The development and implementation of an electronic departmental note in a colposcopy clinic.

Hospital-wide electronic medical records can be limited in addressing clinical department needs. A study was undertaken to examine the development and implementation of an electronic informaton system in a colposcopy unit in a large teaching hospital in Canada. A case study design was used, and 24 semistructured interviews were conducted with nurses and physicians working in the colposcopy clinic and individuals from the information technology team. Interviews occurred in two phases-directly after implementation and again 9 months later. Computerized audit data were gathered to examine usage patterns. The results provide insight into the processes and challenges of defining and capturing information for both clinical and research purposes and creating a standardized referral note. The findings demonstrated some initial uncertainty around roles and responsibilities concerning the electronic system and its integration into clinical routines. After a period of 12 months, and further refinement, it was found that the system was accessible and user-friendly, although some concerns raised during the developmental stage persisted. Audit data revealed that 9 months after its introduction, nurses' adoption of the system rate reached 89%, and physicians, 96%. This study has demonstrated that practitioners in a colposcopy clinic successfully collaborated with information technology specialists and each other to develop and implement a clinical departmental information system. While certain challenges were encountered, nurses and physicians have bought into the system, recognize its potential for research and patient care, and are therefore committed to figuring out how to adapt to the changes in communication both within the clinic and with referring physicians.

Factores asociados con lesiones neoplásicas del tracto genital inferior femenino en adolescentes del departamento de Caldas / Fatores associados com lesões neoplásticas do conduto genital inferior feminino em adolescentes do departamento de Caldas / Factors associated with neoplasm of the lower female genital tract in teens in the department of Caldas

En este artículo se presentan los resultados de un estudio epidemiológico analítico-descriptivo, cuyos objetivos fueron: conocer y determinar cómo se asocian factores biológicos y psicosociales con la presencia de lesiones neoplásicas del tracto genital inferior femenino en una población adolescente del departamento de Caldas, lo cual se relacionó, por un lado, con el análisis de la distribución y frecuencia de la población estudiada en cuanto a sexualidad, reproducción, factores culturales y factores psicosociales, y por otro, con la interacción de factores de riesgo en la aparición de dichas lesiones. Se tomó una muestra de 269 mujeres, seleccionadas después de su participación en jornadas educativas respecto a cáncer de cuello uterino y de mama. A este grupo se le aplicó una encuesta estructurada, diseñada para tal fin, la cual se diligenció directamente por los investigadores, previo consentimiento informado. A cada informante se le realizó citología y colposcopia, con un manejo estrictamente confidencial de la información. Los datos se analizaron retomando su distribución y frecuencia por categorías de variable, con lo cual se buscó determinar la asociación de los factores con la presencia o no de lesiones neoplásicas al contrastarlos con los resultados de citología y colposcopia.

This article presents the results of an epidemiologic analytical-descriptive study whose objectives were to examine and determine how biological and psychosocial factors are associated to the presence of neoplastic lesions of the lower female genital tract in a teenage population in the department of Caldas. The study analyzed the distribution and frequency of the studied population in terms of sexuality, reproduction, cultural and psychosocial factors, and secondly, the interaction of risk factors in the occurrence of such injury. A sample of 269 women, selected after their involvement in educational sessions related to cervical cancer and breast cancer, was interviewed by means of a structured survey, which was filled-out directly by the researchers, with prior consent from the women. A cervical smear and a colposcopy were performed on each patient, confidentially handling the information. The data was analyzed taking into consideration the distribution and frequency of the variable categories, looking to determine the association of factors with the presence or absence of neoplastic lesions, when contrasted with the cervical smear and colposcopy results.

Em este artigo apresentam se os resultados duma pesquisa epidemiológica analítico-descritivo, cujos objetivos foram: conhecer e determinar como associam se fatores biológicos y psicossociais com a presença de lesões neoplásicas do conduto genital inferior feminino numa povoação adolescente do Departamento de Caldas, o qual se relacionou, por um lado, com a análise da distribuição e freqüência da povoação estudada em quanto a sexualidade, reprodução, fatores culturais e fatores psicossociais, e por outro lado, com a interação de fatores de risco na aparição de ditas lesões. Tomou se uma amostra de 269 mulheres, selecionadas depois de sua participação em jornadas educativas respeito ao câncer de colo uterino e mama. A este grupo aplicou se uma enquete estruturada, desenhada tal fim, a qual diligenciou se direitamente por os pesquisadores, prévio consentimento informado. A cada informante realizou se citologia e colposcopia, com um manejo estritamente confidencial da informação. Os dados realizaram se retomando sua distribuição e freqüência por categorias de variável, com o qual se procurou determinar a associação dos fatores com a presença ou não de lesões neoplásicas ao contrastarlos com os resultados de citologias e colposcopias.

A prospective descriptive study of women attending a colposcopy clinic.

