraine process. We chose to study this agent IV in the headache clinic to treat refractory migraines and other headaches in our search for additional agents to offer patients. 30 patients (21=f, 9=m) were treated for refractory migraines in the clinic with IV ketamine. A total of 48 infusions were administered. 18 patients had co-existent pain problems. An IV was placed and pulse oximetry was used in each patient. 0.4mg ketamine/kg was administered by IV infusion over 90 minutes. If there were no side effects, another 0.4mg/kg was administered over the same time. Patients rated their migraines on a 0-10 VAS. 8 patients received a 3rd infusion using the same dosage. Beginning migraine severity was 6.61/10 and this reduced to 3.4/10 after treatment (p

Ketamine is a potent blocker of NMDA-subtype glutamate receptors, thought to play a role in pain transmission. We chose to study this agent IV in the pain clinic to treat pain flareups. 30 patients (22=f, 8=m) were treated for refractory pain in the clinic. 7 different types of pain syndromes were treated, including face, eye and limb pain. 16 had co-existent migraine problems. An IV was placed and pulse oximetry was used in each patient. 0.4mg ketamine/kg was administered by IV infusion over 90 minutes. If there were no side effects, another 0.4mg/kg was administered over the same time. Patients rated their pain on a 0-10 VAS. 12 patients received a single infusion, while the rest received between 2 and 12 IV infusions. Beginning pain severity was 6.5/10 and this reduced to 2.43/10 after treatment (p<.001). Average ketamine infusion time was 137.9 min and the average dose of ketamine was 65.2 mg. Side effects were transient "spaciness" in 4 patients and a sense of exhilaration in 4 more. No person fell asleep during treatment. We conclude that IV ketamine for treating refractory pain is a very effective new form of treatment with implications for pain pathophysiology and double-blind studies are warranted.

Ketamine is a potent blocker of NMDA-subtype glutamate receptors, thought to play a role in pain transmission and migraine pathophysiology. We chose to study this agent intramuscularly (IM) in the clinic to treat pain flare-ups and refractory migraines where IV placement was technically difficult for the patient or where time was of the essence. 9 patients (7=f, 2=m) were treated for refractory pain and headache in the clinic. A total of 19 IM injections of ketamine were given. 0.45mg/kg of ketamine was administered by IM injection [1/3rd of this dose was given, 10 minutes apart] and the VAS headache or pain score rated. If there were no side effects, another 0.45 mg/kg was administered in the same fashion. Patients rated their pain/headache on a 0-10 VAS. 1 patient received 11 injections for recurring migraines using the same dosage schedule. Beginning pain severity was 8.65/10 and this reduced to 2.71/10 after treatment (p<.001). The average dose of ketamine was 68.3 mg. Side effects were “spaciness” in 3 patients and a sense of exhilaration in 1 more. No person fell asleep during treatment. We conclude that IM ketamine for treating refractory pain and migraine flareups is a very effective new form of treatment in the outpatient clinic. IM ketamine should be studied in a double-blind fashion.