PubMed Health⌕ Search

Biomedical subjects

L E Frisch

Publications and source records attributed to L E Frisch.

At least 19 recordsLinked to original sources
PubMed2000

Enhancing influenza immunization. Postcard and telephone reminders and the challenge of immunization site shift.

OBJECTIVE: To determine if postcard and telephone reminders increased the rate of influenza immunization of Medicare beneficiaries. DESIGN: Before and after trial (postcard reminders) with systematically allocated control group (telephone reminder intervention). SETTING: A semirural family practice residency program. PATIENTS AND OTHER PARTICIPANTS: All 475 noninstitutionalized persons older than 65 years who had received at least 1 office service in the previous 2 years. INTERVENTION: In September 1996, each of 475 patients received a postcard urging prompt influenza immunization. Those not responding within 1 month were systematically allocated either to a group receiving further telephone contact or to a control group. At the time of telephone contact, any offered information about influenza immunization received outside the Smoky Hill Family Practice Center, Salina, Kan, was recorded. MAIN OUTCOME MEASURES: We measured the percentage of change in practice-administered influenza immunizations compared with the baseline rate of the preceding 2 years; the difference in immunization rates between the telephone intervention group and controls; and the number of patients contacted by telephone who reported receiving influenza immunization at a site other than the Family Practice Center. RESULTS: Twenty-eight percent of patients who received a postcard obtained office influenza immunizations within 1 month, but no additional immunizations could be attributed to the telephone intervention. Thirty-five percent of patients contacted by telephone reported receiving influenza immunization at a site other than the Family Practice Center. CONCLUSIONS: The postcard intervention was associated with a significant increase in the office immunization rate. This increase may have been confounded by "site shift" in which individuals came to the office for an immunization that they might otherwise have received at other community sites.

Aged↗
PubMed1994

Naked-eye inspection of the cervix after acetic acid application may improve the predictive value of negative cytologic screening.

BACKGROUND: The purpose of this study was to assess the predictive value of naked-eye inspection of the cervix (NIC) after acetic acid application as an adjunct to Papanicolaou (Pap) testing for cervical cancer screening. METHODS: Study subjects were women attending a medical college student health clinic either for cervical cytologic screening (67%) or because of a recent atypical cytologic screening result (33%). All study participants received cytologic screening, cervicography, and NIC. RESULTS: Of the 95 patients, 71 (75%) had abnormal findings on NIC. Fifty-one patients underwent colposcopy with biopsy, including 48 of the 71 with an abnormal finding on NIC. The results of 40 of the biopsies were abnormal: 36 showed human papillomavirus or low-grade squamous intraepithelial lesions, 3 showed high-grade squamous intraepithelial lesions, and 1 showed invasive cervical cancer. Sixty-five percent (26) of the abnormal biopsy findings occurred in women with normal cytologic test results. NIC and cervicography both were effective in identifying patients with abnormalities, but the combination of NIC followed by cervicography referred fewer women for colposcopy than did a positive result on NIC alone (52% vs 75%). The combination of a negative Pap smear and a negative NIC result had a 91% predictive value for the absence of cervical intraepithelial neoplasia. This was a significant improvement over cytologic screening alone. CONCLUSIONS: In this study, the combination of cytologic screening (Pap smear) and NIC increased the screening yield as compared with a Pap smear alone but with some loss of positive predictive value. NIC significantly improved the predictive value of negative cytologic screening results.

Acetates↗
PubMed1993

Cervicography: an intermediate triage test for the evaluation of cervical atypia.

