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Biomedical subjects

D G Ferris

Publications and source records attributed to D G Ferris.

59 records · Page 4Linked to original sources
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Women's triage and management preferences for cervical cytologic reports demonstrating atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions.

OBJECTIVE: To determine women's triage test preferences for the evaluation and management of atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) Papanicolaou smear reports. DESIGN: A 35-item questionnaire. SETTINGS: Primary care clinic waiting rooms. PARTICIPANTS: A convenience sample of 968 women. INTERVENTION: Women received standardized descriptions of the meaning of ASCUS and LSIL Papanicolaou smear classifications and uniform descriptions of the 4 triage tests: Papanicolaou smear, human papillomavirus DNA test, cervicography, and colposcopy. MAIN OUTCOME MEASURES: Subjects' responses to questionnaire. RESULTS: More women (58.4%) preferred a repeat Papanicolaou smear for an ASCUS report than would choose human papillomavirus DNA testing (7.3%), cervicography (20.6%), or colposcopy (13.8%) (P < .001, chi 2). Alternatively, 51% of women wanted colposcopy to evaluate an LSIL report compared with the other 3 options (P < .001, chi 2). Test accuracy was the most important factor that influenced women's decisions for each test, compared with cost, discomfort, and other reasons (P < .001, chi 2). Positive predictors for women's selection of colposcopy to evaluate a Papanicolaou smear showing LSIL included older age (P < .01, logistic regression analysis), higher level of income (P < .001, chi 2), greater level of education (P < .001, logistic regression analysis), greater level of knowledge of colposcopy and Papanicolaou smears (P < .001, logistic regression analysis), family history of cervical cancer (P < .01, chi 2), and history of cervical dysplasia (P = .02, chi 2). CONCLUSIONS: Most women preferred a repeat Papanicolaou smear to further evaluate an initial Papanicolaou smear demonstrating ASCUS and colposcopy to evaluate a report of LSIL. Women identified test accuracy as the most important reason for triage test selection. Multiple factors, primarily involving patient and family history of cervical neoplasia, level of education, income, age, and knowledge of tests, influence women's desire for specific triage tests. Because no optimal management of women with ASCUS and LSIL Papanicolaou smear reports has been determined, consideration of women's triage test preferences should complement overall patient care.

Adult↗
PubMedDate not supplied

Colposcopy practice and training in family practice residency programs.

BACKGROUND: The potential growth of colposcopy as a family medicine procedural skill is directly related to the training currently offered to family practice residents. To define whether these skills are being adequately offered to physicians who want to perform this procedure for their patients, a study was designed to investigate the current status of colposcopy practice and training in family practice residency programs. METHODS: A 16-item survey sent to 356 family practice residency directors in the United States included items concerning colposcopy practice, training, educational programs and strategies, colposcopy coordinator educational background, and colposcopic resource materials and equipment. RESULTS: Surveys were returned from 204 (57 percent) family practice residencies. Colposcopy was performed at 45 percent of the residencies that responded. Ninety-six percent of the respondents who did not perform colposcopy believed colposcopy is a procedure that should be performed by family physicians. Clinical teaching and supervision was the most common method of resident training (74 percent). Colposcopy training coordinators were usually family physicians (72 percent), primarily trained by gynecologists. Assistance with implementing a colposcopy training program was requested by 85 percent of those programs presently not performing colposcopy. CONCLUSIONS: This study indicates that there are opportunities for further development of colposcopy practice and training in family practice residencies.

Attitude of Health Personnel↗
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Electrosurgical loop excision of the cervical transformation zone: preclinical training proficiency.

INTRODUCTION: The purpose of this investigation was to evaluate learning errors and preclinical psychomotor skill acquisition among physicians learning the electrosurgical loop excision of the cervical transformation zone (ELECTZ) procedure. METHODS: Gynecologists attending one-day ELECTZ continuing medical education courses demonstrated their newly acquired ELECTZ cognitive and procedural skills. A bovine cervical model was used to simulate the uterine cervix and cervical pathology. Subjects performed successive procedures until an adequate specimen was obtained. RESULTS: The mean number of procedural attempts to achieve proficiency was 1.61; 38 of 51 (75%) subjects were proficient following three trials. Thirty-nine percent (20 of 51) of subjects were successful following the first attempt, and an additional 14 of 23 were successful after the second trial. The most common (27%) defective specimen shape resulted from rapid terminal excision and subsequent shallow skewed tissue. Temporary loop electrode or tissue impedance was experienced by 35% of subjects during the first procedure. CONCLUSIONS: The ELECTZ procedure is mastered by most physicians with few complications following a minimal number of attempts. The most common procedural errors resulted from excessively rapid surgical technique. Realistic management scenarios with simulated model practice should be used when teaching the ELECTZ procedure to physicians.

Adult↗