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Biomedical subjects

D G Ferris

Publications and source records attributed to D G Ferris.

At least 37 records · Page 2Linked to original sources
PubMed1995

Physician office laboratory education and training in primary care residency programs.

OBJECTIVE: To assess the status of office laboratory residency education and training in family practice, internal medicine, obstetrics and gynecology, and pediatric residency programs. DESIGN: A single mailed survey to 1299 residency programs from December 1992 to February 1993. PARTICIPANTS: Primary care residency directors from 507 (39%) of 1299 programs. INTERVENTIONS: A 27-item survey of residency-based office laboratory practices, education, training, and resources. MAIN OUTCOME MEASURES: Differences between specialties in provision and quantity of office laboratory education and training, presence of a residency-based office laboratory, laboratory classification under the Clinical Laboratory Improvement Amendments, and available laboratory tests. RESULTS: Of those responding, office laboratories were present in 89% of family practice, 19% of internal medicine, 29% of obstetrics and gynecology, and 24% of pediatrics residency programs. Laboratory training was available at 60% of family practice, 16% of internal medicine, 15% of obstetrics and gynecology, and 30% of pediatrics programs. The median number of hours of formal skills training was 10 hours for family practice residency programs but less than 2 hours for the other specialties. Only 25% of the programs reported educational assistance from pathologists. Merely 4% of the programs had postassessment examinations and 2% awarded certificates of achievement. A majority of family practice programs performed waivered tests and physician-performed microscopy tests, but moderately complex tests were performed in less than 50% of family practice programs. CONCLUSIONS: Family practice residency programs provide more office laboratory training for residents than other specialties. There is a need for improved residency training in the basics of office laboratory practice.

Curriculum↗
PubMed1995

Office laboratory diagnosis of vaginitis. Clinician-performed tests compared with a rapid nucleic acid hybridization test.

BACKGROUND: The traditional diagnosis of vaginitis incorporates patient symptoms, clinical findings observed during vaginal examination, and laboratory analysis of vaginal fluid. The purpose of this study was to evaluate routine clinician-performed office laboratory diagnostic techniques for women with abnormal vaginal symptoms, and to compare these results with those obtained by a DNA hybridization test for Trichomonas vaginalis, Gardnerella vaginalis, and Candida species. METHODS: The study included 501 symptomatic women who were between the ages of 14 and 67 years. Three vaginal specimens were obtained for saline wet mount, potassium hydroxide (KOH) prep, amine "sniff", pH, and nucleic acid hybridization (T vaginalis, G vaginalis, and Candida sp) tests. Clinicians and medical technicians independently evaluated the wet mount, KOH prep, amine, and pH tests. A medical technician processed the DNA tests according to manufacturer's protocol. RESULTS: Of 499 subjects for whom complete data were available, vulvovaginal candidiasis was diagnosed in 20.0%, vaginal trichomoniasis in 7.4%, and bacterial vaginosis in 52.1%. Fourteen percent of subjects had multiple vaginal infections. The sensitivity and specificity of clinician microscopically diagnosed vulvovaginal candidiasis, vaginal trichomoniasis, and bacterial vaginosis were 39.6% and 90.4%, 75.0% and 96.6%, and 76.5% and 70.8%, respectively. The sensitivity and specificity of the DNA probe diagnosis of the same types of vaginitis were 75.0% and 95.7%, 86.5% and 98.5%, and 95.4% and 60.7%, respectively. When only women with multiple vaginal infections were considered, the percentages of correct clinician diagnoses for vulvovaginal candidiasis, vaginal trichomoniasis, and bacterial vaginosis were 49.3%, 83.6%, and 59.7%, respectively. For the DNA probe test, the percentages of correct diagnoses were 72.9%, 92.9%, and 90.0%, respectively. CONCLUSIONS: Primary care clinicians demonstrated a high specificity but low sensitivity when identifying vaginal trichomoniasis and vulvovaginal candidiasis by microscopic techniques. Correct microscopic diagnosis of bacterial vaginosis was even more difficult for clinicians, as was the diagnosis of multiple vaginal infections. Clinicians were not as accurate as the DNA probe test in diagnosing vaginal infections. Clinicians need more education in the laboratory diagnosis of vaginitis. Clinicians should carefully scrutinize each microscopic slide, systematically examine the slide for each type of vaginitis, and consider specimen pH and the presence of leukocytes, Lactobacillus organisms, or amine odor as additional clues to infection.

Adolescent↗
PubMed1995

Electrosurgical loop excision of the cervical transformation zone: the experience of family physicians.

