Utilisation of co-testing (human papillomavirus DNA testing and cervical cytology) after treatment of CIN: - a survey of GPs' awareness and knowledge.

BACKGROUND: Patients have an increased risk of persistent/recurrent cervical disease if they received treatment for a high-grade squamous intraepithelial lesion (HSIL). Consequently, understanding whether co-testing (human papillomavirus [HPV] DNA testing and cervical cytology) is fully utilised by general practitioners (GPs) is paramount. METHODS: After consultation with key stakeholders, an anonymous, self-completion questionnaire was developed and disseminated to GPs who had provided cervical cytology. RESULTS: Responses were received from 745 GPs (30.9% response rate). A significant number (34.3%) of GPs were unaware of the use of co-testing (HPV DNA testing and cervical cytology) for the management of patients after HSIL treatment. Additionally, the majority of GPs reported they did not 'always' receive a clear follow-up plan for patients after treatment of an HSIL. DISCUSSION: GPs require further support and education to ensure successful adoption of co-testing (HPV DNA testing and cervical cytology), specifically, for patients treated for an HSIL.

The role of general practitioners in the continued success of the National Cervical Screening Program.

BACKGROUND: As the gateway to healthcare for Australian women, general practitioners (GPs) are critical to the success of the National Cervical Screening Program (NCSP). Despite an enviable record - halving the incidence and mortality of cervical cancer - in 2010-2011 more than 2.7 million women did not comply with the recommended 2-yearly screening interval. OBJECTIVE: General practice strategies are presented to assist GPs in encouraging all women, in particular, high-risk and vulnerable women, to participate in cervical screening. DISCUSSION: GPs play a crucial part in addressing the demographic, psychosocial and healthcare barriers that prevent women's participation in cervical screening. Encouraging uptake of the human papillomavirus vaccine and educating all patients on the importance of continued participation in cervical screening is essential for further decreasing the prevalence of this disease through early detection and treatment of cervical abnormalities.

Does routine induction of labour at 41 weeks really reduce the rate of caesarean section compared with expectant management?

OBJECTIVE: It is contended that routine induction of labour at 41 completed weeks of gestation reduces, or at least does not increase, a woman's chance of Caesarean section (CS), compared with expectant management. We wanted to know if this was true in our own hospital. METHODS: We performed a retrospective review of 1367 nulliparous women who had reached 41+0 weeks undelivered with a live, singleton, fetus with a cephalic presentation. The women comprised two non-randomized contemporaneous cohorts: in one group, expectant management was planned, and in the second group the intention was to induce labour at 41 weeks. The primary outcome measure was the rate of CS in each group. RESULTS: Of 645 women in whom expectant management was planned, 17.7% delivered by CS. Of 722 women in whom induction of labour was planned, 21.3% delivered by CS (P = 0.09). Of the total of 907 women in whom expectant management was planned or who laboured spontaneously before planned induction could be carried out, 16.6% delivered by CS. Of 460 women in whom induction was planned and actually carried out, 25.4% delivered by CS (P = 0.001). CONCLUSION: The contention that routine induction of labour at 41 weeks reduces a woman's chance of delivery by Caesarean section was not supported by the findings of our study. Inducing labour may actually increase the nulliparous woman's risk of delivery by CS.