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Objectives In this study, Increasing Viral Testing in the Emergency Department (InVITED), the authors investigated if a brief intervention about human immunodeficiency virus (HIV) and hepatitis C virus (HCV) risk-taking behaviors and drug use and misuse in addition to a self-administered risk assessment, compared to a self-administered risk assessment alone, increased uptake of combined screening for HIV and HCV, self-perception of HIV/HCV risk, and impacted beliefs and opinions on HIV/HCV screening. Methods InVITED was a randomized, controlled trial conducted at two urban emergency departments (EDs) from February 2011 to March 2012. ED patients who self-reported drug use within the past 3 months were invited to enroll. Drug misuse severity and need for a brief or more intensive intervention was assessed using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Participants were randomly assigned to one of two study arms: a self-administered HIV/HCV risk assessment alone (control arm) or the assessment plus a brief intervention about their drug misuse and screening for HIV/HCV (intervention arm). Beliefs on the value of combined HIV/HCV screening, self-perception of HIV/HCV risk, and opinions on HIV/HCV screening in the ED were measured in both study arms before the HIV/HCV risk assessment (pre), after the assessment in the control arm, and after the brief intervention in the intervention arm (post). Participants in both study arms were offered free combined rapid HIV/HCV screening. Uptake of screening was compared by study arm. Multivariable logistic regression models were used to evaluate factors related to uptake of screening. Results Of the 395 participants in the study, the median age was 28 years (interquartile range [IQR] = 23 to 38 years), 44.8% were female, 82.3% had ever been tested for HIV, and 67.3% had ever been tested for HCV. Uptake of combined rapid HIV/HCV screening was nearly identical by study arm (64.5% vs. 65.2%; Δ = –0.7%; 95% confidence interval [CI] = –10.1% to 8.7%). Of the 256 screened, none had reactive HIV antibody tests, but seven (2.7%) had reactive HCV antibody tests. Multivariable logistic regression analysis results indicated that uptake of screening was not related to study arm assignment, total ASSIST drug scores, need for an intervention for drug misuse, or HIV/HCV sexual risk assessment scores. However, uptake of screening was greater among participants who indicated placing a higher value on combined rapid HIV/HCV screening for themselves and all ED patients and those with higher levels of perceived HIV/HCV risk. Uptake of combined rapid HIV/HCV screening was not related to changes in beliefs regarding the value of combined HIV/HCV screening or self-perceived HIV/HCV risk (post– vs. pre–risk assessment with or without a brief intervention). Opinions regarding the ED as a venue for combined rapid HIV/HCV screening were not related to uptake of screening. Conclusions Uptake of combined rapid HIV/HCV screening is high and considered valuable among drug using and misusing ED patients with little concern about the ED as a screening venue. The brief intervention investigated in this study does not appear to change beliefs regarding screening, self-perceived risk, or uptake of screening for HIV/HCV in this population. Initial beliefs regarding the value of screening and self-perceived risk for these infections predict uptake of screening. Resumen Objetivos El estudio Increasing Viral Testing in the Emergency Department (InVITED) investiga si una intervencion breve sobre los comportamientos de riesgo en relacion con el virus de inmunodeficiencia humana (VIH) y la hepatitis C (VHC), consumo y abuso de drogas, junto con una evaluacion autoadministrada del riesgo, en comparacion con solo la evaluacion autoadministrada del riesgo, incrementaba la aceptacion de despistaje combinado de VIH y VHC, el riesgo autopercibido de VIH/VHC, y las creencias y opiniones del despistaje de VIH/VHC. Metodologia InVITED fue un ensayo clinico controlado y aleatorizado llevado a cabo en dos SU urbanos de febrero de 2011 a marzo de 2012. Se invito a participar a los pacientes del SU que autorefirieron consumo de drogas en los tres ultimos meses. La gravedad del abuso de drogas y la necesidad de una intervencion breve o mas intensa se valoro usando el Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Los pacientes fueron asignados aleatoriamente a uno de los dos brazos del estudio: solamente evaluacion autoadministrada del riesgo de VIH/VHC (grupo control) o la evaluacion mas una intervencion breve sobre sus abusos de drogas y el despistaje de VIH/VHC (grupo de intervencion). Se midieron las creencias acerca del valor del despistaje combinado VIH/VHC, la autopercepcion del riesgo de VIH/VHC, y las opiniones acerca del despistaje de VIH/VHC en el SU en ambos brazos del