Biomedical subjects
D C Slawson
Publications and source records attributed to D C Slawson.
Are Papanicolaou smears enough? Acetic acid washes of the cervix as adjunctive therapy: a HARNET study. Harrisburg Area Research Network.
BACKGROUND: The Papanicolaou smear has a false-negative rate ranging from 10% to 50%. Adjunctive screening methods for detecting cervical disease are thus of interest. We studied an adjunctive acetic acid wash of the cervix to detect additional cases of cervical disease not found by the Papanicolaou smear. METHODS: All women attending six family practice offices for health maintenance during the period August 1989 through April 1990 were examined (N = 2827). Papanicolaou smears were obtained using a Cytobrush and wooden spatula. Each subject's cervix was also visually examined 1 minute after application of 5% acetic acid. Women with abnormal Papanicolaou smear results or abnormal acetowhite areas on visual inspection of the cervix underwent colposcopy. RESULTS: Ninety-three cases of biopsy-proven condyloma or cervical intraepithelial neoplasia (CIN) were found on the basis of abnormal Papanicolaou smear results alone, 33 on the basis of abnormal acetic acid wash results alone, and 14 on the basis of abnormal results from both a Papanicolaou smear and an acetic acid wash. The prevalence of CIN was 3%. The overall positive predictive value for abnormal results obtained by acetic acid wash was .55 (95% CI = .43 to .63). CONCLUSIONS: Using a 1-minute 5% acetic acid wash improves the detection of cervical disease by 30%. Consideration should be given to augmenting the Papanicolaou smear with this safe, simple, and effective technique on premenopausal women during regular health maintenance examinations.
Antibiotic use in the treatment of non-streptococcal pharyngitis.
Treatment of non-streptococcal pharyngitis (NSP) varies among physicians. Recent data regarding difficult-to-culture bacterial pathogens have increased interest in antibiotic treatment of NSP. This study examined physician behavior regarding antibiotic treatment of NSP in preparation for a prospective clinical trial. The records of 358 patients with pharyngitis-related diagnoses from a large private family physician practice and an urban hospital's housestaff clinic were reviewed. No significant relationship between the presence of streptococcus and the prescribing of antibiotics was found. Physicians gave antibiotics to 50% of patients with clinical signs and symptoms of pharyngitis. Many of these tested negative for streptococcus. Physicians used antibiotics effective against Mycoplasma and Chlamydia less than one half of the time. Projected costs of drug treatment for patients with NSP was $1,200. Family medicine educators are encouraged to monitor their own and their residents' antibiotic prescribing behaviors when treating common upper respiratory infections.
Case-control studies.
Case-control studies investigate associations between exposures to risk factors and a condition of interest. Subjects with the condition (cases) are compared to subjects known not to have the condition (controls) with respect to the presence of risk factors in the past. This design is particularly useful when the condition of interest is relatively uncommon. Case-control studies are useful for studying the etiology of conditions in primary care. Invalid results may be obtained, however, if a study's design allows the occurrence of selection bias, information bias, or confounding.