Papanicolaou smears: to swab or not to swab.

OBJECTIVE: To determine whether cleaning the cervix with a cotton swab affects the quality of the conventional Papanicolaou smear. DESIGN: Prospective, single-blinded randomized case-control study. SETTING: Two academic family medicine teaching units and 1 community family practice site. PARTICIPANTS: Female patients, 18 to 65 years of age, who presented for a routine Pap smear in the family practice setting were randomized into the Swab Group (n = 300) or the No Swab Group (n = 316). INTERVENTION: Before the Pap smear, the cervix of patients in the Swab Group was wiped with a cotton swab until visibly free of mucus. In the No Swab Group, the cervix was not cleaned with a cotton swab before the Pap smear. MAIN OUTCOME MEASURES: The quality of the conventional Pap smear was determined by the presence or absence of endocervical cells noted on the pathology report. RESULTS: There was no major difference in the quality of the Pap smear in terms of the adequacy of endocervical cells between the Swab and No Swab Group. CONCLUSION: Cleaning the cervix with a cotton swab does not appear to affect the quality of the conventional Pap smear in terms of adequacy of endocervical cells. This implies that the practice of wiping or not wiping the mucus from the cervix before taking the Pap smear can be employed at the discretion of the clinician.

A Screening Instrument to Identify Adults with Nutritional Risks in a Family Medicine Practice.

Family practice is the point of entry for many individuals seeking medical attention in the community. It is an ideal site for instituting preventative measures aimed at risk management. The objective of this study was to develop a valid, reliable instrument to screen adults for risk of suboptimal nutrition in a family practice population. A self-administered nutrition questionnaire was developed and sent to 50 registered dietitians in Alberta to establish face validity. The ability of the tool to identify nutritional risk was established by comparing the results of the screen to a dietitian's full assessment, that would include weight, weight changes, body mass index, adequacy of nutrition intake, available laboratory data, and medical and social factors that influence nutrition status. A score of 12 or higher on the screen was found to have an 80% sensitivity and defined the high-risk individuals who required immediate nutrition intervention (14% of our study population). At a score of seven, the screening instrument had a sensitivity of 67% and a specificity of 77%. This score was used to define moderate risk individuals, who required some nutrition advice. Screen scores below seven corresponded with individuals who were not at nutritional risk. The study has shown that a simple, self-administered screening tool can effectively identify the nutritional risk of adults in a family medicine practice.