Screening and counseling practices reported by obstetrician-gynecologists for patients with hepatitis C virus infection.
(49/401)
BACKGROUND: Obstetrician-gynecologists are important providers of primary health care to women, and the hepatitis C virus (HCV) infection screening practices and recommendations provided by obstetrician-gynecologists for HCV-infected patients are unknown. METHODS: We surveyed American College of Obstetricians and Gynecologists (ACOG) Fellows, including 413 Fellows who were participating in the Collaborative Ambulatory Research Network (CARN) and 650 randomly sampled Fellows, about HCV screening and counseling practices. RESULTS: In total, 74% of CARN members and 44% of non-CARN members responded. Demographics and practice structure were similar between the two groups. More than 80% of providers routinely collected drug use and blood transfusion histories from their patients. Of the respondents, 49% always screened for HCV infection when patients had a history of injection drug use, and 35% screened all patients who had received a blood transfusion before 1992. For HCV-infected patients, 47% of the physicians always advised against breastfeeding, 70% recommended condom use with a long-term steady partner, and 64% advised against alcohol consumption. Respondents who considered themselves to be primary care providers were no more likely to screen or provide appropriate counseling messages than were other providers. CONCLUSIONS: Most obstetrician-gynecologists are routinely collecting information that can be used to assess HCV infection risk, but HCV screening practices and counseling that are provided for those with HCV infection are not always consistent with current Centers for Disease Control and Prevention and ACOG recommendations. (+info)
A comparison of cytology with Pap smears taken by a gynecologist and with a self-sampling device.
(50/401)
Cervical cancer is the most common cancer in Thai women and as yet screening programmes are minimally effective. The Pap smear is the test accepted to be most appropriate for cervical cancer screening so far. One of the main reasons why women do not come to have Pap smear done is "shyness", which weakens compliance with recommendations to undergo Pap smear with pelvic examination. The self-administered device by the Kato method was established to overcome this problem and the present study was carried out to confirm the adequacy of the specimens obtained with this technique in comparison with specimens collected by gynecologists. Two hundred women were invited to participate in the study voluntarily. Each was allocated to have a Pap smear conducted by a gynecologist and then instructed to produce a self-obtained smear using Kato's device. The cytology results of Pap smears from both methods were compared to test for agreement using Kappa statistics. There was agreement between the adequacy of smears collected by gynecologists and those self-sampled with the percentage agreement of 96.5% and a Kappa score of 0.43 (95% CI 0.33-0.54, P<0.001). There were 8 cases detected as epithelial cell abnormalities from the cervical cells collected by gynecologists and also with the self-administered technique. Good agreement for detection of cellular changes was found with a percentage of 78.0% and the Kappa's score was 0.61 (95% CI 0.46-0.76, P<0.001). The results from this study provide convincing evidence that the self-administered device can be an alternative choice for women who are too shy to undergo pelvic examination or even for those who have limited time to visit health care centers or doctors to have a Pap smear test. (+info)
ACOGQUEST: the model phase of the IAIMS project of the American College of Obstetricians and Gynecologists.
(51/401)
In 1990, the American College of Obstetricians and Gynecologists (ACOG) became the first national organization to receive a model phase Integrated Academic Information Management System (IAIMS) grant from the National Library of Medicine. The goal of the ACOG model phase project is to develop and test a prototype for an integrated system that will meet the needs of ACOG and NAACOG members in patient care, research, education, and administrative information. The model phase goal will be accomplished primarily through ACOGQUEST, an integrated approach to providing accurate, current, quality-filtered information to ACOG and NAACOG members in a variety of formats. Another method of information dissemination now being tested is a heuristic-based patient management database, which will include a concise, interactive display of ACOG-reviewed information that can be incorporated into patient records. (+info)
Casts of the vagina as a means of evaluating structural changes and treatment.
(52/401)
A method of making three-dimensional molds of the vagina with the materials used by dentists for oral impressions gives considerably more information about normal and abnormal anatomic features than other methods of study, including direct viewing, palpation and contrast x-ray studies. The molds are of value in the demonstration of anatomic patterns in relation to normal and abnormal functions, in evaluation of surgical and other therapeutic techniques, in teaching, and in explaining the abnormalities and the aims of treatment to patients. The use of such molds is being applied to the study of pelvic prolapse, urinary stress incontinence, sexual function of the vagina and birth injuries. (+info)
THE USE OF HYSTEROSALPINGOGRAPHY IN THE DIAGNOSIS OF INFERTILITY AND OTHER GYNECOLOGICAL CONDITIONS.
(53/401)
Hysterosalpingography was performed on 175 patients who had gynecological symptoms but negative pelvic findings, in order to test a new method of introducing the contrast medium into the uterus and tubes and to record the incidence of pathology revealed. In 132 patients, an attempt was made to secure a No. 14 Foley catheter in the uterus for introducing the contrast medium. This method was successful in 124 patients and can be recommended as being simple, less painful and more efficient than older methods. Of 156 patients with the complaints of infertility (68), dysmenorrhea (31), pelvic pain (29) or menstrual disorder (28), hysterosalpingography revealed significant abnormality in 58; most of these (47) had chronic salpingitis. One flare-up of pelvic inflammation occurred but no other complications were observed. It was concluded that hysterosalpingography is now sufficiently safe and reliable to merit wider utilization in gynecological diagnosis. (+info)
Vaginitis in a gynecologic practice in Israel: causes and risk factors.
