AP MEAR A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Pap Smear: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84152-7 1. Pap Smear-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.
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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on Pap smear. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.
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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON PAP SMEAR ............................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Pap Smear ..................................................................................... 4 E-Journals: PubMed Central ....................................................................................................... 26 The National Library of Medicine: PubMed ................................................................................ 27 CHAPTER 2. NUTRITION AND PAP SMEAR ..................................................................................... 71 Overview...................................................................................................................................... 71 Finding Nutrition Studies on Pap Smear.................................................................................... 71 Federal Resources on Nutrition ................................................................................................... 72 Additional Web Resources ........................................................................................................... 72 CHAPTER 3. ALTERNATIVE MEDICINE AND PAP SMEAR ............................................................... 75 Overview...................................................................................................................................... 75 National Center for Complementary and Alternative Medicine.................................................. 75 Additional Web Resources ........................................................................................................... 80 General References ....................................................................................................................... 82 CHAPTER 4. DISSERTATIONS ON PAP SMEAR ................................................................................. 83 Overview...................................................................................................................................... 83 Dissertations on Pap Smear......................................................................................................... 83 Keeping Current .......................................................................................................................... 84 CHAPTER 5. PATENTS ON PAP SMEAR ............................................................................................ 85 Overview...................................................................................................................................... 85 Patents on Pap Smear .................................................................................................................. 85 Patent Applications on Pap Smear ............................................................................................ 100 Keeping Current ........................................................................................................................ 104 CHAPTER 6. BOOKS ON PAP SMEAR.............................................................................................. 107 Overview.................................................................................................................................... 107 Book Summaries: Federal Agencies............................................................................................ 107 Book Summaries: Online Booksellers......................................................................................... 108 The National Library of Medicine Book Index ........................................................................... 109 Chapters on Pap Smear.............................................................................................................. 110 CHAPTER 7. MULTIMEDIA ON PAP SMEAR ................................................................................... 111 Overview.................................................................................................................................... 111 Audio Recordings....................................................................................................................... 111 Bibliography: Multimedia on Pap Smear................................................................................... 112 CHAPTER 8. PERIODICALS AND NEWS ON PAP SMEAR ................................................................ 115 Overview.................................................................................................................................... 115 News Services and Press Releases.............................................................................................. 115 Newsletter Articles .................................................................................................................... 118 Academic Periodicals covering Pap Smear ................................................................................ 119 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 123 Overview.................................................................................................................................... 123 NIH Guidelines.......................................................................................................................... 123 NIH Databases........................................................................................................................... 125 Other Commercial Databases..................................................................................................... 128 APPENDIX B. PATIENT RESOURCES ............................................................................................... 129 Overview.................................................................................................................................... 129 Patient Guideline Sources.......................................................................................................... 129 Finding Associations.................................................................................................................. 136 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 139
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Overview.................................................................................................................................... 139 Preparation................................................................................................................................. 139 Finding a Local Medical Library................................................................................................ 139 Medical Libraries in the U.S. and Canada ................................................................................. 139 ONLINE GLOSSARIES................................................................................................................ 145 Online Dictionary Directories ................................................................................................... 146 PAP SMEAR DICTIONARY........................................................................................................ 147 INDEX .............................................................................................................................................. 185
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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with Pap smear is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about Pap smear, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to Pap smear, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on Pap smear. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to Pap smear, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on Pap smear. The Editors
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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.
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CHAPTER 1. STUDIES ON PAP SMEAR Overview In this chapter, we will show you how to locate peer-reviewed references and studies on Pap smear.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and Pap smear, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “Pap smear” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •
Heart and Soul's 7 Days of Health Source: Heart and Soul. p.60-62,64,67. April-May, 1997. Summary: This article describes seven ways women can improve their health. The seven suggestions are: get fit and eat healthy, avoid stress and hypertension, get a PAP smear and mammogram, educate yourself about diabetes, protect yourself from HIV-AIDS, treat your asthma, and develop your spirituality.
