Fatores associados a não realização de exame citopatológico em São Leopoldo, Rio Grande do Sul, 2015: estudo transversal de base populacional / Factores asociados a la no realización de examen citopatológico en São Leopoldo, Rio Grande do Sul, Brasil, 2015: estudio transversal de base poblacional / Factors associated with not having Pap Smears in São Leopoldo, Rio Grande do Sul, Brazil, 2015: a cross-sectional population-based study

Objetivo: estimar a prevalência de exame citopatológico não realizado nos últimos três anos e de nunca realizado em mulheres, e analisar fatores associados. Métodos: estudo transversal, com mulheres de 20 a 69 anos de idade, em São Leopoldo, RS, Brasil, em 2015; calcularam-se as razões de prevalência (RP) por regressão de Poisson. Resultados: entre 919 mulheres, a prevalência de exame atrasado foi 17,8% (intervalo de confiança de 95% [IC95%15,4;20,3), e de nunca realizado, 8,1% (IC95%6,3;9,8); na análise ajustada, o aumento na prevalência de exame atrasado mostrou-se associado à classe econômica D/E (RP=2,1 - IC95%1,3;3,5), idade de 20-29 anos (RP=3,2 - IC95%2,1;4,9) e nenhuma consulta realizada (RP=3,0 - IC95%2,1;4,1); nunca ter realizado exame associou-se com classe econômica D/E (RP=2,6 - IC95%1,4;5,0), idade de 20-29 anos (RP=24,1 - IC95%6,4;90,9) e nenhuma consulta (RP=2,9 - IC95%1,7;4,8). Conclusão: a cobertura de exame foi alta e com iniquidade.

Objetivo: estimar la prevalencia de examen en mujeres, no realizado en los últimos tres años y de nunca realizado, y analizar factores asociados. Métodos: estudio transversal con mujeres de 20 a 69 años de edad de São Leopoldo, RS, Brasil, en 2015; se calcularon las razones de prevalencia (RP) por la regresión de Poisson. Resultados: entre 919 mujeres, la prevalencia de examen retrasado fue 17,8% (intervalo de confianza del 95% [IC95%]15,4;20,3) y de nunca realizado fue del 8,1% (IC95%6,3;9,8); en el análisis ajustado, el aumento en la prevalencia de examen retrasado se asoció con clase económica D/E (RP=2,1 - IC95%1,3;3,5), a edad entre 20-29 años (RP=3,2 - IC95%2,1;4,9) y ninguna consulta (RP=3,0 - IC95%2,1;4,1); nunca haber realizado examen se asoció con clase D/E (RP=2,6 - IC95%1,4;5,0), a 20-29 años de edad (RP=24,1 - IC95%6,4;90,9) y ninguna consulta (RP=2,9 - IC95%1,7;4,8). Conclusión: la cobertura de examen fue alta y con inequidad.

Objective: to estimate the prevalence of Pap tests not performed in the last three years and never performed in women and to analyze factors. Methods: this was a cross-sectional study with women aged 20 to 69 years living in São Leopoldo, RS, Brazil, in 2015; prevalence ratios (PR) were calculated using Poisson regression. Results: among 919 women, prevalence of delayed testing was 17.8% (95% confidence interval [95%CI]15.4;20.3) and never tested prevalence was 8.1% (95%CI6.3%;9.8%); in the adjusted analysis, the increase in the prevalence of delayed testing was associated with economic class D/E (PR=2.1 - 95%CI1.3;3.5), being aged 20-29 years (PR=3.2 - 95%CI2.1;4.9) and not having had a medical appointment (PR=3.0 - 95%CI2.1;4.1); never having tested was associated with economic class D/E (PR=2.6 - 95%CI1.4;5.0), being aged 20-29 years (PR=24.1 - 95%CI6.4;90.9), and not having had a medical appointment (PR=2.9 - 95%CI1.7;4.8). Conclusion: coverage of the test was high but characterized by social inequality.

Gynecologic Screening for Men in an OBGYN Resident Community Outreach Clinic: The Transgender Care Experience.

