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Biomedical subjects

J Nuovo

Publications and source records attributed to J Nuovo.

At least 19 recordsLinked to original sources
PubMed2001

New tests for cervical cancer screening.

The Papanicolaou (Pap) smear has been used to screen women for cervical cancer since 1940. Recently, a number of new technologies have been developed to improve the detection of cervical cancer and its precursors. However, there is substantial controversy about whether the new tests offer meaningful advantages over the conventional Pap smear. Ideally, these new tests will increase the early detection of meaningful Pap smear abnormalities, reduce the number of unsatisfactory smears and provide fewer ambiguous results. It is also hoped that these new screening methods will not increase the number of false-positive results, but will improve the productivity of cytology laboratories without substantially increasing costs. The new tests include liquid-based/thin-layer preparations to improve the quality and adequacy of the Pap smear; computer-assisted screening methods to improve Pap smear interpretation; and new-generation human papillomavirus testing methods that may be useful in triaging patients with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions. Evidence on these new tests is reviewed and the advantages and disadvantages of their use are discussed.

Cytopathogenic Effect, Viral↗
PubMed2000

Treatment outcomes for squamous intraepithelial lesions.

OBJECTIVE: To assess the effectiveness of cone biopsy, cryotherapy, laser ablation and the loop electrosurgical procedure in the treatment of squamous intraepithelial lesions. METHOD: Systematic review of randomized controlled trials in subjects who underwent treatment of low- and high-grade squamous intraepithelial lesions with these modalities. Main outcome measures included the following: percent resolution and persistence of a lesion and notable complications for each procedure. RESULT: Pooled rates of resolution for low-grade, high-grade, or combined squamous intraepithelial lesions were similar across the different treatment modalities (range 85.2-94.7%), with substantial overlap among the 95% confidence intervals. Significant hemorrhage occurred most frequently in subjects who received cone biopsy (4.6%) (95% CI: 2.15, 6.99), followed by laser ablation (1.75%) (95% CI: 0.70, 2.81), and LEEP (1.35%) (95% CI: 0.24, 2.47). No hemorrhages were reported among subjects who received cryotherapy. Study sample sizes were relatively small. There were no reported cases of progression to invasive cancer, but duration of follow-up (median follow-up time for all eligible studies = 12 months) was not sufficient to evaluate long-term outcomes. CONCLUSIONS: There were no substantive differences in outcomes regarding persistence and resolution in the treatment of squamous intraepithelial lesions for subjects receiving cone biopsy, cryotherapy, laser ablation, or LEEP.

Biopsy↗
PubMed1999

Interpretation of the electronic fetal heart rate during labor.

Electronic fetal heart rate monitoring is commonly used to assess fetal well-being during labor. Although detection of fetal compromise is one benefit of fetal monitoring, there are also risks, including false-positive tests that may result in unnecessary surgical intervention. Since variable and inconsistent interpretation of fetal heart rate tracings may affect management, a systematic approach to interpreting the patterns is important. The fetal heart rate undergoes constant and minute adjustments in response to the fetal environment and stimuli. Fetal heart rate patterns are classified as reassuring, nonreassuring or ominous. Nonreassuring patterns such as fetal tachycardia, bradycardia and late decelerations with good short-term variability require intervention to rule out fetal acidosis. Ominous patterns require emergency intrauterine fetal resuscitation and immediate delivery. Differentiating between a reassuring and nonreassuring fetal heart rate pattern is the essence of accurate interpretation, which is essential to guide appropriate triage decisions.

Bradycardia↗
PubMed1999

Failure to keep clinic appointments: implications for residency education and productivity.

BACKGROUND AND OBJECTIVES: Missed clinic appointments significantly impact continuity of care, resident education, and clinical productivity. This national survey analyzed the awareness of family practice residency clinics regarding their missed appointment rate and the use of reminder systems. METHODS: We mailed a questionnaire to all 468 family practice residency programs in the United States and mailed two follow-up surveys to nonrespondents. RESULTS: The overall survey response rate was 60%. More than one third of the clinics reported a no-show rate of > 21%. When asked how the clinic arrived at their no-show rate, 64 (17.7%) respondents stated that the reported rate was an estimate. More than one third of all clinics did not use a patient reminder system for clinic appointments. When comparing clinics with high (> 20%) and low (< 20%) no-show rates, there was no statistically significant difference between the use or nonuse of mailed, telephone, or combined reminder systems. CONCLUSIONS: The clinic appointment no-show rate varies greatly among family practice residency programs. Even with the widely reported use of reminder systems, one third of programs continue to have no-show rates above 20%. This study is unusual in that there was no statistically significant difference in no-show rates between programs, based on the use of reminder systems. In an era of cost containment and increased accountability, appointment failures are a factor that will require additional study and intervention by family practice residency programs nationwide.