BACKGROUND: Electrosurgical loop excision of the cervical transformation zone (ELECTZ) is an excisional surgical procedure for treatment of premalignant cervical disease and the abnormal transformation zone by wire loop electrodes. The purpose of this study was to describe and assess the clinical experiences and complications of family-physician-performed ELECTZ and ELECTZ conization. METHODS: Women who were scheduled for the ELECTZ or ELECTZ conization procedures were enrolled in the study between March 1992 and March 1993, inclusive. Subjects were recruited from the practices of six family physician colposcopists located at five sites. The ELECTZ and ELECTZ conization procedures were performed on patients with abnormal Papanicolaou (Pap) smears or abnormal histologic results and abnormal colposcopic findings. Procedural complications were documented. Subjects were serially assessed during the first postoperative year by Pap smears, colposcopy, and, when necessary, by biopsy to determine therapeutic cure. RESULTS: Of 198 subjects enrolled in the study, 148 women were assessed at least once in follow-up by Pap smear and colposcopy. Only 7.6% of women were defined as treatment failures by subsequent histologic assessment. Women treated by ELECTZ conization were older (32.2 vs 25.1 years, P = .02), were more likely to develop posttreatment cervical stenosis (25.9% vs 3.8%, P = .001), and were more likely to have the postoperative squamocolumnar junction positioned in the endocervical canal (32.4% vs 8.7%, P = .002) than were women treated by ELECTZ: Loop excision specimen margins demonstrated dysplasia for 27 (13.6%) subjects. Significant operative bleeding (> 25 mL) was noted in 6.8% of subjects. Histologic thermal artifact was reported for 9.6% of specimens. One case of microinvasive cancer and one case of invasive cancer were identified unexpectedly by ELECTZ conization. CONCLUSIONS: Electrosurgical loop excision of the cervical transformation zone and ELECTZ conization may be safely and effectively performed in office settings by family physicians. Complications and treatment failure rates for the ELECTZ and ELECTZ conization procedures were similar to those experienced by other clinicians.

Adolescent↗
PubMed1995

Treatment of bacterial vaginosis: a comparison of oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream.

BACKGROUND: Treatment options for bacterial vaginosis are numerous. The purpose of this study was to compare the efficacy of oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream for the treatment of bacterial vaginosis using traditional clinical and laboratory methods, as well as a new DNA probe test. We also determined the percentage of patients receiving each treatment who developed posttreatment vaginal candidiasis, a potential complication of treating bacterial vaginosis. METHODS: One hundred one women in whom bacterial vaginosis was diagnosed by standard criteria were randomly assigned to receive: oral metronidazole 500 mg twice daily for 1 week, 0.75% metronidazole vaginal gel 5 g twice daily for 5 days, or 2% clindamycin vaginal cream 5 g once daily for 7 days. Women with coexisting vulvovaginal candidiasis or vaginal trichomoniasis were excluded. Tests of cure by vaginal saline wet prep and potassium hydroxide microscopic examinations, Gram's stain, pH and DNA probe tests for Gardnerella vaginalis and Candida species were scheduled 7 to 14 days following treatment. RESULTS: There were no statistically significant differences in cure rates for oral metronidazole (84.2%), metronidazole vaginal gel (75.0%), or clindamycin vaginal cream (86.2%) (chi 2 = 1.204, df = 2, P = .548) using traditional clinical and laboratory criteria. Cure rates were lower based on DNA testing, indicating that Gardnerella vaginalis may remain after a clinical cure. This would explain cases of recurrent disease. Posttreatment vulvovaginal candidiasis was experienced by 12.5% of subjects treated with oral metronidazole, 14.8% of subjects treated with clindamycin vaginal cream, and 30.4% of subjects treated with metronidazole vaginal gel (chi 2 = 2.607, df = 2, P = .272). CONCLUSIONS: Oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream achieved nearly equivalent cure rates for the treatment of bacterial vaginosis. Patients treated with these agents experienced similar rates of posttreatment vulvovaginal candidiasis, but those using the intravaginal products reported being more satisfied with the treatment.

Administration, Intravaginal↗
PubMed1995

Vaginal intraepithelial neoplasia III detected after hysterectomy for benign conditions.

Because primary vaginal cancer is rare, many experts discourage routine cytologic sampling of the vaginal vault following hysterectomy for benign circumstances. The following report describes a case of vaginal intraepithelial neoplasia III (VAIN III) detected by a vaginal vault Papanicolaou smear obtained from an asymptomatic 57-year-old woman 23 years after she had a total abdominal hysterectomy for a benign condition. As VAIN III is a true vaginal cancer precursor, the innocent disregard of recommended screening practices averted significant morbidity and possibility mortality for this otherwise healthy woman.