OBJECTIVE: The aim of the study was to promote the importance of providing gynecologic screening for transgender men (TGM) who desire to keep their female organs. MATERIALS AND METHODS: In June 2015, the Women's Health Center (WHC) at Reading Hospital was approached to become a resource for transgender (TG) patients in our community. This also presented the opportunity to develop an educational program for OBGYN residents/providers in TG healthcare. From June 2015 to August 2016, we educated ourselves, established standards of care, collaborated with other services, and reached out to the community we represent. We present our experience in creating this specialty clinic as well as our first 16 months of experiential data to help other facilities meet the needs of this community. RESULTS: The primary outcome was the establishment of a comprehensive service for TG patients in our community. From August 2016 to December 2017, a total of 27,516 patient visits were conducted in WHC, 67 (0.2%) were TG patient visits with an average age of 33 years. Of 67, 16 (23.9%) were TGM and 51 (76.1%) were transgender women (TGW) visits, representing a total of 20 new TG patients including 9 (45%) TGM and 11 (55%) TG women. A total of 5 (55.6%) of 9 TGM received vaginal/cervical cytology screening. Sexually transmitted infection screenings were performed in 14 (70%) TG patients versus 6,689 (40.7%) in a non-TG WHC population. CONCLUSIONS: Servicing the transgender community is an important aspect of care for OBGYN providers. Our data suggest that TGM have similar gynecologic needs to the rest of our clinic population.

Team Objective Structured Bedside Assessment (TOSBA) as formative assessment in undergraduate Obstetrics and Gynaecology: a cohort study.

BACKGROUND: Team Objective Structured Bedside Assessment (TOSBA) is a learning approach in which a team of medical students undertake a set of structured clinical tasks with real patients in order to reach a diagnosis and formulate a management plan and receive immediate feedback on their performance from a facilitator. TOSBA was introduced as formative assessment to an 8-week undergraduate teaching programme in Obstetrics and Gynaecology (O&G) in 2013/14. Each student completed 5 TOSBA sessions during the rotation. The aim of the study was to evaluate TOSBA as a teaching method to provide formative assessment for medical students during their clinical rotation. The research questions were: Does TOSBA improve clinical, communication and/or reasoning skills? Does TOSBA provide quality feedback? METHODS: A prospective cohort study was conducted over a full academic year (2013/14). The study used 2 methods to evaluate TOSBA as a teaching method to provide formative assessment: (1) an online survey of TOSBA at the end of the rotation and (2) a comparison of the student performance in TOSBA with their performance in the final summative examination. RESULTS: During the 2013/14 academic year, 157 students completed the O&G programme and the final summative examination . Each student completed the required 5 TOSBA tasks. The response rate to the student survey was 68 % (n = 107/157). Students reported that TOSBA was a beneficial learning experience with a positive impact on clinical, communication and reasoning skills. Students rated the quality of feedback provided by TOSBA as high. Students identified the observation of the performance and feedback of other students within their TOSBA team as key features. High achieving students performed well in both TOSBA and summative assessments. The majority of students who performed poorly in TOSBA subsequently passed the summative assessments (n = 20/21, 95 %). Conversely, the majority of students who failed the summative assessments had satisfactory scores in TOSBA (n = 6/7, 86 %). CONCLUSIONS: TOSBA has a positive impact on the clinical, communication and reasoning skills of medical students through the provision of high-quality feedback. The use of structured pre-defined tasks, the observation of the performance and feedback of other students and the use of real patients are key elements of TOSBA. Avoiding student complacency and providing accurate feedback from TOSBA are on-going challenges.

[Health care for women over 50: programmatic vulnerability in the Family Health Strategy]. / Atenção à saúde da mulher após os 50 anos: vulnerabilidade programática na Estratégia Saúde da Família.

