scholarly journals Adherence to the American Society for Colposcopy and Cervical Pathology guidelines: an observational study

Author(s):  
Sarah Kay Conrad ◽  
Bassam Dahman ◽  
Anita Kumar ◽  
Jordan Hylton ◽  
Christine Isaacs
Author(s):  
Sarah Conrad ◽  
Bassam Dahman ◽  
Christine Isaacs ◽  
Anita Kumar ◽  
Jordan Hylton

Objective: To evaluate adherence to the 2012 ASCCP guidelines by physicians referring patients to a large academic center for a colposcopy and to understand the factors associated with incorrect referrals. Design: A retrospective observational study Setting: A large tertiary referral hospital Population: Woman referred to Virginia Commonwealth University for colposcopy or loop electrosurgical excision procedure from January 2015 to December 2016. Methods: Data on patient demographics, cervical cytology, human papillomavirus status, and the recommended interventions were gathered. Main Outcome Measures: Concordance with ASCCP guidelines Results: Referral requests for 430 women were reviewed. Of the referrals, 17.4% were discordant with the ASCCP guidelines. The most common discordant colposcopy referrals were for low-grade squamous intraepithelial (LSIL) lesion (48%) and atypical squamous cell of undetermined significance (29%). The likelihood of incorrect referral was decreased for high grade lesions (OR 0.03), increased in women age < 25 (OR 31.6) and those referred by family medicine (OR 3.6) or internal medicine (OR 4.4). Ten patients were referred for cervical cytology collected on vaginal cuffs despite hysterectomies performed for benign reasons. Conclusions: Patients referred outside of the guidelines were most often women age < 25 with low-grade lesions. Referrals outside of evidence-based guidelines may lead to unnecessary procedures and added healthcare expense. Our results help identify areas for provider education and potential areas for concern in the implementation of the 2019 ASCCP updates.


Author(s):  
Sweety Rani ◽  
Abha Rani Sinha

Aim: To evaluate degree of chronic pelvic pain and degree of adhesion. Materials and Methods: The present clinico-observational study was conducted in the Department of Obstetrics and Gynecology, Patna Medical College and Hospital, Patna, from December 2016 to December 2017.among 40 women diagnosed with endometriosis. Pain intensity was assessed by visual analogue scale (VAS) and categorized as mild, moderate or severe accordingly. This was followed by laparoscopy/ laparotomy and staging of endometriosis which was done as per the American Society for Reproductive Medicine (ASRM) classification system. Corrective procedures were done simultaneously. Results: Mean age of study cohort was 30 ±5.75 years. As per VAS, majority felt moderate pain (47.5%) in present study. The presenting symptoms were dysmenorrhoea (45.0%), dyspareunia (17.5%) and chronic pelvic pain (35.5%). Conclusion: Degree of tubal involvement was more in all the women as compared to ovarian involvement. Post-operatively the intensity of the pain subsides. Keywords:  VAS, Adhesion, Endometriosis, Tubal, Ovarian


Author(s):  
Ayhan Kaydu ◽  
Erhan Gökçek

Background: Ultrasound measurement of dynamic changes in inferior vena cava (IVC) diameter and collapsibility index (CI) evaluates to estimate the fluid responsiveness and intravascular volume status. We conducted a analysis to quantify the sonographic measurement of IVC diameter changes in adult patients at preoperative and postoperative period. Methods: Ultrasonography was performed on 72 patients scheduled for surgery with American Society of Anesthesiologists physical status I to III. Quantitative assessments of the end-expiration (Dmin), end-inspiration (Dmax) and CI at preoperative and postoperative period were compared in a prospective, observational study. The patients received intravenous fluid according to standard protocol regimes peroperatively. The cutt-off value of dIVC 40% was accepted as hypovolemia. Results: Ultrasonography of IVC measurement was unsuccessful in 12.5% of patients and 63 patients remained for analyses. The mean age was 43.29 &plusmn; 17.22 (range 18 - 86) years. The average diameter of the Dmin, Dmax and dIVC at preoperative and postoperative were 1.99 &plusmn; 0.31 vs. 2.05 &plusmn; 0.29 cm, 1.72 &plusmn; 0.33 vs. 1.74 &plusmn; 0.32 cm, 14.0 &plusmn; 9.60 % vs. 15.14 &plusmn; 11.18 %, respectively (p&lt;0.05). Using a threshold dIVC of 40%, one patient preoperatively and 5 postoperatively were hypovolemic (p&lt;0.05). CI was also positively associated preoperatively and postoperatively (regression coefficient = 0.438, p&lt;0.01). Conclusion: The diameter of IVC did not change preoperatively and postoperatively in adult patients with standard fluid regimens. The parameters of the IVC diameter increased postoperatively according to preoperative period.


Author(s):  
John J. Friel

Committee E-04 on Metallography of the American Society for Testing and Materials (ASTM) conducted an interlaboratory round robin test program on quantitative energy dispersive spectroscopy (EDS). The test program was designed to produce data on which to base a precision and bias statement for quantitative analysis by EDS. Nine laboratories were sent specimens of two well characterized materials, a type 308 stainless steel, and a complex mechanical alloy from Inco Alloys International, Inconel® MA 6000. The stainless steel was chosen as an example of a straightforward analysis with no special problems. The mechanical alloy was selected because elements were present in a wide range of concentrations; K, L, and M lines were involved; and Ta was severely overlapped with W. The test aimed to establish limits of precision that could be routinely achieved by capable laboratories operating under real world conditions. The participants were first allowed to use their own best procedures, but later were instructed to repeat the analysis using specified conditions: 20 kV accelerating voltage, 200s live time, ∼25% dead time and ∼40° takeoff angle. They were also asked to run a standardless analysis.


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