This paper reports the findings of a prospective convenience sample cohort study investigating self-reported purpose of pap smears and worry interference associated with having abnormal pap smear results in women attending a public colposcopy service between 05 April and 19 December 2003. Intrusive thoughts about cancer have been postulated to be associated with dysfunction in women at increased risk of developing breast or ovarian cancer. A study designed questionnaire and the Multidimensional Health Locus of Control was completed by the women whilst waiting to have colposcopy. This study shows that Asian women need to have information about abnormal pap smear results explained well in order to avoid intrusive thoughts and anxiety. It also demonstrates that nurses provide a key role in providing information that leads to less concern and better understanding of the concepts.

Significance of toluidine blue positive findings after speculum examination for sexual assault.

To determine the incidence of toluidine blue positive findings after speculum examination of sexual assault victims, we performed a prospective before and after study of 27 female patients presenting after sexual assault to a free-standing nurse examiner clinic. Before the insertion of a speculum, a 1% aqueous solution of toluidine blue was applied to the posterior fourchette and photographs were taken using colposcopy with digital imaging (16 x magnification). After the forensic examination was completed, dye was reapplied. Photographs taken before and after speculum examination were reviewed by three EM physicians for superficial lacerations or abrasions. Before speculum examination, genital injuries from sexual assault were documented in 67% of the patients (mean number of genital injuries, 1.4). After speculum examination, one patient (3.7%) demonstrated a new genital injury-an abrasion to the labia. Until further studies are performed, use of a speculum should be delayed until after toluidine dye application.

Quality in colposcopy.

This article analyses the colposcopy service, which is a crucial part of the National Health Service Cervical Screening Programme (NHSCSP), to assess how quality is measured and delivered. It highlights the role of the nurse colposcopist and discusses where improvements to the service could be made.

Effect of nurse colposcopists on a hospital-based service.

The number of colposcopies performed annually in the UK is increasing. Nurse colposcopists have been introduced by many units to cope with this workload. The small amount of evidence to support the introduction of nurse colposcopists suggests that nurses are viable alternative providers of colposcopy. This study compares the performance of nurse colposcopists with that of doctors.

Is the SANE role within the scope of nursing practice? On "pelvics," "colposcopy," and "dispensing of medications".

Clearly communicating with other professionals and with sexual assault survivors about the boundaries and imitations of the SANE medical-forensic examination is important. Although SANEs work cooperatively in an interdisciplinary sexual assault response team model to better meet the needs of sexual assault victims, they function as independent professional nurses in their role of collecting medical forensic evidence. Properly defined to focus on assessment, identification, and documentation of trauma, the SANE role is an independent professional role but is still within the scope of basic nursing practice. The answer to our question, "Is the SANE role advanced practice nursing or is it within the scope of basic nursing practice?" is thus "The SANE role is clearly within the scope of basic nursing practice."

Colposcopy.

Colposcopy is a method of examination of the cervix using an optical magnifying instrument. Tracy Smith discusses the assessment process, the cervical screening programme, management for patients who have abnormal smears, patient counselling and the role of the nurse colposcopist.

Women's experiences in coping with abnormal Papanicolaou results and follow-up colposcopy.

OBJECTIVES: To delineate the primary concerns women associate with abnormal Papanicolaou (Pap) results and colposcopy and to identify women's strategies for coping with these potential stressors. DESIGN: A longitudinal, descriptive study involving telephone interviews after participants received abnormal Pap results and mailed questionnaires before and after colposcopy. SETTING: Private and public women's health clinics in the midwestern United States. PARTICIPANTS: Seventy-five women who had abnormal Pap results and needed initial colposcopy completed telephone interviews; 40 completed a precolposcopy questionnaire and 35 completed a postcolposcopy questionnaire. MAIN OUTCOME MEASURES: Clients' concerns and coping strategies were assessed after they learned their Pap results were abnormal, the day before colposcopy, and the day after the procedure. RESULTS: Women's primary concerns involved not understanding the Pap results, cancer, or infertility. Coping strategies used most, and rated as helpful throughout the experience, were seeking social support and distraction. CONCLUSIONS: Nursing interventions can be designed to improve women's understanding of the meaning of abnormal Pap results, address concerns about abnormal Pap results, and encourage women to use social support and distraction while awaiting colposcopy.

Cervical cancer. 2: Colposcopy, treatment and patient education.

In the first article in this two-part series (Vol 8(11): 730-34) the issue of cervical screening and the cervical smear test was described and discussed. This article looks at colposcopy. When a woman receives an abnormal smear test result, she will often require further examination of the cervix in order to identify the degree and area of dyskaryosis. Colposcopy can often provoke feelings of fear and anxiety in women and the nurse must help to alleviate these fears and anxieties. Colposcopy and cervical intraepithelial neoplasia are discussed and the treatment (if any) is outlined.