Biomedical subjects

Walter Prendiville

Publications and source records attributed to Walter Prendiville.

3 recordsLinked to original sources

PubMed2006

Diagnostic accuracy of human papillomavirus testing in primary cervical screening: a systematic review and meta-analysis of non-randomized studies.

OBJECTIVE: This is a meta-analysis of studies comparing HPV testing to cytology with regard to their accuracy in the detection of underlying high grade cervical intraepithelial neoplasia in primary cervical cancer screening. METHODS: A systematic review was conducted following the Cochrane Collaboration Guidelines. A systematic search was performed in 8 electronic databases. Strict selection criteria were applied in terms of types of participants, types of interventions and methods to limit verification bias. Where possible we calculated the sensitivity, specificity, positive and negative predictive value of cytology and the HPV test, as well as sensitivity and specificity ratios for the detection of CIN2 or worse. Random effect models were used for pooling accuracy parameters. The results were displayed using forest plots. RESULTS: We identified 25 studies fulfilling the inclusion criteria. The pooled sensitivity of HC2, PCR, cytology (ASCUS or worse) and cytology (LSIL or worse) was 90%, 80.9%, 72.7% and 61.6%, respectively, and the pooled specificity was 86.5%, 94.7%, 91.9% and 96.0%, respectively. The ratio of the sensitivity of HC2 to cytology (ASCUS) was 1.25 (95% CI=1.20-1.29), and the corresponding specificity ratio was 0.97 (95% CI=0.96-0.98). The ratio of the sensitivity of combination of HC2 and cytology (ASCUS) to HC2 alone was 1.05 (95% CI=1.04-1.06) and the ratio of the specificity 0.95 (95% CI=0.94-0.96). For women over 30 years, the sensitivity of HC2 was 94.8% and the specificity 86.0%. CONCLUSIONS: Compared to cytology, the HC2 and PCR are substantially more sensitive for prevalent CIN2 or worse but significantly less specific. The combination of HC2 and cytology has the highest sensitivity and lowest specificity. However, reduction of the incidence of or mortality from invasive cervical cancer among HPV screened subjects compared to cytologically screened subjects has not yet been demonstrated.

Female↗

PubMed2005

Recent innovations in colposcopy practice.

Colposcopic practice continues to evolve. As its need has expanded, so has the role of training, audit and continuing medical education. The recently published National Health Service Cervical Screening Programme clinical guidelines document covers almost every aspect of clinical practice in an evidence-based directory. Excision of the transformation zone (TZ) may be a very minor or major entity. The recent TZ classification system of the International Federation of Cervical Pathology and Colposcopy attempts to clarify and standardize nomenclature so that therapy can be realistically compared. The role of human papillomavirus (HPV) in clinical practice continues to be controversial and has not yet found a place in the UK. For the evaluation of borderline nuclear abnormal smear and for post-treatment surveillance, HPV is clinically useful and efficient. Other biological tumour markers are likely to become clinically useful as their predictive profiles emerge.

Ambulatory Surgical Procedures↗

PubMed2005

Amnioinfusion for the prevention of the meconium aspiration syndrome.

BACKGROUND: It is uncertain whether amnioinfusion (infusion of saline into the amniotic cavity) in women who have thick meconium staining of the amniotic fluid reduces the risk of perinatal death, moderate or severe meconium aspiration syndrome, or both. METHODS: We performed a multicenter trial in which 1998 pregnant women in labor at 36 or more weeks of gestation who had thick meconium staining of the amniotic fluid were stratified according to the presence or absence of variable decelerations in fetal heart rate and then randomly assigned to amnioinfusion or to standard care. The composite primary outcome measure was perinatal death, moderate or severe meconium aspiration syndrome, or both. RESULTS: Perinatal death, moderate or severe meconium aspiration syndrome, or both occurred in 44 infants (4.5 percent) of women in the amnioinfusion group and 35 infants (3.5 percent) of women in the control group (relative risk, 1.26; 95 percent confidence interval, 0.82 to 1.95). Five perinatal deaths occurred in the amnioinfusion group and five in the control group. The rate of cesarean delivery was 31.8 percent in the amnioinfusion group and 29.0 percent in the control group (relative risk, 1.10; 95 percent confidence interval, 0.96 to 1.25). CONCLUSIONS: For women in labor who have thick meconium staining of the amniotic fluid, amnioinfusion did not reduce the risk of moderate or severe meconium aspiration syndrome, perinatal death, or other major maternal or neonatal disorders.

Amniotic Fluid↗