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[PMID]:28719688
[Au] Autor:Grossman DC; Bibbins-Domingo K; Curry SJ
[Ad] Endereço:Washington Health Research Institute, Kaiser Permanente, Seattle.
[Ti] Título:Screening Pelvic Examinations-Reply.
[So] Source:JAMA;318(3):300-301, 2017 07 18.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Exame Ginecológico
Programas de Rastreamento
[Mh] Termos MeSH secundário: Seres Humanos
Exame Físico
Fatores de Risco
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171121
[Lr] Data última revisão:
171121
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170719
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.7837


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[PMID]:28719685
[Au] Autor:Qaseem A; Humphrey L; Forciea MA
[Ad] Endereço:American College of Physicians, Philadelphia, Pennsylvania.
[Ti] Título:Screening Pelvic Examinations.
[So] Source:JAMA;318(3):300, 2017 07 18.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Exame Ginecológico
Programas de Rastreamento
[Mh] Termos MeSH secundário: Medicina Baseada em Evidências
Feminino
Neoplasias dos Genitais Femininos/diagnóstico
Exame Ginecológico/efeitos adversos
Seres Humanos
Relações Médico-Paciente
Fatores de Risco
[Pt] Tipo de publicação:LETTER
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170831
[Lr] Data última revisão:
170831
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170719
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.7825


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[PMID]:28700088
[Au] Autor:Plumptre I; Mulki O; Granados A; Gayle C; Ahmed S; Low-Beer N; Higham J; Bello F
[Ad] Endereço:Faculty of Medicine, Imperial College, London, UK.
[Ti] Título:Standardizing bimanual vaginal examination using cognitive task analysis.
[So] Source:Int J Gynaecol Obstet;139(1):114-119, 2017 Oct.
[Is] ISSN:1879-3479
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To create a standardized universal list of procedural steps for bimanual vaginal examination (BVE) for teaching, assessment, and simulator development. METHODS: This observational study, conducted from June-July 2012 and July-December 2014, collected video data of 10 expert clinicians performing BVE in a nonclinical environment. Video data were analyzed to produce a cognitive task analysis (CTA) of the examination steps performed. The CTA was further refined through structured interviews to make it suitable for teaching or assessment. It was validated through its use as a procedural examination checklist to rate expert clinician performance. RESULTS: BVE was deconstructed into 88 detailed steps outlining the complete examination process. These initial 88 steps were reduced to 35 by focusing on the unseen internal examination, then further refined through interviews with five experts into 30 essential procedural steps, five of which are additional steps if pathology is suspected. Using the CTA as a procedural checklist, the mean number of steps performed and/or verbalized was 21.6 ± 3.12 (72% ± 10.4%; range, 15.9-27.9, 53%-93%). CONCLUSION: This approach identified 30 essential steps for performing BVE, producing a new technique and standardized tool for teaching, assessment, and simulator development.
[Mh] Termos MeSH primário: Competência Clínica
Exame Ginecológico
[Mh] Termos MeSH secundário: Avaliação Educacional
Feminino
Ginecologia/educação
Seres Humanos
Entrevistas como Assunto
Modelos Anatômicos
Obstetrícia/educação
Análise e Desempenho de Tarefas
Gravação em Vídeo
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY; VALIDATION STUDIES
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170713
[St] Status:MEDLINE
[do] DOI:10.1002/ijgo.12260