Carcinoma in Situ↗
PubMed1994

Reid's Colposcopic Index.

Reid's Colposcopic Index (RCI) is a systematic, objective method of colposcopically grading the severity of premalignant cervical lesions. The index considers four colposcopic signs: lesion margin, color of acetowhitening, blood vessels, and iodine staining. The RCI can accurately predict the histologic grade of cervical disease, readily permitting differentiation between low-grade cervical disease and high-grade disease. Hence, use of the index helps direct the clinician to perform a biopsy of the most significant abnormal cervical lesions and enhances the formulation of the colposcopic impression.

Acetates↗
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↗
PubMed1994

Cervicography--an adjunct to Papanicolaou screening.

Cervicography is a technically simple screening test for cervical abnormalities and can be used in conjunction with the Papanicolaou test. Cervicography may be performed by both physicians and paraprofessionals; experience in colposcopic techniques is not required. A significantly greater percentage of premalignant disease is detected when cervicography is used in conjunction with the Pap smear than when the Pap smear is used alone. Cervicography may also be used as an effective intermediate triage test to evaluate women with atypical findings on Pap smear.

Cervix Uteri↗
PubMed1994

Gynecologic and dermatologic electrosurgical units: a comparative review.

Electrosurgery is a popular surgical technique in which high-frequency, low-voltage electrical energy produced by an electrosurgical unit is used to excise abnormal tissue with hemostasis. In this study, electrosurgical units were critically evaluated for safety, electrical specifications, design, and performance characteristics. Quantitative electrical specification and histologic thermal artifact measurements and qualitative observations were recorded for 13 electrosurgical units representing 11 manufacturers. The Aspen Sabre 180 and Laerscope e10 were considered exemplary units based on safety criteria alone. Cut-mode thermal artifact was less than 10 microns for the Cooper Leep 6000, Laserscope e10, and Utah Finesse. A maximum fulguration distance of greater than 0.5 mm was demonstrated by the Gyne-Tech Autolepe 2000 and 4000, Laserscope e10, and the Elmed ESU 30. For gynecologic electrosurgery, the Aspen Sabre 180 and Laserscope e10 were rated best, followed closely by the Utah Finesse and Finesse II and the Gyne-Tech Autolepe 4000. Dermatologic electrosurgery may be well accomplished with many of the electrosurgical units, except as noted.

Ambulatory Surgical Procedures↗
PubMed1994

Colposcopy and cervical biopsy educational training models.

BACKGROUND: Realistic simulation models serve meaningful educational purposes. The intent of this article is to review the physical and educational features of three instructional colposcopy models, and to discuss the advantages and implications of the use of models in teaching colposcopic skills. METHODS: Models made from latex, steak, and the bovine cervix were assessed as instructional devices to simulate the uterine cervix and cervical disease. Model construction, preparation, and unique features were critiqued. The models were also evaluated for their potential use in the preclinical teaching of important colposcopic skills. RESULTS: The latex model required minimal assembly but was costly. It was limited in design, which would exclude the training of most colposcopic techniques. The steak model used readily available materials, facilitated colposcopic skill acquisition, and was the least expensive model. The bovine model best simulated human cervical tissue, was intermediate in cost, and enabled teaching a variety of colposcopic procedures. The optional silicone inserts realistically demonstrated the spectrum of cervical disease. CONCLUSIONS: Various cervical biopsy models have different strengths and weaknesses for teaching colposcopic procedural skills. Available models each possess unique features designed to reproduce anatomy, pathology, tissue texture, and technical spatial limitations. The models permit assessment of gynecologic knowledge and psychomotor abilities.

Animals↗
PubMed1994

Cervical carcinoma in situ undetected by Papanicolaou smear but identified by cervicography. A case report.

The following case report demonstrates the clinical use of cervicography as an adjunct test to identify premalignant or malignant cervical disease. An asymptomatic woman seeking routine health maintenance care was screened by serial Papanicolaou (Pap) smears and cervicography. The interval Pap smears were interpreted as satisfactory and within normal limits; however, the cervigrams were interpreted sequentially as atypical and positive. A subsequent cervical biopsy revealed carcinoma in situ. Cervicography, as an adjunct test, enhanced cervical cytologic screening of a woman considered to be at high risk because of a prior history of genital human papillomavirus infection.

Adult↗
PubMed1994

Lethal tissue temperature during cervical cryotherapy with a small flat cryoprobe.