OBJECTIVE: To assess the health care process for women over 50 at a Family Health Unit based on the concept of programmatic vulnerability. METHOD: This study is inserted in the field of health care assessments. The framework proposed by Donabedian was used to analyze 90.5% of the 790 records of women registered at the unit. RESULTS: It was observed that none of the women that did not have a diagnosed pathology attended the recommended consultations or underwent the recommended tests. Of the total number of women with hypertension or diabetes, 20.7% were registered in the Hiperdia Programme and less than 1.0% had attended the consultations and undergone the necessary tests. Only 11.9% of the women had had a gynaecological examination, a clinical breast examination and a mammography the year before data collection. CONCLUSION: It is concluded that women over 50 are in a situation of programmatic vulnerability in terms of the indicators established in this study. Knowledge of this reality can help nurses provide care that is best suited for this group.

Health care for women over 50: programmatic vulnerability in the Family Health Strategy / Atención a la salud de la mujer después de 50 años: la vulnerabilidad programática de la Estratégia de Salud de la Família / Atenção à saúde da mulher após os 50 anos: vulnerabilidade programática na Estratégia Saúde da Família

OBJECTIVE: To assess the health care process for women over 50 at a Family Health Unit based on the concept of programmatic vulnerability. METHOD: This study is inserted in the field of health care assessments. The framework proposed by Donabedian was used to analyze 90.5% of the 790 records of women registered at the unit. RESULTS: It was observed that none of the women that did not have a diagnosed pathology attended the recommended consultations or underwent the recommended tests. Of the total number of women with hypertension or diabetes, 20.7% were registered in the Hiperdia Programme and less than 1.0% had attended the consultations and undergone the necessary tests. Only 11.9% of the women had had a gynaecological examination, a clinical breast examination and a mammography the year before data collection. CONCLUSION: It is concluded that women over 50 are in a situation of programmatic vulnerability in terms of the indicators established in this study. Knowledge of this reality can help nurses provide care that is best suited for this group. .

OBJETIVO: evaluar el proceso de atención a las mujeres a partir de los 50 años de edad en la Unidad de Salud de la Familia, tomando como referencia el concepto de vulnerabilidad del programa. MÉTODO: Estudio insertado en la evaluación de programas de salud, tuvo Donabediam como referencia, siendo analizados el 90,5% de los 790 registros médicos de mujeres inscritas en la unidad. Fueran creados indicadores de evaluación. RESULTADOS: Ninguna mujer sin patología diagnosticada realizó consultas y exámenes recomendados. De todas las hipertensas y diabéticas, 20,7% estaban inscritas en el Programa Hiperdia y menos del 1,.0% había realizado consultas y exámenes necesarios. Sólo el 11.9% de las mujeres había realizado el examen ginecológico, examen clínico de los senos y la mamografía en el año anterior a la recolección de datos. CONCLUSIÓN: Concluye que las mujeres mayores de 50 años están en situación de vulnerabilidad programática en relación con los indicadores definidos en este estudio. Por lo tanto, conocer la realidad puede resultar en la atención de enfermería más adecuada para este grupo. .

OBJETIVO: Avaliar o processo de atenção prestada a mulheres, a partir dos 50 anos de idade, em Unidade de Saúde da Família, tomando-se como referência o conceito de vulnerabilidade programática. MÉTODO: Estudo inserido no campo da avaliação de programas de saúde; utilizou-se o referencial proposto por Donabediam, sendo analisados 90.5% dos 790 prontuários de mulheres matriculadas na Unidade. RESULTADOS: Observou-se que nenhuma mulher sem patologia diagnosticada realizou consultas e exames preconizados. Do total de hipertensas e diabéticas, 20.7% estavam inscritas no Programa Hiperdia e menos de 1.0% tinha realizado as consultas e exames necessários. Apenas 11.9% das mulheres tinham realizado exame ginecológico, exame clínico das mamas e mamografia, no ano que antecedeu a coleta de dados. CONCLUSÃO: Conclui-se que as mulheres com mais de 50 anos estão em situação de vulnerabilidade programática, relacionada aos indicadores definidos neste estudo. Logo, conhecer a realidade poderá resultar no atendimento de enfermagem mais adequado para esse grupo. .

[Use of hysteroscopy at the office in gynaecological practice]. / Az office hiszteroszkópia alkalmazása a nogyógyászati gyakorlatban.