BACKGROUND: A substantial number of abnormal Papanicolaou (Pap) smears are reported as demonstrating "cytologic atypia." This finding may actually represent premalignant cervical disease. Some of these patients may not be able to afford definitive colposcopic examinations, and simply repeating cytologic testing may result in missed treatable disease. The purpose of this study was to evaluate the use of cervicography as an intermediate triage test for women with atypical cervical cytology. METHODS: Women with a recent smear demonstrating cytologic atypia were evaluated using colposcopy, biopsy, and cervicography. RESULTS: Colposcopically directed cervical biopsies were obtained from 224 of 685 women with cytologic atypia. The histologic specimens confirmed evidence of cervical dysplasia for 166 women. Of these women, cervicography detected 74.7% of those who had mild dysplasia, 87.5% of those who had moderate dysplasia, 75% of those who had severe dysplasia, and the one patient who had cervical cancer. Most (93%) of the women with dysplasia that was undetected by cervicography had mild dysplasia. CONCLUSIONS: Cervicography may be an effective intermediate triage test for the evaluation of young women with Pap smears demonstrating cytologic atypia.

Acetates↗
PubMed1993

Cervicography: adjunctive cervical cancer screening by primary care clinicians.

BACKGROUND: Cervicography is an adjunct method of cervical cancer screening intended to complement cervical cytologic sampling, ie, Papanicolaou (Pap) smear. Cervicography involves obtaining and evaluating a photographic image of the cervix. The purpose of this investigation was to evaluate the screening use of cervicography as an adjunct to clinical cytologic screening. METHODS: Women presenting at four clinical sites for annual cervical cytologic screening or for follow-up evaluation after receiving an abnormal Pap smear result were enrolled in the study. Each patient received a Pap smear and a cervigram. Those women in whom abnormalities were detected by either test subsequently underwent colposcopy, and when appropriate, histologic specimens were obtained. RESULTS: Pap smear and cervigram data were obtained for 1449 women. When premalignant or malignant histologic test results were considered as a true positive, the Pap smear correctly identified 25.6% of subjects with dysplasia and 37.5% with severe dysplasia. The Pap smear failed to identify the one patient with invasive cancer. The cervigram detected 50.5% of the subjects with dysplasia and 77.8% of the subjects with severe dysplasia, and it identified the one patient with invasive cancer when a positive cervigram was considered a true positive. When the results were combined, the two tests identified 62.9% of subjects with histologically confirmed dysplasia, 81.3% of subjects with severe dysplasia, and 100% (one patient) with cancer. CONCLUSIONS: The cervigram detected twice the number of patients with premalignant disease as the Pap smear alone, and correctly identified the invasive cancer. Cervicography improved the detection of cervical disease.

Adolescent↗
PubMed1990

An analysis of and intervention in the sexual transmission of disease.

Sexually transmitted diseases are a serious threat to the public health. Indeed, when an individual seeks medical treatment for a sexually transmitted disease, health authorities frequently attempt to identify, procure, and treat that individual's sexual contact(s). We conducted a comparative analysis of three alternative approaches to tracing the sexual partners of individuals diagnosed as having a sexually transmitted disease. The first approach involved counseling individuals (n = 27) infected with either gonorrhea or nongonococcal urethritis and exhorting them to procure their sexual partners for treatment. In addition to counseling, the second and third approaches involved distributing "occasion cards" for patients to use when informing sexual contacts of the need for treatment. Moreover, in the second approach, the counselor (a nurse or physician) informed infected patients (n = 19) that they and their partners could waive the $3 clinic fee contingent upon the partners seeking treatment within 1 week. In the third approach, the counselor asked infected persons (n = 19) to accept a follow-up telephone contact if their sexual partners failed to seek treatment within 1 week. The third approach was most effective. Ninety percent of the partners identified through this approach sought treatment, versus only about 60% of the partners in the other two conditions. The third approach was also the least expensive, costing about $2.95 to procure each partner for treatment.

Adolescent↗
PubMed1989

Interlaboratory test discordance in screening adolescents for Chlamydia with direct immunofluorescence.

