A clinical audit of a nurse colposcopist. Colposcopy: cytology: histology correlation.

The role of the nurse colposcopist has been established in some countries for a number of years. At National Women's Health the first New Zealand nurse colposcopist training programme was developed in 2000. A clinical audit was undertaken to assess the diagnostic skills of the nurse colposcopist measuring colposcopy: histology: cytology correlation. A retrospective audit of the colposcopy clinical records was performed during the nurse's training programme between July 2000 and March 2002. An 82% (82/100) histology: cytology: colposcopy correlation was achieved by the nurse in the third phase of her training programme. The results are comparable with other reported studies involving medical and nurse colposcopists. Expertise in colposcopy examination can be incorporated into the broader role of a Nurse Practitioner working in the area of women's health.

Factors affecting abnormal Pap smear follow-up among HIV-infected women.

Women with HIV infection are at least 10 times more likely to have an abnormal Pap smear than women who are HIV negative. Unfortunately, many women with HIV do not return for care after an abnormal Pap smear. Through the use of focus groups and individual interviews, HIV-positive women's experiences with abnormal Pap smears and the factors that affected whether they returned for care were explored. Two thirds of the 18 participants were minority women, and the average age was 40. Using techniques of constant comparative analysis, five factors were identified that affected whether women came back for care. These factors included fear, the asymptomatic nature of the problem, life circumstances, the participant's perspectives on health, and the health care provider. The findings from this study have implications for clinical practice and future research regarding adherence and abnormal Pap smear follow-up among women with HIV.

Gynecologic care for women with HIV infection.

The purpose of this article is to review the gynecologic conditions encountered among women with HIV and to outline elements of gynecologic care for these women. The most prevalent problems are vulvo-vaginal candidiasis and cervical dysplasia; however, other sexually transmitted diseases, pelvic inflammatory disease, genital ulcer disease, and menstrual abnormalities are also seen. Drug interactions may limit the effectiveness or increase the toxicities associated with hormonal contraception. Intrauterine devices are contraindicated.

Pap test results among low-income youth: prevalence of dysplasia and practice implications.

OBJECTIVES: To describe Papanicolaou (Pap) test findings and identify prevalence and correlates of dysplastic cervical abnormalities in low-income adolescent females. DESIGN AND SETTING: This cross-sectional study included a modified random sample of female students ages 16 to 25 years at 54 U.S. Job Corps centers. PARTICIPANTS: 5,734 female students enrolled in a federal job training program. Admission health records were reviewed and abstracted. MAIN OUTCOME MEASURE: Pap test findings using the Bethesda classifications. Pap smear results indicating dysplasia (atypical squamous cells of undetermined significance [ASCUS] with dysplasia) or squamous intraepithelial lesions (low-grade squamous interepithelial lesions [LGSIL] or high-grade squamous intraepithelial lesions [HGSIL]). Participants with less severe findings were compared with those who needed follow-up. RESULTS: For 71.4% of participants, no abnormalities were found. 15.6% had benign cellular changes, 9.2% had reactive changes, and 9.9% had epithelial cell abnormalities. Of those tested, 5.6% (+/- 0.8%) had dysplastic Pap smear findings, with 0.3% (n = 12) HGSIL. All groups were equally affected, with abnormalities not associated with race/ethnicity, age, geographic region, education level, size of city of residence, or receiving public assistance. CONCLUSIONS: In this population, dysplastic Pap smear results were not uncommon. Findings indicate that Pap screening, alone or in combination with more sensitive tests, can identify cervical abnormalities, including HGSIL, that suggest a need for further evaluation or follow-up.

Papanicolaou smear: an update on classification and management.

Current research has caused us to reconsider the factors associated with cervical dysplasia. New recommendations for the collection of cervical specimens, interpretation of the Papanicolaou smear, and patient management have also evolved. Research findings and a discussion of the classifications to be used when reporting the results of the smear are updated in this paper. Interpretation and nurse-practitioner management of the normal and mildly abnormal Pap result is included.

Assessment and management of cervical intraepithelial neoplasia.

Although cervical intraepithelial neoplasia (CIN) once was thought to be a clinical problem primarily for older women, data reveal an alarming rise of this condition among younger women. The gains made in decreasing the incidence of cervical cancer have been tempered by the steadily increasing incidence of its precursor state, CIN. Because of increasing evidence of the association of the human papillomavirus (HPV) with cervical cancer and CIN, this virus is of particular concern. Colposcopy is a valuable method for evaluating CIN that has been indicated on Pap, as well as for identifying HPV. Since having an abnormal Pap and undergoing colposcopic examination may be stressful, the clinician can play a significant role in helping the client cope with the process of evaluation and treatment of abnormal Paps in addition to controlling cervical cancer.