INTRODUCTION: Nowadays minimally invasive techniques are a leading factors in medicine. According to this trend, hysteroscopy has been used in gynecology more and more frequently. Office hysteroscopy gives opportunity for a faster examination with less costs and strain for the patient. AIM: The aim of this work was to get familiar with the novel method. The author examined the level of pain during hysteroscopy performed for different indications with different types of instruments. In addition, the novel method invented for evaluating tubal patency was compared to the gold standard laparoscopy in 70 tubes. METHOD: Office hysteroscopy was performed in 400 cases for indications according to the traditional method. All examinations were performed in University of Debrecen, Department of Obstetrics and Gynecology in an outpatient setting. A 2.7 mm diameter optic with diagnostic or operative sheet was used. Hysteroscopies were scheduled between the 4th and 11th cycle day. For recording pain level VAS was used in 70 cases. Comparison of hysteroscopic evaluation of tubal patency to the laparoscopic method was studies in 70 cases. RESULTS: It was found that office hysteroscopy can be performed in an outpatient setting, without anesthesia. Pain level showed no difference among subgroups (nulliparous, non-nulliparous, postmenopausal, diagnostic, operative) (mean±SD, 3.5±1.01; p=0.34). For the evaluation of tubal patency, office hysteroscopy showed 92.06% accuracy when compared to laparoscopy. CONCLUSIONS: Office hysteroscopy has several advantages over traditional method. This procedure is fast, it has less strain for the patient. The novel method, rather than traditional hysteroscopy, should be used in the work-up of infertility as well.

Ecografía 3D en indicaciones ginecológicas no obstétricas / 3D ultrasound for non-obstetric gynecological indications

INTRODUCCIÓN: Se estima que aproximadamente el 5-10% de las mujeres con masas anexiales van a requerir una cirugía, cuyo principal objetivo es determinar si se trata de cáncer de ovario. La incidencia de cáncer de ovario es de 1 en 70, siendo más frecuente en la post-menopausia. También se estima que aproximadamente el 5-10% de todas las mujeres que presentan metrorragia de la post-menopausia tiene diagnóstico de carcinoma endometrial. En ambas patologías, la ecografía constituye el primer estudio diagnóstico, realizándose el diagnóstico de certeza mediante la biopsia en un procedimiento invasivo. También existen otros estudios que pueden realizarse para asistir a la toma de decisiones, como por ejemplo el uso de doppler, la tomografía computada y la resonancia magnética. Sumado a estos estudios, surgió la ecografía 3D, con o sin doppler, que podría constituir una nueva herramienta diagnóstica en estos casos, permitiendo la evaluación del volumen y/o el flujo vascular de las regiones de interés, pudiendo obtener los planos deseados más sencillamente y pudiendo navegar por la imagen en forma virtual. La utilización de Power doppler (un tipo de doppler que permite evaluar flujos dentro de estructuras sólidas) permitiría la reconstrucción del árbol vascular tumoral para la evaluación de microaneurismas, shunts arterio-venosos, ramas vasculares anormales y cambios en el calibre y tortuosidad vascular, todas ellas características de tumores malignos. Por otra parte, se propuso el uso de esta tecnología en los casos de endometriosis, una patología cuya prevalencia es cercana al 10% en las mujeres en edad reproductiva. La endometriosis profunda puede presentar sintomatología intensa, con dismenorrea, dolor pelviano crónico, dispareunia y/o disuria. Su diagnóstico correcto permite un mejor abordaje quirúrgico. El primer estudio diagnóstico es la ecografía convencional aunque la resonancia magnética la puede complementar, identificando lesiones recto-sigmoidales u otras posteriores, o para las lesiones de gran tamaño. En este documento se evalúa la potencial utilidad de la ecografía 3D en la evaluación de mujeres con sospecha de masas anexiales, metrorragia de la post-menopausia o endometriosis profunda. TECNOLOGÍA: La ecografía 3D utiliza la capacidad de la ecografía convencional para construir, en tiempo real, mediante la utilización de una computadora, una imagen con volumen que luego puede ser explorada desde diferentes puntos de vista. OBJETIVO: Evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las políticas de cobertura del uso de la ecografía 3D en indicaciones ginecológicas no obstétricas. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas (incluyendo Medline, Cochrane y CRD), en buscadores genéricos de Internet, agencias de evaluación de tecnologías sanitarias y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS) y económicas, guías de práctica clínica (GPC) y políticas de cobertura (PC) de otros sistemas de salud cuando estaban disponibles. RESULTADOS: Se encontró una revisión sistemática, un estudio de corte transversal y una política de cobertura. Las guías de práctica clínica encontradas no mencionan el uso de esta tecnología y, por lo tanto, no fueron incluidas. CONCLUSIONES: La evidencia encontrada es escasa y de moderada calidad. En la evaluación de patología ginecológica con sospecha de malignidad, la gran heterogeneidad en el diseño de los estudios hace difícil la obtención de resultados válidos. No se observó ningún beneficio del uso de ecografía 3D en comparación con ecografía 2D para la evaluación de masas tumorales ováricas ni para evaluación endometrial en mujeres con metrorragia de la postmenopausia. Sólo se observó que podría existir algún beneficio de la ecografía 3D con Power doppler en el muestreo esférico del sector más vascularizado de masas anexiales, aumentando la especificidad. De todos modos, habría que evaluar el uso seriado de 2D y 3D con Power doppler para concluir si su uso de este modo podría redituar en algún beneficio. En cuanto a su uso en endometriosis de localización profunda, se observó que podría tener una mayor especificidad en las áreas posteriores no intestinales. De todos modos, son necesarios más estudios que comparen esta tecnología con la resonancia magnética, que suele utilizarse en estos casos para delimitar mejor la presencia de endometriosis profunda. En resumen, no se ha encontrado ninguna evidencia que justifique el uso de la ecografía 3D en patología ginecológica no obstétrica hasta que no haya más estudios que corroboren los datos encontrados.