estudio antes de la evaluacion del riesgo de VIH/VHC (pre), despues de la evaluacion en el grupo control, y despues de la intervencion breve (post). Se ofrecio gratuitamente un test de despistaje rapido VIH/VHC a los participantes de ambos brazos del estudio. La aceptacion del despistaje se comparo segun el brazo del estudio. Se usaron modelos de regresion logistica multivariable para evaluar los factores relacionados con la aceptacion del despistaje. Resultados De los 395 participantes del estudio, la mediana de edad fue de 28 anos (RIC de 23 a 38), un 44,8% fueron mujeres, un 82,3% nunca habia recibido un test de VIH, y un 67,3% nunca de VHC. La aceptacion del despistaje rapido combinado de VIH/VHC fue practicamente igual en ambos brazos del estudio (64,5% contra 65,2%; Δ = -0,7%; IC 95% = -10,1% a 8,7%). De los 256 a los que se les realizo el despistaje, ninguno tuvo un test de anticuerpos de VIH positivo, pero siete (2,7%) presentaron un test de anticuerpos de VHC positivo. Los resultados del analisis de regresion logistica multivariable indicaron que la aceptacion del despistaje no se relaciono con el brazo de asignacion del estudio, el total de las puntuaciones del test ASSIST, la necesidad de una intervencion sobre el abuso de drogas, o las puntuaciones de evaluacion del riesgo sexual de VIH/VHC. Sin embargo, la aceptacion del despistaje fue mayor entre los participantes que indicaron otorgar un mayor valor al despistaje rapido combinado de VIH/VHC para si mismos y para todos los pacientes del SU, y aquellos con mayores niveles de riesgo percibido de VIH/VHC. La aceptacion del despistaje rapido combinado de VIH/VHC no se relaciono con cambios en las creencias sobre el valor del despistaje combinado VIH/VHC o la autopercepcion del riesgo de VIH/VHC (valoracion del riesgo pre, con o sin intervencion breve, frente a post). Las opiniones acerca del SU como un lugar para el despistaje rapido combinado de VIH/VHC no se relacionaron con la aceptacion del despistaje. Conclusiones La aceptacion del despistaje rapido combinado de VIH/VHC es elevada y se considero valiosa entre los pacientes del SU con consumo o abuso de drogas sin mucha preocupacion sobre el SU como lugar de despistaje. La intervencion breve investigada en este estudio no parece cambiar las creencias acerca del despistaje, el riesgo autopercibido, o la aceptacion del despistaje de VIH/VHC en esta poblacion. Las creencias iniciales respecto al valor del despistaje y al riesgo autopercibido para estas infecciones predijeron la aceptacion del despistaje.

CONTEXT Research has demonstrated the potential adverse impact of pharmaceutical company marketing techniques on doctor knowledge and prescribing practices. Lack of experience may make resident doctors particularly vulnerable to pharmaceutical industry influence. Curricula addressing resident-pharmaceutical industry relations have been reported, but there is no consensus regarding the best approach to take. OBJECTIVE This study aimed to review published curricula that address resident-pharmaceutical industry relations and to assess them for content, validity and outcomes measures. METHODS Curricula were identified via searches of electronic databases and bibliographies of collected articles. Inclusion criteria required articles to describe an educational curriculum, applied in graduate medical education, on relations between doctors and the pharmaceutical industry. RESULTS The search identified 9 curricula. Most addressed detailing of residents by pharmaceutical representatives. Two articles described curriculum development. Eight articles included an evaluation component; only 1 included a control group for comparison. Modest improvements were noted in resident confidence, knowledge of guidelines, belief in the potential influence of marketing on behaviour, and self-reported acceptance of gifts. Only 2 evaluations used a validated outcome instrument, and no studies included longterm follow-up. CONCLUSIONS A limited number of curricula have addressed resident-pharmaceutical industry interactions. Inconsistency in content, application and evaluation methodology prevents any meaningful synthesis of data. Resident attitudes and behaviours may be affected, but the outcome measures used lacked sufficient validity to assess improvements in knowledge and analytic skills. A clearer delineation of the curriculum development process and the use of standardised outcome measures would facilitate the reproduction of positive results at other institutions.

This paper describes the management of a 24-month-old boy who presented with self-inflicted trauma to his lower lip and tongue, and teeth grinding, 21 days after developing meningococcal septicaemia. A decision to observe and prescribe palliative therapy was made. Extraction of the lower right deciduous canine, which had become non-vital, possibly due to bruxism, was carried out.