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[PMID]:28538493
[Ti] Título:Committee Opinion No. 703 Summary: Asymptomatic Microscopic Hematuria in Women.
[So] Source:Obstet Gynecol;129(6):1153-1154, 2017 Jun.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Asymptomatic microscopic hematuria is an important clinical sign of urinary tract malignancy. Asymptomatic microscopic hematuria has been variably defined over the years. In addition, the evidence primarily is based on data from male patients. However, whether the patient is a man or a woman influences the differential diagnosis of asymptomatic microscopic hematuria, and the risk of urinary tract malignancy (bladder, ureter, and kidney) is significantly less in women than in men. Among women, being older than 60 years, having a history of smoking, and having gross hematuria are the strongest predictors of urologic cancer. In low-risk, never-smoking women younger than 50 years without gross hematuria and with fewer than 25 red blood cells per high-power field, the risk of urinary tract malignancy is less than or equal to 0.5%. Furthermore, the evaluation may result in more harm than benefit and is unlikely to be cost effective. Thus, data support changing current hematuria recommendations in this low-risk group. The American College of Obstetricians and Gynecologists and the American Urogynecologic Society encourage organizations producing future guidelines on the evaluation of microscopic hematuria to perform sex-specific analysis of the data and produce practical sex-specific recommendations. In the meantime, the American College of Obstetricians and Gynecologists and the American Urogynecologic Society recommend that asymptomatic, low-risk, never-smoking women aged 35-50 years undergo evaluation only if they have more than 25 red blood cells per high-power field.
[Mh] Termos MeSH primário: Hematúria/etiologia
Neoplasias Urológicas/diagnóstico
[Mh] Termos MeSH secundário: Feminino
Exame Ginecológico/normas
Seres Humanos
Sociedades Médicas
Estados Unidos
Urinálise/normas
Neoplasias Urológicas/complicações
Neoplasias Urológicas/urina
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170714
[Lr] Data última revisão:
170714
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170525
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002110


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[PMID]:28528899
[Au] Autor:Sawaya GF; Smith-McCune KK; Gregorich SE; Moghadassi M; Kuppermann M
[Ad] Endereço:Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA; Center for Healthcare Value, University of California, San Francisco, San Francisco, CA. Electronic address: george.sawaya@ucsf.edu.
[Ti] Título:Effect of professional society recommendations on women's desire for a routine pelvic examination.
[So] Source:Am J Obstet Gynecol;217(3):338.e1-338.e7, 2017 Sep.
[Is] ISSN:1097-6868
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The American College of Physicians strongly recommends against performing pelvic examinations in asymptomatic, nonpregnant women, citing evidence of harm (false-positive testing, unnecessary surgery) and no evidence of benefit. In contrast, the American Congress of Obstetricians and Gynecologists recommends pelvic examinations in asymptomatic women beginning at age 21 years, citing expert opinion. OBJECTIVE: We sought to evaluate if providing women with professional societies' conflicting statements about pelvic examinations (recommendations and rationales) would influence their desire for a routine examination. STUDY DESIGN: We recruited 452 women ages 21-65 years from 2 women's clinics to participate in a 50-minute face-to-face interview about cervical cancer screening that included a 2-phase study related to pelvic examinations. In the first phase, 262 women were asked about their desire for the examination without being provided information about professional societies' recommendations. In the second phase, 190 women were randomized to review summaries of the American College of Physicians or American Congress of Obstetricians and Gynecologists statement followed by an interview. RESULTS: First-phase participants served as the referent: 79% (208/262) indicated they would want a routine examination if given a choice. In the second phase, a similar percentage of women randomized to the American Congress of Obstetricians and Gynecologists summary had this desire (82%: 80/97; adjusted odds ratio, 1.37; 95% confidence interval, 0.69-2.70). Women randomized to the American College of Physicians summary, however, were less likely to indicate they would opt for an examination (39%: 36/93; adjusted odds ratio, 0.12; 95% confidence interval, 0.06-0.21). Overall, 94% (179/190) believed the potential benefits and harms should be discussed prior to the examination. CONCLUSION: Providing women with a professional society's recommendation advising against routine pelvic examinations substantially reduced their desire to have one. Educational materials are needed to ensure women's informed preferences and values are reflected in decisions about pelvic examinations.
[Mh] Termos MeSH primário: Exame Ginecológico/normas
Preferência do Paciente
Sociedades Médicas
[Mh] Termos MeSH secundário: Adulto
Idoso
Tomada de Decisões
Feminino
Conhecimentos, Atitudes e Prática em Saúde
Seres Humanos
Entrevistas como Assunto
Meia-Idade
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170523
[St] Status:MEDLINE