INTRODUCTION: It is estimated that approximately 5 to 10% of women with adnexal masses will require surgery mainly aimed at ruling out ovarian cancer. The incidence of ovarian cancer is 1 in 70, this being higher after menopause. It is also estimated that approximately 5 to 10% of all women who develop post-menopausal metrorrhagia will have diagnosed endometrial carcinoma. In both pathologies, ultrasound is the first diagnostic test; the diagnosis is ascertained by means of biopsy in an invasive procedure. There are also other studies which may be performed to help decision making, such as Doppler, computed tomography and magnetic resonance imaging. In addition to these studies, 3D ultrasound, with or without Doppler, was also included because it could become a new diagnostic tool for these cases; since it allows evaluating the volume and/or vascular flow of the areas of interest, obtaining the desired planes more easily and virtually navigating the image. The use of Power Doppler (a type of Doppler which allows flow evaluation within solid structures) would permit reconstruction of the tumor vascular tree to evaluate microaneurisms, arteriovenous shunts, abnormal vascular branches and changes in vessel tortuosity and inner diameter; all of them in malignant tumors. On the other hand, the use of this technology was proposed for cases of endometriosis, a disorder whose prevalence is approximately 10% in women of reproductive age. Deep endometriosis may present important symptoms: dysmenorrhea, chronic pelvic pain, dyspareunia and/or dysuria. Its correct diagnosis allows a better surgical approach. The first diagnostic study is conventional ultrasound, although magnetic resonance imaging may supplement it, thus identifying rectosigmoideal or other posterior lesions, or large-size lesions. This document assesses the potential usefulness of 3D ultrasound when evaluating women with suspected adnexal masses, post-menopausal metrorrhagia or deep endometriosis. TECHNOLOGY: 3D ultrasound uses the capacity of conventional ultrasound to build an image with volume, in real time, using a computer, which can be analyzed from different points of view. PURPOSE: To assess the available evidence on the efficacy, safety and coverage related aspects regarding 3D ultrasound use in non-obstetric gynecological indications. METHODS: A bibliographic search was carried out on the main databases (such as MEDLINE, Cochrane and CRD), in general Internet engines, in health technology assessment agencies and health sponsors. Priority was given to the inclusion of systematic reviews (SRs); controlled, randomized clinical trials (RCTs); health technology assessments (HTAs) and economic evaluations; clinical practice guidelines (GCPs) and coverage policies (CPs) of other health systems, when available. RESULTS: One systematic review, one cross-sectional study and one coverage policy were found. The clinical practice guidelines found do not mention the use of this technology and, were therefore excluded. CONCLUSIONS: The evidence found is scarce and of moderate quality. For gynecological disorder evaluation, in case of suspected malignancy, the wide heterogeneity of study design makes difficult to obtain valid results. No benefit was observed with the use of 3D ultrasound compared with 2D ultrasound to evaluate ovarian tumor masses or endometrial evaluation in women with postmenopausal metrorrhagia. It was only observed that there might be some benefit from 3D ultrasound with Power Doppler in the spherical sampling of the most vascularized area in adnexal masses, thus increasing specificity. However, serial use of 2D and 3D ultrasound with Power Doppler should be assessed to be able to conclude if its use could be beneficial. As regards its use in deep endometriosis, it was observed that it could have higher specificity in the non-intestinal posterior areas. Nevertheless, it is necessary to conduct additional studies comparing this technology with magnetic resonance imaging, which is usually used in these cases to better detect the presence of deep endometriosis. In summary, no evidence was found accounting for the use of 3D ultrasound for non-obstetric gynecological disorders until more studies corroborating the data found are conducted.