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Preventive Health Care Measures Before and After Start of Renal Replacement Therapy Source: Journal of General Internal Medicine. 17: 588-595. August 2002.
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Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 638-6423. Summary: This article reports on a study undertaken to describe the utilization of preventive health care measures in patients with chronic kidney disease (CKD), both in the year prior to onset of renal replacement therapy (RRT) and in the first year of RRT. The authors identified a large cohort of patients with CKD in the New Jersey Medicaid and Medicare programs with fixed enrollment into the cohort at 1 year prior to RRT. The authors then applied commonly used quality assurance instruments and defined levels and correlates of use of preventive care measures before and after RRT. These included mammography, Pap smear testing, prostate cancer screening, diabetic eye exams, and glycosylated hemoglobin testing (HbA1c, a measure of blood glucose over time). Overall, screening rates were low with the exception of diabetic eye exams. Prostate cancer screening, diabetic eye exams, and HbA1c testing were performed less often after onset of RRT compared to the year before. The authors conclude that preventive health care interventions remain underutilized among RRT patients. Greater attention to such preventive measures could lead to significant improvements in the health status of such vulnerable patients. Thus, quality improvement of the general health care for patients on RRT should become a priority in renal health policy. 1 figure. 4 tables. 23 references.
Federally Funded Research on Pap Smear The U.S. Government supports a variety of research studies relating to Pap smear. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to Pap smear. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore Pap smear. The following is typical of the type of information found when searching the CRISP database for Pap smear: •
Project Title: A COMMUNITY INTERVENTION TO PROMOTE CANCER SCREENING Principal Investigator & Institution: Roetzheim, Richard G.; Associate Professor; Family Medicine; University of South Florida 4202 E Fowler Ave Tampa, Fl 33620 Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 30-JUN-2003 Summary: ABSTACT=Racial and ethnic minorities, persons of lower socioeconomic status, and the underinsured have especially low rates of cancer screening. This project will implement and test a simple, cost-effective office intervention to increase cancer
2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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screening rates among disadvantaged populations. The intervention strategy utilizes an office system approach designed to maximize cancer screening during routine primary care visits. The office intervention consists of a low-cost kit of materials and explicit responsibilities for patients and office staffs that will help providers perform opportunistic screening. Feedback of screening rates to providers is a second component of the intervention designed to maintain intervention effects. The intervention will be tested in a 4-year quasi-experimental trial involving 16 primary care clinics that serve predominately disadvantaged populations in Tampa, Florida and the surrounding county. We hypothesize that patients attending intervention clinics will be more likely to receive cancer screening services (Pap smears, mammograms, fecal occult blood testing) than those attending control sites. We will also explore the relative costeffectiveness of the intervention strategy and the durability of intervention effects over time. This project takes advantage of clinical sites serving populations with demonstrated deficits in cancer screening. It also targets the most common reason patients give for not receiving cancer screening services (physicians didn't recommend it). Finally, the intervention utilizes resources that are available to most patients (primary care clinics and their personnel), and relies on low cost methods to promote screening. These factors greatly increase the likelihood that a successful intervention can diffuse into standard medical care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: BREAST AND CERVICAL CANCER SCREENING IN KOREANAMERICANS Principal Investigator & Institution: Choi, Eunice E.; None; University of San Diego 5998 Alcala Pk San Diego, Ca 92110 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 31-AUG-2004 Summary: The long-term objective of this program of research is to develop, implement, and evaluate a culturally tailored intervention to increase the rates of obtaining mammogram, CBE, and Pap smear screens and practicing BSE in Korean American (KA) women. Dr. Choi's goals during this proposed training are to: 1) Gain advanced skills in developing culturally valid instruments; 2) Enhance her understanding of health promotion and disease prevention issues; 3) Generate knowledge related to KA women's utilization of the cancer screening tests; and 4) Generate knowledge