  6 / 372 MEDLINE  
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[PMID]:28368896
[Au] Autor:Committee on Gynecologic Practice, American Urogynecologic Society
[Ti] Título:Committee Opinion No.703: Asymptomatic Microscopic Hematuria in Women.
[So] Source:Obstet Gynecol;129(6):e168-e172, 2017 Jun.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Asymptomatic microscopic hematuria is an important clinical sign of urinary tract malignancy. Asymptomatic microscopic hematuria has been variably defined over the years. In addition, the evidence primarily is based on data from male patients. However, whether the patient is a man or a woman influences the differential diagnosis of asymptomatic microscopic hematuria, and the risk of urinary tract malignancy (bladder, ureter, and kidney) is significantly less in women than in men. Among women, being older than 60 years, having a history of smoking, and having gross hematuria are the strongest predictors of urologic cancer. In low-risk, never-smoking women younger than 50 years without gross hematuria and with fewer than 25 red blood cells per high-power field, the risk of urinary tract malignancy is less than or equal to 0.5%. Furthermore, the evaluation may result in more harm than benefit and is unlikely to be cost effective. Thus, data support changing current hematuria recommendations in this low-risk group. The American College of Obstetricians and Gynecologists and the American Urogynecologic Society encourage organizations producing future guidelines on the evaluation of microscopic hematuria to perform sex-specific analysis of the data and produce practical sex-specific recommendations. In the meantime, the American College of Obstetricians and Gynecologists and the American Urogynecologic Society recommend that asymptomatic, low-risk, never-smoking women aged 35-50 years undergo evaluation only if they have more than 25 red blood cells per high-power field.
[Mh] Termos MeSH primário: Hematúria/etiologia
Neoplasias Urológicas/diagnóstico
[Mh] Termos MeSH secundário: Feminino
Exame Ginecológico/normas
Seres Humanos
Sociedades Médicas
Estados Unidos
Urinálise/normas
Neoplasias Urológicas/complicações
Neoplasias Urológicas/urina
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170714
[Lr] Data última revisão:
170714
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170404
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002059


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[PMID]:28343555
[Au] Autor:Dargie EE; Chamberlain SM; Pukall CF
[Ad] Endereço:Department of Psychology, Queen's University, Kingston, ON.
[Ti] Título:Provoked Vestibulodynia: Diagnosis, Self-Reported Pain, and Presentation During Gynaecological Examinations.
[So] Source:J Obstet Gynaecol Can;39(3):145-151, 2017 03.
[Is] ISSN:1701-2163
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To explore factors associated with the diagnosis of provoked vestibulodynia (PVD) through (1) self-reported pain characteristics and (2) Friedrich's criteria (vestibular pain during sexual activity/gynaecological examination). We also identified cases in which incorrect diagnoses were assigned and explored group differences in gynaecological examination presentation and associations with self-reported pain. METHODS: Data were extracted from nine studies conducted in our research laboratory. Information obtained during a telephone interview and a standardized gynaecological examination was compiled for 106 participants with vulvar pain and 106 pain-free control participants, matched for age, hormonal contraceptive use, and parity. RESULTS: Cohen's kappa (0.78) indicated substantial agreement (87.3%) between the telephone interview group categorization and diagnosis after the gynaecological examination. A discriminant function analysis yielded one significant function: Friedrich's first two criteria correctly classified 84.2% of cases, accounting for 76.0% of group membership variance. Of note, those in the other genital pain group were most likely to have received an incorrect diagnosis following the telephone interview (P < 0.001). Paired-samples t tests showed that those with pain reported lower pain intensity during the gynaecological examination than during intercourse (P < 0.001) and that intercourse pain was not necessarily related to pain during the examination. However, many participants (72.8%) indicated that the pain elicited during the cotton swab test was similar to the pain they felt with intercourse. CONCLUSION: These results support the use of a targeted clinical interview and the evaluation of vestibular pain during sexual activity and the gynaecological examination for diagnosing PVD. Caution should be exercised when a patient presents with genital pain symptoms other than those typically observed in PVD. Furthermore, the cotton swab test may underestimate the degree of pain regularly experienced.
[Mh] Termos MeSH primário: Dispareunia/diagnóstico
Exame Ginecológico
Autorrelato
Vulvodinia/diagnóstico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estudos de Casos e Controles
Coito
Feminino
Seres Humanos
Meia-Idade
Medição da Dor
Comportamento Sexual
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170328
[St] Status:MEDLINE