Screening pelvic examination in adult women: a clinical practice guideline from the American College of Physicians.

DESCRIPTION: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the utility of screening pelvic examination for the detection of pathology in asymptomatic, nonpregnant, adult women. METHODS: This guideline is based on a systematic review of the published literature in the English language from 1946 through January 2014 identified using MEDLINE and hand-searching. Evaluated outcomes include morbidity; mortality; and harms, including overdiagnosis, overtreatment, diagnostic procedure-related harms, fear, anxiety, embarrassment, pain, and discomfort. The target audience for this guideline includes all clinicians, and the target patient population includes asymptomatic, nonpregnant, adult women. This guideline grades the evidence and recommendations using the ACP's clinical practice guidelines grading system. RECOMMENDATION: ACP recommends against performing screening pelvic examination in asymptomatic, nonpregnant, adult women (strong recommendation, moderate-quality evidence).

Insufficient assessment of sexual dysfunction: a problem in gynecological practice.

BACKGROUND AND OBJECTIVE: Sexual health is an important part of a woman's life and well-being. Female sexual dysfunction is a complicated problem, it is often underestimated in the healthcare process, and its management is complex. Giving women the opportunity to talk about sexual problems is a fundamental part of healthcare and may improve their quality of life. The aim of this study was to find out patients' experience and attitudes toward the involvement of gynecologists addressing sexual issues, to disclose the main barriers to initiate a conversation, and to assess the prevalence of sexual disorders among patients in a gynecological clinic. MATERIAL AND METHODS: A questionnaire-based approach was used to survey 18- to 50-year-old voluntary patients in the gynecological clinic. The study population comprised 300 different gynecological (except oncologic) patients independently of reasons for being in the clinic. The duration of the study was 6 months. RESULTS: Only one-third of the patients had ever been asked about their sexual life by a gynecologist, whilst the majority (80%) of the respondents reported they would like to be asked abaut and discuss sexual issues. The patients mostly did not complain because of psychoemotional barriers, and shame was the main barrier for patients to talk about their problems. Sexual dysfunction was a frequent disorder among gynecological patients, reaching especially high levels in the arousal (46.41%) and lubrication (40.67%) domains. CONCLUSIONS: The assessment of sexual health is insufficient in gynecological care, and sexual history-taking and evaluation of sexual functions should be included in routine gynecological health assessments.

Gynaecological assessment and history taking.