Appointments and Schedules↗
PubMed1998

Natural history of cervical squamous intraepithelial lesions: a meta-analysis.

OBJECTIVE: To define the strengths and weaknesses of existing research on the natural history of cervical squamous intraepithelial lesions (SIL) and to estimate rates of progression and regression without treatment. DATA SOURCES: Studies of women whose cervical smears showed squamous atypia or worse and who were observed for a minimum of 6 months were identified by a search of MEDLINE from 1966 to 1996, Current Contents, the Federal Research in Progress database, and references of review articles and identified studies, and by experts in the field. METHODS OF STUDY SELECTION: Fifteen of 81 studies were eligible for data extraction. To be eligible, studies had to report a minimum of 6 months' follow-up without treatment; relate entry cytologic findings to outcomes; and report entry cytologic findings so that the study population could be stratified into categories of atypical cells of undetermined significance (ASCUS), low-grade SIL, or high-grade SIL. Studies published before 1970 were excluded. TABULATION, INTEGRATION, AND RESULTS: Eligible studies, representing 27,929 patients, were stratified according to entry cytologic findings. The following rates of progression to high-grade SIL at 24 months were found: ASCUS, 7.13% (95% confidence interval [CI] 0.8%, 13.5%); low-grade SIL, 20.81% (6.08%, 35.55%); and high-grade SIL, 23.37% (12.82%, 32.92%). The following rates of invasive cancer at 24 months were found: ASCUS, 0.25% (0%, 2.25%); low-grade SIL, 0.15% (0%, 0.71%); and high-grade SIL, 1.44% (0%, 3.95%). The following rates of regression to normal were found: ASCUS, 68.19% (57.51%, 78.86%); low-grade SIL, 47.39% (35.92%, 58.86%); and high-grade SIL, 35.03% (16.57%, 53.49%). Study heterogeneity was not explained by regression analysis of study level variables. CONCLUSION: Our findings for borderline and low-grade abnormal cervical cytologic results suggest a relatively low risk of invasive cervical cancer with observation up to 24 months and support the clinical policy of early colposcopy for high-grade lesions.

Carcinoma in Situ↗
PubMed1997

Detection of high-grade cervical dysplasia: impact of age and Bethesda system terminology.

Pap smear, colposcopy, and biopsy results were collected from 1988-1993 at a group of family planning clinics. Positive predictive values and likelihood ratios were calculated for diagnosis of high-grade lesions based on age and Pap smear results. One thousand and forty-seven colposcopies were logged; 771 had a biopsy or endocervical curettage. Seventy-nine (10%) were high-grade lesions. If only human papillomavirus (HPV) was reported on the Pap smear, the likelihood of a high-grade biopsy was lowest (positive predictive value, 4.5%; likelihood ratio, 0.4). Women under age 25 were less likely to have high-grade biopsies (positive predictive value, 7.3%; likelihood ratio 0.7). Repeat Pap smears for atypical cells of undetermined significance (ASCUS) and low grade squamous intra-epithelial lesion (LGSIL) showing only HPV in women under age 30 would have reduced the immediate colposcopy rate by 60% and delayed diagnosis by 23% of high-grade lesions. Consideration of patient age and whether HPV is the only Pap smear finding may reduce referral for immediate colposcopy.

Adult↗
PubMed1997

Cancer prevention and screening in women.

Although there is no recommended screening for ovarian or endometrial cancers, the use of oral contraceptives is a primary prevention maneuver. The prevention of cervical cancer is accomplished best by Pap smear screening every 1 to 3 years. Clinical breast examination and mammography every 1 to 2 years after age 50 years are effective in reducing breast cancer mortality. Screening for BRCA1 and BRCA2 mutations is now available, but the role of these tests is still not clear; extensive patient counseling is required.

Adult↗
PubMed1996

Management choices for patients with "squamous atypia" on Papanicolaou smear. A toss up?