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[PMID]:28287815
[Au] Autor:Kadioglu S; Ögenler O; Uzel I
[Ad] Endereço:Department of History of Medicine and Medical Ethics, Medical School, Çukurova University, Adana, Turkey.
[Ti] Título:A Classical Wooden Vaginal Speculum Mentioned in Old Medical Manuscripts.
[So] Source:Arch Iran Med;20(3):193-195, 2017 Mar.
[Is] ISSN:1735-3947
[Cp] País de publicação:Iran
[La] Idioma:eng
[Ab] Resumo:The subject of this paper is the story of an ancient medical instrument. This instrument is a wooden vaginal speculum used in classical and Islamic medicine. Its drawings can be found in Abulcasis al-Zahrawi's and Serefeddin Sabuncuoglu's illustrated books of surgery.
[Mh] Termos MeSH primário: Desenho de Equipamento/história
Ginecologia/história
Obstetrícia/história
Instrumentos Cirúrgicos/história
[Mh] Termos MeSH secundário: Exame Ginecológico/instrumentação
Ginecologia/instrumentação
História do Século XV
História Antiga
História Medieval
Seres Humanos
Manuscritos Médicos como Assunto
Obstetrícia/instrumentação
[Pt] Tipo de publicação:HISTORICAL ARTICLE; JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170314
[St] Status:MEDLINE
[do] DOI:0172003/AIM.0013


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[PMID]:28267862
[Au] Autor:Bibbins-Domingo K; Grossman DC; Curry SJ; Barry MJ; Davidson KW; Doubeni CA; Epling JW; García FA; Kemper AR; Krist AH; Kurth AE; Landefeld CS; Mangione CM; Phillips WR; Phipps MG; Silverstein M; Simon M; Siu AL; Tseng CW; US Preventive Services Task Force
[Ad] Endereço:University of California, San Francisco.
[Ti] Título:Screening for Gynecologic Conditions With Pelvic Examination: US Preventive Services Task Force Recommendation Statement.
[So] Source:JAMA;317(9):947-953, 2017 03 07.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Many conditions that can affect women's health are often evaluated through pelvic examination. Although the pelvic examination is a common part of the physical examination, it is unclear whether performing screening pelvic examinations in asymptomatic women has a significant effect on disease morbidity and mortality. Objective: To issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for gynecologic conditions with pelvic examination for conditions other than cervical cancer, gonorrhea, and chlamydia, for which the USPSTF has already made specific recommendations. Evidence Review: The USPSTF reviewed the evidence on the accuracy, benefits, and potential harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women 18 years and older who are not at increased risk for any specific gynecologic condition. Findings: Overall, the USPSTF found inadequate evidence on screening pelvic examinations for the early detection and treatment of a range of gynecologic conditions in asymptomatic, nonpregnant adult women. Conclusions and Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women. (I statement) This statement does not apply to specific disorders for which the USPSTF already recommends screening (ie, screening for cervical cancer with a Papanicolaou smear, screening for gonorrhea and chlamydia).
[Mh] Termos MeSH primário: Doenças dos Genitais Femininos/diagnóstico
Exame Ginecológico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Comitês Consultivos
Idoso
Detecção Precoce de Câncer
Feminino
Seres Humanos
Programas de Rastreamento
Meia-Idade
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1704
[Cu] Atualização por classe:171121
[Lr] Data última revisão:
171121
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170308
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.0807