Nurse practitioners (NPs) rarely undertake gynaecological histories or female genital examinations yet, by doing so, they can broaden their scope of practice. This article discusses what NPs should ask women about their gynaecological histories and how to undertake pelvic examinations, and reviews common gynaecological symptoms. Further articles will cover different aspects of the pelvic examination and potential differential diagnoses.

Assessment of female sexual function in patients with psoriasis.

INTRODUCTION: Psoriasis has a major impact on sexual health due to the disfiguring skin lesions affecting self-image and self-esteem. However, this topic has not been fully explored. AIM: The study aims to assess sexual function in female patients with psoriasis. METHODS: This cross-sectional study included 52 sexually active female patients with psoriasis regardless of their age (group I) and 30 normal volunteers (who were age matched with the patients) who served as a control group (group II). Full history taking, general and systemic examination, including sexual history, together with clinical examination to evaluate the extent of skin disease using Psoriasis Assessment Severity Index (PASI) score and evaluation of sexual function using the Female Sexual Function Index (FSFI) Questionnaire, were done for all the subjects enrolled in the study. MAIN OUTCOME MEASURES: Correlation between PASI and FSFI domain scores was determined in matched groups using Pearson correlation. RESULTS: This study revealed a negative correlation between the PASI score and the overall sexual satisfaction in the studied group. Also, psoriatic female patients with genital psoriasis have more significantly impaired sexual function compared with either those without genital lesions or those with lesions elsewhere in the body. CONCLUSIONS: It is imperative to do full sexual and psychological assessment of psoriatic patients to improve outcomes and increase patients' compliance with treatment.

Comparing two methods of detection for Chlamydia trachomatis in liquid-based Papanicolaou tests.

This study compared the performance of Chlamydia trachomatis testing using 2 methods: the BD ProbeTec Chlamydia trachomatis Q(x) Amplified DNA Assay (CTQ) on the BD Viper System with XTR technology (CTQ assay) and the Hybrid Capture (HC) 2 assay. A total of 1,054 Surepath and ThinPrep specimens were tested for C trachomatis nucleic acids using the CTQ assay and the HC2 assay. For positive and discrepant C trachomatis test results, confirmatory test for C trachomatis was performed using a reverse transcriptase-polymerase chain reaction. Of 1,054 liquid-based gynecologic cytology samples tested for C trachomatis using both assays, 1,041 tested negative on both. In 6 (0.57%) samples, findings were discordant. The CTQ assay and the HC2 assay had sensitivity rates of 100% and 66.7%, respectively, with comparable specificity (99.9%). The positive predictive values were 92.3% and 88.9% with the CTQ and HC2 assays, respectively. In this study, the CTQ assay was found to be more sensitive than the HC2 assay in detecting chlamydial infection; the CTQ assay also demonstrated a higher positive predictive value.

Gynecologic issues in geriatric women.

The number of women over the age of 65 is projected to almost double in the next 20 years, and clinicians need to be comfortable treating conditions common to this cohort. This review covers several common gynecologic conditions seen in older women, including atrophic vaginitis, lichen sclerosis, pelvic floor disorders, and postmenopausal bleeding. We conclude with evidence-based screening recommendations for gynecologic cancers in older women and tips on doing a pelvic examination.

[Health assessment of newborns with congenital urinary malformation].

Improvement in diagnosis of prenatal congenital urinary malformations (CUM) resulted in increased detection of CUM cases among newborns. To facilitate medical care for CUM newborns, we have developed an objective method of CUM newborns' health assessment. We studied 40 case histories of newborns with prenatally detected CUM admitted to urological clinics (20 with diagnosis of poor health and 20 with moderate condition severity) and 40 CUM newborns examined outpatiently (moderate health hazard). The computer analysis of the available data has established 13 most informative diagnostic criteria: 4 sonographic criteria, 3 lab criteria and 6 physical exam criteria estimated by 4 points - from 0 to 4. The criteria were pooled to a table which was used as a scale to assess general health condition. After delivery, CUM newborn gets inpatient health assessment by a neonatologist using 13 criteria. According to the total score, the condition is assessed as satisfactory (0-5), moderately severe (6-11), severe ( > 12). Efficacy of such health assessment was proved in a population study of 312 prenatal CUM newborns. Grouping of such newborns helps design of programs of further examination and management.