Appropriate management of borderline abnormalities on Papanicolaou (Pap smears is controversial. This decision analysis compared two strategies for management of women with the Pap smear result of "squamous atypia." A policy of immediate colposcopy and biopsy was compared with repeating the cervical smear at 6-month intervals. Relevant probabilities and ranges were extracted from published studies in the English language medical literature from 1966 to 1993. When no relevant studies could be located, probabilities with a plausible range were determined through consensus of a panel of experts. Outcome values were assigned for the analysis to contrast the time period (approximately 2 years) covered by the analysis. Using baseline estimates, either policy resulted in an essentially equivalent probability of invasive cervical cancer. The estimated likelihood of remaining free of invasive cervical cancer was .9974 for follow-up by repeat smear versus .9976 for immediate colposcopy and biopsy. In sensitivity analysis, very high probabilities of progression to invasive cervical cancer favored the policy of immediate colposcopy and biopsy. Follow-up of squamous atypia on cervical smear by repeating the smear at 6-month intervals is unlikely to result in a detectable increase in invasive cervical cancers.

California↗
PubMed1995

Management of patients with atypical and low-grade Pap smear abnormalities.

Family physicians frequently encounter patients with atypical and low-grade Papanicolaou (Pap) smear findings. While near consensus exists regarding the evaluation and management of patients with high-grade dysplasia and carcinoma detected on Pap smear, the appropriate management of patients with atypical and low-grade abnormalities continues to be controversial. Recent guidelines from the National Cancer Institute propose consideration of a more conservative management approach, with repeat Pap smear as an alternative to immediate colposcopy. Conservative management, as an alternative to an ablative or excisional procedure, has also been proposed for women with histologic evidence of lowgrade dysplasia. It is unlikely that an approach including a conservative diagnostic strategy and careful follow-up will result in an increase in the number of missed cases of cervical cancer. This assumption needs to be assessed by prospective clinical trials.

Algorithms↗
PubMed1991

Should family physicians test for human papillomavirus infection? An opposing view.

Recent advances in the field of molecular biology have expanded the knowledge of HPV manifestations. We have attempted to separate those circumstances when HPV testing may be useful in patient management and when it may not. Routine screening for HPV has not yet been shown to be useful. One must weigh informing 10% of patients that they have a potentially oncogenic virus against the ability of a repeat Papanicolaou smear to detect the lesion. On the other hand, HPV detection in the setting of an abnormal Papanicolaou smear and an acetowhite lesion that on biopsy lacks the histologic features of CIL does predict who is at high risk for CIL. HPV typing should not affect clinical management, and we do not recommend it. HPV detection by in situ hybridization is a very useful adjunct to histological analysis in genital tract lesions that are clinically suggestive of an HPV lesion but where the histological analysis is equivocal. This ability to distinguish true HPV lesions from its mimics is often crucial to the patient, given the implications of having a sexually transmitted disease.

DNA, Viral↗
PubMed1989

Use of dietary fiber to lower cholesterol.

Dietary water-soluble fiber may be a key factor in the management of hypercholesterolemia. Food items that are rich in this type of fiber are common and are easy to incorporate into a patient's diet. The lipid-lowering effect is dose-related. Consumption of an adequate amount of water-soluble fiber each day may reduce cholesterol levels by 10 to 20 percent.

Anticholesteremic Agents↗
PubMed1986

Overanxious parents.

Some parents experience excessive anxiety when their children have minor illnesses. Characteristic behaviors of overanxious parents include a reluctance to finish the office visit and a lack of satisfaction with treatment recommendations. The failure of these parents to recognize the underlying sources of their anxiety may result in dissatisfaction with care, inappropriate use of the health care system and problems in the parent-child relationship.

Adult↗
PubMed1985

Clinical application of a high-risk scoring system on a family practice obstetric service.

A previously described antepartum risk-scoring system was evaluated in 113 consecutive deliveries done by family physicians to determine whether a request for obstetric or pediatric assistance could be predicted. In the defined low-risk group (score less than or equal to 3) assistance was requested in 12 of 72 patients. In the defined high-risk group (score greater than 3) assistance was requested in 23 of 41 patients. Out of 28 requests for obstetric assistance, 22 requests were for a specific skill (cesarean sections, difficult forceps, premature deliveries, shoulder dystocia, and retained placenta). All of the 27 requests for pediatric assistance were for acute resuscitation of the newborn. Reinforced in this study was the finding that a relatively small segment of patients (36 percent of the population) gave rise to most (67 percent) of the morbidity. Knowledge of this simple, reliable method to predict high-risk obstetric patients should help family physicians reduce maternal and infant morbidity.

Family Practice↗