Chlamydia testing using direct fluorescent antibodies (DFA) is widely employed for screening and in clinical practice. We submitted duplicate DFA specimens to two pairs of laboratories during two study periods separated by a year. We found discordance between reports (one positive, one negative on the same individual) in 75% of chlamydia-positive cases when one pair of laboratories was compared and in 50% of cases when a second pair was compared. Calculations show that with optimum published test performance, a discordance rate of 40% might be anticipated. Our observed discordance of 75% suggests inaccurate test performance by one laboratory with regard to sensitivity and specificity, albeit not to levels differing from those reported by others for in-the-field test performance. The implications of suboptimal test sensitivity and specificity for epidemiologic study and clinical practice are discussed. Because a diagnosis of sexually transmitted disease may be disruptive for adolescent relationships, maximum laboratory accuracy is needed.

Adolescent↗
PubMed1989

Management of the abnormal Papanicolaou smear.

Since 1943, Papanicolaou (Pap) smears have been widely used to screen for cervical cancer. Over the past 25 years, new understanding of the natural history of cervical epithelial neoplasia has defined the existence and importance of dysplasia, also termed cervical intraepithelial neoplasia (CIN), and more recently, its probable link to human papilloma virus (HPV). Inflammatory atypia (IA) is a common cytological diagnosis whose significance is less understood. Current gynecological opinion strongly supports a practice of colposcopic evaluation for all women with cytology showing any degree of CIN. Data from studies in our health service and elsewhere establish that 15% to 30% of patients with IA will have CIN if evaluated by colposcopy. Although clinicians may choose to follow such patients with repeated Pap smears, there are strong arguments for offering colposcopic evaluation to patients with IA. Potential problems with false-positive cervical biopsy reports, however, may limit the utility of colposcopy in patients with IA cytology.

Carcinoma in Situ↗
PubMed1988

Presumed reduction of acute ossicular subluxation by pneumatic otoscopy. Tympanometric evidence.

A 19-year-old college student sustained an otologic injury by striking the side of his face on water after diving off a 5-meter platform. Tympanometry performed immediately after the injury revealed a high-compliance notched tracing that reverted to normal after pneumatic otoscopy. Relevant experimental data on notched tracings in surgically induced ossicular discontinuity is reviewed. This case likely represents ossicular subluxation possibly related to previous otologic trauma and reduced during pneumatic otoscopy.

Acoustic Impedance Tests↗
PubMed1985

Adolescent cavitary tuberculosis. Secondary case finding using a social contact scale.

The spread of tuberculosis in a university environment following a case of cavitary disease was studied. Six loci of potential secondary infection were ascertained and the persons at risk were identified for tuberculin screening. All named contacts were ranked by the index patient and her friends on a closeness scale for social contact. This scale proved to be an excellent predictor of tuberculin positivity, suggesting that in a noninstitutionalized setting the risk of tuberculin conversion is associated more with social contact than with mere living proximity.

Adolescent↗
PubMedDate not supplied

Inflammatory epithelial changes and nonviral cervicovaginal pathogens.

To assess the relationship between inflammatory epithelial changes (IECs) and cervicovaginal infection, 249 women with cytologic diagnoses of IEC were studied. The findings showed a Chlamydia infection in 15.7% of the cases, Monilia in 38.1%, Trichomonas in 1.6% and a lateral vaginal wall pH of greater than 5.5 in 29.7%. These results were compared with those for 211 controls drawn from the same population; women with abnormal cytologic reports were excluded from the control group. The controls had a prevalence of yeast and trichomoniasis no different from that of the IEC group. In contrast, the prevalence of chlamydial infection (7.6%) and pH greater than 5.5 (10.7%) were significantly lower in the controls than in the IEC cases. Chlamydia was found in 30.2% of 43 women with an atypical transformation zone, equally distributed between women whose biopsies were normal and those whose biopsies showed cervical intraepithelial neoplasia. The traditional guidelines of treating cases with cytologic diagnoses of IEC prior to obtaining a repeat smear may need reevaluation in the light of these findings.

