Pap smear versus speculum examination: can we teach providers to educate patients?

OBJECTIVE: To test whether provider-based training in focused patient communication can improve patient knowledge about Pap screening as part of the speculum examination in an urban urgent care setting. METHODS: A separate samples pretest, posttest study evaluated the intervention. Before the intervention, we surveyed a convenience sample of 383 consecutive patients who received a speculum examination in a gynecology urgent care clinic of an urban public hospital about their understanding of the Pap smear and its correct use. The intervention trained healthcare providers to briefly explain speculum examinations and Pap smears. After the intervention, we surveyed 130 additional consecutive patients. RESULTS: The intervention was associated with improved identification that a Pap smear had not been performed (57.7% preintervention vs. 70.7% postintervention, p = 0.013) and improved knowledge that the Pap smear screens only for cervical cancer (12.0% preintervention vs. 23.8% postintervention, p = 0.002). In logistic regression analysis controlling for age and other potential confounders, being in the postintervention group and speaking Spanish predicted correct identification of Pap test use (odds ratio [OR], 95% confidence interval [CI] 2.70, 1.54-4.75, and 2.98, 1.48-5.98, respectively). CONCLUSIONS: In an urban urgent care setting, patients may lack awareness that screening tests are not being performed at the time of a problem-oriented pelvic examination. A targeted intervention to improve physician counseling was associated with partial improvement in patient awareness and knowledge.

Vaginal cleansing before cesarean delivery to reduce postoperative infectious morbidity: a randomized, controlled trial.

OBJECTIVE: The objective of the study was to determine whether vaginal preparation with povidone iodine before cesarean delivery decreased the risk of postoperative maternal morbidities. STUDY DESIGN: The design of the study was a randomized, controlled trial in women undergoing cesarean delivery with subjects assigned to have a preoperative vaginal cleansing with povidone iodine or to a standard care group (no vaginal wash). The primary outcome was a composite of postoperative fever, endometritis, sepsis, readmission, wound infection, or complication. RESULTS: There were 155 vaginal cleansing subjects and 145 control subjects. Overall, 9.0% developed the composite outcome, with fewer women in the cleansing group (6.5%) compared with the control group (11.7%), although the difference was not statistically significant (relative risk, 0.55; 95% confidence interval, 0.26-1.11; P = .11). Length of surgery, being in labor, and having a dilated cervix were all associated with the composite morbidity outcome. CONCLUSION: Vaginal cleansing with povidone iodine before cesarean delivery may decrease postoperative morbidities, although the reduction is not statistically significant.