Malignant tumors of the female pelvic floor: self-assessment module.

The educational objectives for this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of malignant tumors of the female pelvic floor and the imaging features that determine therapy.

Early laparoscopy for the evaluation of nonspecific abdominal pain: a critical appraisal of the evidence.

BACKGROUND: Patients with nonspecific abdominal pain (NSAP) are frequently seen in emergency departments. Different studies have suggested that early laparoscopy (EL) could be an adequate tool to accelerate diagnosis and therapy. The aim of this study was to assess the effectiveness of EL in terms of diagnosis, persistence of NSAP, mortality, morbidity, cost, hospital stay, and quality of life relative to observation in NSAP. METHODS: We performed a systematic review to identify randomized controlled trials (RTC) comparing EL versus active observation (AO) in NSAP. The primary outcomes were the number of patients with positive and negative findings, the utility for each group, and the cases with persistence of NSAP. Methodologic quality was assessed using the recommendations of the Cochrane Collaboration. RESULTS: Five studies that included a total of 921 patients were included: 460 in the EL group and 461 in the AO group. The use of an important methodologic heterogeneity between included studies avoided a pooled analysis. Data suggested that EL performed better in establishing a final diagnosis (79.2-96.9%) vs. AO (28.1-78.1%); however, the final therapeutic utility of laparoscopy was lower than the diagnostic rate (10.9-86.5%). The mortality rate of EL was similar to AO, and morbidity ranged from 1.15 to 23.72% in EL compared with the range from 1.9 to 31.14% in AO. The length of hospital stay ranged from 1.3 to 4.18 days in EL compared with the range from 2 to 7.3 days in AO. CONCLUSIONS: There is an important heterogeneity between the populations and in the degree of methodologic quality in the included studies. Data suggest that EL performs better in establishing a final diagnosis after admission, but the lack of uniform information does not allow for the recommendation of EL as a routine strategy in clinical practice. We recommend that a large trial be conducted with specific operative characteristics to solve problems identified in primary trials.

[Comparative assessment of the methods of treatment of Condylomata acuminata].

The treatment of Condylomata acuminata often causes disappointment to both the physician and the patient since most of the current medical approaches require multiple examines while on the other hand success rates are low and recurrence rates remain high. The treatment approaches include surgical as well as non-surgical methods. The non-surgical treatment includes the application of local agents such as imiquimod, podophyllotoxin, and 5-fluorouracil. Other local agents, used in outpatient treatment settings, include trichloroacetic acid (TCA), podophyllin, or the intralesional application of agents such as interferon and bleomycin. The surgical methods include cryotherapy, electrosurgery, excision and laser therapy. Their major goal is the removal of the visible lesions. The development of the laser systems and the new HPV vaccines are a significant progress in the treatment and prevention of the HPV infections.

Cost-analysis comparison of outpatient see-and-treat hysteroscopy service with other hysteroscopy service models.

STUDY OBJECTIVE: To conduct a cost analysis of 3 different hysteroscopy service models. DESIGN: Decision-analytic model constructed from the UK National Health Service perspective (Canadian Task Force classification III). SETTING: Tertiary-care hospital. PATIENTS: Women undergoing hysteroscopy (N=1109). INTERVENTIONS: Three hysteroscopy service models: outpatient see-and-treat service; outpatient diagnostic hysteroscopy followed by referral for operative hysteroscopy under general anesthesia (outpatient and referral service); and general anesthesia see-and-treat service. MEASUREMENTS AND MAIN RESULTS: Costs were measured in 2008 UK pounds sterling. Of the 3 treatment arms, total costs were lowest with outpatient see-and-treat service. The lower cost of the outpatient see-and-treat service was observed across a number of patient subgroups (age, menopause status, and indication) and when subjected to sensitivity analyses. CONCLUSIONS: Outpatient see-and-treat hysteroscopy was associated with the lowest treatment costs. This service model may reduce the total cost of care in women referred for hysteroscopy.