BACKGROUND: Some female patients, especially those with cervical intraepithelial neoplasia III (CIN III), are not successfully cured following cervical cryotherapy, for which a small flat cryoprobe tip is commonly used. The thermodynamic effect produced in the cervical tissue by this device has not been previously described. This study examined the capability of a small flat cryoprobe tip to generate a lethal temperature during thermocouple-monitored cryosurgery of the cervix. METHODS: A thermocouple was placed in the cervix 5 mm from the cryoprobe margin, and a pyrometer indicated temperatures generated by nitrous oxide cryosurgery. Iceball lateral spread of freeze was measured with a cryosurgical iceball gauge. RESULTS: A minimum temperature of -2C degrees was generated at the termination of freeze (6 1/2 minutes). The maximum lateral spread of freeze at termination was 6.2 mm. A lethal zone of 4.2 mm was estimated based on a 2-mm recovery zone. CONCLUSIONS: When compared with morphometric studies of cervical dysplasia depth of involvement, an estimated 12.5% of CIN III would be inadequately treated based on our in vivo data. A small flat cryoprobe is incapable of eradicating all severe premalignant cervical disease deep within the glandular clefts. An alternative treatment method, such as electrosurgical loop excision of the cervical transformation zone (ELECTZ), therefore, may be the preferred treatment modality for CIN III:

Cryosurgery↗
PubMed1993

Cryotherapy precision. Clinician's estimate of cryosurgical iceball lateral spread of freeze.

OBJECTIVE: To examine physicians' ability to estimate the lateral spread of freeze (LSF) of a cryosurgical iceball using three techniques. DESIGN: A nonrandomized control trial of in vitro nitrous oxide cryosurgical procedures. SETTING: Primary care residency training programs. PARTICIPANTS: A convenience sample of 80 resident and faculty physicians from four family practice residency programs and one obstetrics and gynecology residency program. INTERVENTIONS: After performing cryosurgery with standard naked-eye and colposcopic-assisted techniques, subjects used a new experimental cryosurgical iceball gauge (CIG) to estimate the LSF during cryotherapy. MAIN OUTCOME MEASURES: LSF estimations reported physicians were compared simultaneously with those measured by an observer. RESULTS: The mean (+/- SD) LSF estimation errors at the termination of freeze were as follows: 2.62 +/- 2.42 mm for the colposcopy technique, 2.00 +/- 2.16 mm for the naked-eye method, and 1.28 +/- 0.87 mm for the CIG technique. The range of maximum error was 6.5 to 11 mm for the colposcopic technique, 5.5 to 12.5 mm for the naked-eye method, and 3.0 to 4.0 mm for the CIG technique. CONCLUSIONS: Overestimation of the LSF, which increases the risk of undertreatment and residual disease, was more common than underestimation. The CIG minimized perceptual error and provided the best cryosurgical precision.

Calibration↗
PubMed1993

Noninvasive detection of Chlamydia trachomatis in men: a comparison of two immunoassay tests.

This investigation compared a rapid enzyme immunoassay test and an enzyme-amplified immunoassay test with culture for the noninvasive detection of Chlamydia trachomatis urethritis in men. Urine specimens from 108 male subjects were evaluated for the presence of C trachomatis antigen, using the Kodak Surecell Chlamydia rapid enzyme immunoassay test and IDEIA Chlamydia enzyme-amplified immunoassay test. The test results were then compared with urethral C trachomatis culture and urethral Gram's stain analyses. Performance characteristics of the two tests were similar. The rapid chlamydial enzyme immunoassay test demonstrated several clinical advantages. Appropriate use of these tests may decrease patient morbidity and clarify organism etiology for enhanced specific medical care of urethritis in men.

Adult↗
PubMed1993

Chlamydial cervical infections in rural and urban pregnant women.

The purpose of this investigation was to determine the incidence of cervicitis due to Chlamydia trachomatis in rural pregnant women, urban pregnant women, and urban nonpregnant women in Georgia. Evaluation of endocervical chlamydial cultures from 447 women showed prevalence rates for C trachomatis cervicitis of 12% in the urban pregnant group, 7% in urban nonpregnant women, and 21% in rural pregnant women. Fewer rural pregnant women (2%) reported a previous history of C trachomatis cervicitis than urban pregnant women (9%) and urban nonpregnant women (19%). Data from this study imply that screening for C trachomatis may be done less frequently in rural women than in urban women. The high prevalence of C trachomatis infection observed in rural pregnant women emphasizes the importance of routinely screening this group as currently recommended. Laboratory testing for C trachomatis may be overlooked because of insufficient funds and an emphasis on other sexually transmitted diseases.

Adult↗
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↗