Animals↗
PubMedDate not supplied

Improving the sensitivity of cervical cytologic screening. A comparison of duplicate smears and colposcopic examination of patients with cytologic inflammatory epithelial changes.

During a ten-month period, 264 cervical cytologic specimens were submitted in duplicate to two separate cytology laboratories. An attempt was made to perform colposcopy on all 45 patients reported as having an abnormality by either laboratory. All but one patient with a cytologic diagnosis of cervical intraepithelial neoplasia (CIN) underwent colposcopy, as did 68% of the patients with a diagnosis of nondysplastic atypia (inflammatory epithelial changes [IEC]). Five cases of histologically verified CIN were found by colposcopic study of patients with a cytologic diagnosis of CIN; two additional cases were found by colposcopic study of patients with a cytologic diagnosis of IEC. On the assumption that patients not colposcoped were not systematically different from the others with IEC, the screening sensitivities for both laboratories and for cytology followed by colposcopy of IEC cases were estimated. A statistically significant improvement in screening sensitivity was achieved by colposcopic examination of patients with IEC. This conclusion was tempered by a Bayesian analysis that suggested that some of the apparent improved sensitivity could be due to falsely positive biopsy reports. Despite potential benefits, it is premature to recommend universal colposcopic examination of patients with cytologic reports of inflammatory epithelial changes.

Cervix Uteri↗
PubMedDate not supplied

Nongonococcal urethritis incidence has fallen at one university health service: are "safer sex" messages being heard?

The authors determined the incidence of nongonococcal urethritis (NGU) longitudinally in patients attending a university health service between August 1986, and May 1988. During this period, the authors observed a statistically significant fall in NGU incidence. This fall coincided with awareness of AIDS risks due to national and local media encouragement of condom use and avoidance of anonymous or promiscuous contacts. Although the authors have no evidence that these educational efforts resulted in the observed fall in NGU incidence, other examined, potentially intervening variables can not completely explain the observed changes. A fall in NGU incidence may be a marker for a more generally decreased risk of sexually transmitted diseases (STDs) in at least some men.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Colposcopy of patients with cytologic inflammatory epithelial changes.

Of 3,308 cervical cytologies performed at a university health service between September 1986 and September 1987, 371 were reported as showing inflammatory epithelial changes (IECs). Colposcopy was offered to all patients with this diagnosis and was actually performed on 200 (54%). Of these women, 44 had an atypical transformation zone; of the 33 who were biopsied, 23 had histologic diagnoses ranging from human papillomavirus (HPV) infection (4 cases) to grade III cervical intraepithelial neoplasia (CIN; 4 cases). Most biopsies showed CIN I. In our clinic, the 95% confidence limits for the histologic diagnosis of HPV or CIN in women with a cytologic diagnosis of IEC are 8.5% to 23.5%. Colposcopic examination of women with IEC may be able to detect patients with CIN who are missed by standard cytologic screening. Concerns about a potential bias from false-positive histology reports must be resolved before such an approach can be recommended.

Biopsy↗
PubMedDate not supplied

Inflammatory atypia. An apparent link with subsequent cervical intraepithelial neoplasia explained by cytologic underreading.

A review of 5,752 cervical smears done on college students at a medium-sized midwestern university in a 24-month period showed 496 cytologic diagnoses of inflammatory atypia and 132 of dysplasia (cervical intraepithelial neoplasia: CIN). Further retrospective review of a nonselected cohort (178 cases) of the 496 patients with inflammatory atypia showed that their subsequent cytologic smears were more likely to show CIN than could be explained by chance alone. Only ten cases accounted for this difference, and a case-controlled blind review of the original cytologic smears of these ten patients resulted in the reclassification to CIN (mild dysplasia) of seven who had subsequently "progressed" from inflammatory atypia to dysplasia. Only one control smear was reclassified. In this population, underreading of a small number of cervical smears explained a strong statistical apparent correlation between inflammatory atypia and the subsequent development of CIN.

Adult↗