RESUMO
OBJECTIVE: To determine the pap smear adequacy, and to compare the quality using cervical cytobrush with that obtain by using cotton swab in the endocervical sample. DESIGN: Transversal study. Carried out in two periods both pre and post intervention. SETTING: Primary care centre in the south of Madrid. INTERVENTION: We have analysed all the pap smear performed during two periods. In the first period we obtained 1130 smears using cotton swab and 884 smears using cervical cytobrush in the second period. We used the Ayre Spatula to obtain the exocervical samples. RESULTS: 2014 pap smears were analysed. Of the 1130 smears examined in the primary study using the cotton swab, 25.9% were inadequate because of the absence of the transformation zone cells. In the second group, 884 pap smears obtained by using the cytobrush, only 13.9% were reported as inadequate smears, p < 0.00001 (chi square). 18 smears were positive for malignancy (6 suspicious, 9 CIN I, 3 CIN III, all under the age of 49. 14.6% were positive for infections. There were no significant differences in the smear adequacy in regards to the professional who obtained the sample. CONCLUSIONS: We have improved the smear adequacy 12% by using the cytobrush. We recommend the cytobrush for endocervical smears to avoid having to repeat the sample. We consider it necessary to indicate the smear adequacy in all pathology reports.
Assuntos
Colo do Útero/patologia , Manejo de Espécimes/instrumentação , Manejo de Espécimes/normas , Neoplasias do Colo do Útero/prevenção & controle , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Objetivo. Conocer la calidad de las citologías vaginales y compararla según se utilice el bastoncillo o cepillo cervical en la toma endocervical. Diseño. Estudio transversal realizado en 2 períodos, antes y después de una intervención. Emplazamiento. Centro de Salud Zona Sur de Madrid. Intervención. Se han analizado todas las citologías vaginales realizadas en 2 períodos. En el primero, para obtener la muestra endocervical se utilizó la torunda de algodón, mientras que para la obtención de la misma muestra en el segundo período se utilizó el cepillo cervical. Resultados. Se analizaron un total de 2.014 citologías vaginales. En el primer período se realizaron 1.130, de las cuales un 25,9 por ciento fue informado como inadecuadas por ausencia de las células de la zona de transformación, frente al 13,9 por ciento de las 884 citologías realizadas en el segundo periodo, p < 0,00001 (ji-cuadrado). Se detectaron hallazgos positivos para malignidad en 18 citologías (6 dudosas, 9 CIN I, 3 CIN III), todas en mujeres menores de 49 años. En un 14,6 por ciento de las muestras se encontró patología infecciosa. No hubo diferencias significativas en la calidad de las muestras en función del profesional que realizó la toma. Conclusiones. Se mejoró la calidad de la toma cervicovaginal cuando empleamos el cepillo en un 12 por ciento. Recomendamos la utilización del cepillo para la toma endocervical, ya que se evita repetir tomas que encarecen la actividad. Creemos importante que el patólogo especifique en todo informe citológico la calidad de la muestra (AU)
Assuntos
Pessoa de Meia-Idade , Adulto , Adolescente , Idoso , Feminino , Humanos , Manejo de Espécimes , Colo do Útero , Estudos Transversais , Neoplasias do Colo do ÚteroRESUMO
OBJECTIVES: To evaluate how adequately pain in terminal cancer patients is managed by morphine taken orally. DESIGN: A descriptive, retrospective study, from January 1993 to March 1994. SETTING: Primary care. Four primary care teams of the 10th Health Area of Madrid. PATIENTS: 37 patients with terminal cancer who took morphine under the supervision of primary care doctors. MEASUREMENTS AND MAIN RESULTS: Average age was 64.6 +/- 14. The most common site of the primary tumour was lungs (n = 6), colon (n = 4) and stomach (n = 4). All the patients received conventional analgesics at first and 82% went on to weak opiates before progressing to morphine. Half the patients began with an oral solution of morphine and the other half with long-acting tablets. Increases in the doses of morphine were correct in 62% of cases. 41% of the patients took antiemetics and 55% laxatives. 82% of the bone and 100% of the brain metastases were correctly treated. CONCLUSIONS: In general, primary care doctors in our area correctly handle pain caused by terminal cancer. The most significant errors are to do with increases in doses of morphine and with the associated use of laxatives. These can easily be rectified so that our patients' quality of life can be improved.