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[PMID]:28267861
[Au] Autor:Guirguis-Blake JM; Henderson JT; Perdue LA
[Ad] Endereço:Department of Family Medicine, University of Washington, Tacoma2Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon.
[Ti] Título:Periodic Screening Pelvic Examination: Evidence Report and Systematic Review for the US Preventive Services Task Force.
[So] Source:JAMA;317(9):954-966, 2017 03 07.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Recent changes in the periodicity of cervical cancer screening have led to questions about the role of screening pelvic examinations among asymptomatic women. Objective: To systematically review literature on health benefits, accuracy, and harms of the screening pelvic examination for gynecologic conditions for the US Preventive Services Task Force (USPSTF). Data Sources: MEDLINE, PubMed, and Cochrane Central Register of Controlled Trials for relevant English-language studies published through January 13, 2016, with surveillance through August 3, 2016. Study Selection: Two reviewers independently screened abstracts and studies. The search yielded 8678 unique citations; 316 full-text articles were reviewed, and 9 studies including 27 630 patients met inclusion criteria. Data Extraction and Synthesis: Two reviewers rated study quality using USPSTF criteria. Main Outcomes and Measures: Morbidity; mortality; diagnostic accuracy for any gynecologic cancer or condition except cervical cancer, gonorrhea, and chlamydia, which are covered by other USPSTF screening recommendations; harms (false-positive rates, false-negative rates, surgery rates). Results: No trials examined the effectiveness of the pelvic examination in reducing all-cause mortality, reducing cancer- and disease-specific morbidity and mortality, or improving quality of life. Eight studies reported accuracy for the screening pelvic examination: ovarian cancer (4 studies; n = 26 432), bacterial vaginosis (2 studies; n = 930), trichomoniasis (1 study; n = 779), and genital herpes (1 study; n = 779). In the 4 ovarian cancer screening studies, low prevalence of ovarian cancer consistently resulted in low positive predictive values (PPVs) and false-positive rates, with a lack of precision in accuracy estimates (sensitivity range, 0%-100%; specificity range, 91%-99%; PPV range, 0%-3.6%; negative predictive value [NPV] range, ≥99%). Each diagnostic accuracy study for bacterial vaginosis, trichomoniasis, and genital herpes was performed in a high-prevalence population with substantial proportions of symptomatic patients and reported accuracy characteristics for individual physical examination findings (bacterial vaginosis, homogeneous discharge: sensitivity range, 69%-79%; specificity range, 54%-97%; PPV range, 52%-95%; NPV range, 79%-80%; herpes simplex virus, vulvar ulcerations: sensitivity, 20%; specificity, 98%; PPV, 88%; NPV, 57%; trichomoniasis, colpitis macularis: sensitivity, 2%; specificity, 100%; PPV, 100%; NPV, 85%). Surgery rates resulting from an abnormal screening pelvic examination for ovarian cancer ranged from 5% to 36% at 1 year, with the largest study reporting an 11% surgery rate and 1% complication rate within 1 year of a screening pelvic examination with abnormal findings. Conclusions and Relevance: No direct evidence was identified for overall benefits and harms of the pelvic examination as a 1-time or periodic screening test. Limited evidence was identified regarding the diagnostic accuracy and harms of routine screening pelvic examinations in asymptomatic primary care populations.
[Mh] Termos MeSH primário: Doenças dos Genitais Femininos/diagnóstico
Exame Ginecológico
Programas de Rastreamento
[Mh] Termos MeSH secundário: Adulto
Ensaios Clínicos como Assunto
Feminino
Exame Ginecológico/efeitos adversos
Exame Ginecológico/métodos
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170417
[Lr] Data última revisão:
170417
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170308
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2016.12819



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