(54/401)
BACKGROUND: Vaginal symptoms are a leading reason for a patient to visit her gynecologist. Little is known about the prevalence of the different causes of vaginitis and the risk factors for this entity in Israel. OBJECTIVE: To determine the prevalence of the main forms of vaginitis: vulvovaginal candidiasis, bacterial vaginosis, and trichomoniasis, in a gynecologic practice in Israel. METHODS: We evaluated 208 patients presenting with vaginal symptoms to a gynecologic clinic; 100 asymptomatic women who attended the clinic for routine check-up served as controls. Demographic, medical and gynecologic histories were obtained, and a pelvic examination was performed in all patients. Vaginal specimens were tested for pH and amine reaction, smeared for Gram-staining and cultured for yeasts and Trichomonas vaginalis. Bacterial vaginitis was diagnosed using the Nugent scoring system. Candida infection was diagnosed by microscopic examination and by culture. RESULTS: Candida spp. was the most common pathogen, documented by microscopy and culture in 35.5% of symptomatic women and 15% of asymptomatic controls (P < 0.001). Detection by culture only (negative microscopy) was documented in 18.7% of symptomatic patients and 15% of controls (P = 0.5). Bacterial vaginosis (Nugent score > or = 7) was diagnosed in 23.5% of patients and 13% of controls (P = 0.04). Trichomoniasis was present in 8.1% of symptomatic women and 4% of controls (P = 0.1). The main risk factors were antibiotic use for candidiasis and lack of use of oral contraception and condom use for trichomoniasis. CONCLUSION: Candida was by far the most common pathogen detected in our population. A statistically significant difference between patients and controls was noted for the prevalence of microscopically diagnosed candidiasis and bacterial vaginosis. (+info)
Issues to debate on the Women's Health Initiative (WHI) study. Prescription attitudes among Belgian gynaecologists after premature discontinuation of the WHI study.
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BACKGROUND: A survey was conducted in order to assess the attitude of Belgian practitioners toward HRT, after publication of the results of the 'Women's Health Initiative' (WHI) study. METHODS: Using a single case of a 55-year-old woman (no particular medical history, no longer climacteric symptoms), eight clinical case records were constructed by modifying three variables: (i) the HRT type [either conjugated estrogens (CEE) 0.625 mg + medroxyprogesterone acetate (MPA) or tibolone 2.5 mg]; (ii) the HRT duration (2 years or 11 years); and (iii) the bone density result (T-score +0.5 or -1.5). One case (drawn at random) was sent to Belgian gynaecologists (n = 1374), who were asked whether they would pursue, discontinue or modify the HRT regimen. RESULTS: In total, 577 returns were obtained (42% response rate). Globally, 19.8% of the physicians would stop prescribing the CEE+MPA regimen, 19.5% would continue the same regimen, and 60.7% would prescribe another HRT type, while respectively 15.9% of them would discontinue tibolone, 76.1% would continue it and 8% would prescribe another regimen (P < 0.001). After 2 years of use, 11.7% would discontinue HRT, while 23.5% would do so after 11 years (P < 0.001). No differences in prescription rates or discontinuation rates were observed in relation to the bone density results. CONCLUSIONS: The results of this survey suggested that Belgian gynaecologists intend to continue prescribing HRT, despite the negative findings of the WHI study. When patients are using tibolone, physicians generally maintain the same regimen, but when using CEE+MPA physicians tend to prescribe another HRT regimen. Less than 25% of physicians will spontaneously discontinue HRT, even after 11 years of use. (+info)
The value of transvaginal ultrasound to monitor the position of an intrauterine device after insertion. A technology assessment study.
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BACKGROUND: The intrauterine device (IUD) is an effective contraceptive method. The contraceptive power as well as the side-effects of IUD are thought to relate to the position of the IUD in the uterine cavity. We assessed the accuracy of clinical evaluation of IUD position. METHODS: A prospective comparative study was performed. The clinical evaluation was compared with the TVU measurement of IUD position both immediately after insertion and 6 weeks after insertion. The primary outcome measures were the positive and negative predictive values (PPV and NPV) of the clinical evaluation of IUD position. RESULTS: 195 women were included consecutively, 181 women (92.8%) were available for follow-up. The PPV and NPV of clinical evaluation of IUD position immediately after insertion were respectively 0.60 (95% CI: 0.39-0.81) and 0.98 (95% CI: 0.96-1.0). The prevalence of an abnormally positioned IUD was 7.7% (95% CI: 3.9-11.4). The PPV and NPV of the clinical evaluation at follow-up were respectively 0.54 (95% CI: 0.26-0.81) and 1.0 (95% CI: 0.98-1.0). The prevalence of abnormal position was 4.0% (95% CI: 1.7-7.1). CONCLUSION: Clinical evaluation is an excellent test for the evaluation of the position of an IUD and routine TVU is not indicated for this purpose. (+info)