Lesões precursoras de câncer cervical: significado para mulheres em um centro de referência no Brasil / Lesiones precursoras de cáncer cervical: significado para mujeres en un centro de referencia en Brasil / Cervical cancer precursor lesions: significance for women in a referral center in Brazil

Objetivo: compreender a vivência de mulheres com lesões precursoras de câncer cervical. Método: estudo fenomenológico, com as etapas de redução, construção e destruição. A interpretação dos dados foi realizada por meio da análise compreensiva heideggeriana. Resultados: os fenômenos desvelados eram relativos às dúvidas das mulheres, devido ao desconhecimento do diagnóstico; mudanças no relacionamento com parceiros; dificuldades em ter amigos; importância da família; estratégias de enfrentamento;relacionamento com profissionais da saúde e descrédito na assistência; vergonha e constrangimento na realização do teste de Papanicolau; e medo da morte. Conclusão: constatou-se que urge redimensionar o cuidar da mulher com lesões precursoras de câncer cervical, tendo em vista o desafio de compreender a necessidade do profissional da saúde cuidar sob a perspectiva heideggeriana, estabelecendo uma relação de ser-com-o-outro, valorizando-o como sujeito de possibilidades.

Objective: understand the experience of women with cervical cancer precursor lesions. Method: phenomenological study, with the reduction, construction, and destruction steps. Data interpretation was performed through Heidegger’s comprehensive analysis. Results: the phenomena unveiled were related to women’s doubts, due to lack of diagnosis; changes in relationships with partners; difficulties in making friends; family importance; coping strategies; relationship with health professionals and distrust in care; shame and embarrassment to undergo the Pap test; and fear of death. Conclusion: it was found that there is an urgent need to resize the care for a woman with cervical cancer precursor lesions, given the challenge of understanding the need that a health professional provides care from the Heideggerian perspective, establishing a relationship of being-with-the-other, appreciating her as a subject of possibilities.

Objetivo: comprender la experiencia de mujeres con lesiones precursoras de cáncer cervical. Método: estudio fenomenológico, con las etapas de reducción, construcción y destrucción. La interpretación de los datos se realizó mediante el análisis comprensivo de Heidegger. Resultados: los fenómenos desvelados eran relativos a las dudas de las mujeres, debido a la falta de diagnóstico; cambios en la relación con compañeros; dificultades para tener amigos; importancia de la familia; estrategias de afrontamiento; relación con los profesionales de la salud y desconfianza en la atención; vergüenza y timidez al someterse a la prueba de Papanicolaou; y miedo a la muerte. Conclusión: se constató que hay una necesidad urgente de redimensionar la atención a una mujer con lesiones precursoras del cáncer cervical, dado el reto de comprender la necesidad de que un profesional de la salud cuide bajo la perspectiva heideggeriana, estableciendo una relación de ser-con-el-otro, valorándolo como un sujeto de posibilidades.

Determinants of participation of women in a cervical cancer visual screening trial in rural south India.

The efficacy of a single round of screening of visual inspection with acetic acid (VIA) on cervical cancer incidence and mortality is investigated in a cluster randomized controlled trial in south India. Women aged 30-59 years in 113 clusters in Dindigul District were randomized to VIA screening by nurses (57 clusters, 48,225 eligible women) and to a control group (56 clusters, 30,167 women). 30,577 (63.4%) eligible women participated in screening. Younger, educated, married, multiparous, low-income women and those who have had tubal sterilization had a higher compliance with screening. Of the 2069 women diagnosed with CIN and invasive cancer, 1498 (72.4%) received treatment. Young women, those who practiced contraception and women with high-grade precursor lesions and invasive cancers were more likely to comply with treatment. In summary, our study indicates that women accept screening with VIA by nurses and a moderate level of compliance with screening and treatment can be reached through appropriate service delivery systems including health education activities, personal invitations, clinics in proximity to the target women, and testing and treatment in the same session. Our results imply that integration of screening activities with primary health services seems to have the potential to replicate most of these service delivery conditions in routine programs.

Cervical intraepithelial neoplasia diagnosis: emotional impact and nursing implications.

Cervical intraepithelial neoplasia (CIN) is a progressive disease process that starts with abnormal cellular development in the cervical epithelium and can be identified as low- or high-grade squamous intraepithelial lesions (LGSIL or HGSIL) by the Papanicolaou (Pap) smear test. Persistent abnormal results require follow-up colposcopy, an anxiety-producing procedure. Anxiety and fear can interfere with adequate treatment and follow-up. Early education efforts may reduce anxiety and enhance adherence to treatment and are invaluable in halting the progression of CIN. Diagnosis and treatment, the emotional impact on women, and implications for client education are discussed.

Precursor lesions of the cervix.

Screening has played a major role in decreasing the morbidity and mortality associated with carcinoma of the cervix. Aggressive management of lesions recognized as precursor to invasive squamous carcinoma, (cervical intraepithelial neoplasia), has markedly reduced the incidence of invasive cancer. Squamous carcinomas constitute most of the cervical cancers. The relationship between human papilloma virus and cervical abnormalities is reviewed. Nursing diagnoses and care planning ideas are discussed.