related to health care providers' recommendations of the screening tests for KA women. The theoretical framework of this proposed project is based on Anderson's Behavioral Model supplemented with the Cultural Explanatory Model. The specific aims of this proposed study of KA immigrant women older than 40 years of age and their utilization of these tests are: 1) To develop culturally appropriate instruments and test them; 2) To test the hypothesis that KA women's predisposing variables; enabling variables, and need variables will be related to their utilization of the screening tests; and 3) To identify culturally specific and demographic variables that influence physicians' recommendation or practice of the screening tests. To achieve the specific aims, this proposed project will be conducted in 5 phases: 1) individual interviews with 30 KA women; 2) six focus groups with KA women; 3) modification of existing instruments and/or development of new instruments based on the results of individual interviews and focus groups; 4) individual interviews with 10 KA and 10 Caucasian American physicians; and 5) a survey with a community based random sample of 350 KA women in order to pilot test and to establish psychometric properties of the instruments. This proposed project is innovative since no published project has approached cancer screening services from the perspectives of both recipients as well as their providers to
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provide a comprehensive understanding of the reasons KA women have lower utilization rates of these tests. This project is significant in generating culturally accurate information and instruments to be used in both epidemiological research and culturally tailored intervention research for cancer screening test utilization in KA women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CANCER UNDERSERVED
SCREENING,
MANAGED
CARE,
AND
THE
Principal Investigator & Institution: Pasick, Rena J.; Associate Director; Northern California Cancer Center 32960 Alvarado Niles Rd, Ste 600 Union City, Ca 94587 Timing: Fiscal Year 2002; Project Start 30-SEP-1992; Project End 30-NOV-2003 Summary: Low-income women are at high risk for developing cervical cancer due not only to the higher prevalence of risk factors and lack of access to screening, but also because of barriers to timely follow-up when screened and found to have an abnormality. Lack of follow-up, therefore, contributes to the racial and ethnic health outcome disparities that exist for cervical cancer. While other interventions have shown some success at improving Pap smear follow-up rates, there is no existing randomized intervention trial that has demonstrated such high rates of improvement in follow-up as the Pathfinders study that addresses follow-up barriers in a very high-risk population of ethnically diverse, low-income, inner city women. The intervention consisted of computer-assisted tracking, education, counseling in consumer skills and ways of coping, transportation vouchers, and referrals for suspected mental health, alcohol/drug abuse, and domestic violence. When analyzed by intention to treat, of 348 women who were randomized at the time of the institutional receipt of the abnormal result, twice as many women in the intervention group were confirmed to have a follow-up test within 6 mos. of their abnormal Pap smear than in the control group, 70% versus 36% (p<0.01). By using an expanded tracking protocol, we were able to locate and to deliver the intervention to 128/178 women in the intervention group. Of those who received the intervention, 83% had a documented follow-up test with 6 mos. versus 36% in the intervention group who did not receive the intervention (p<0.01). Overall, we were unable to contact 18 (10%) women, 16 (9%) moved, and 11 (6%) refused the counseling intervention. The average time-cost of tracking and outreach counseling per woman was 109 min. With this project, we have demonstrated that low follow-up rates can be substantially improved by the implementation of a more personal and culturally tailored approach, coupled with utilization of state-of-the-art computer assistance. This supplement addresses the need for dissemination of cost-effective interventions that improve Pap smear follow-up in high-risk populations. We propose a strategy for dissemination and maintenance of the intervention on a local-scale. If successful, we will adapt the intervention, based on what we have learned, for more widespread dissemination. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CAP-PAP TEST FOR SPECIMENS COLLECTED IN SOLUTION Principal Investigator & Institution: Markovic, Nenad; Bioscicon, Inc. 259 Congressional Ln, Ste 602 Rockville, Md 20852 Timing: Fiscal Year 2002; Project Start 15-APR-2002; Project End 31-MAR-2003 Summary: The CAP-PAP test is a single-slide, double-staining, in vitro method for labeling dysplastic cervical cells on Pap smears (USPTO#6, 143, 512). A recently completed clinical laboratory trial (1R43CA86767-01) has shown that this test is easily
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applicable in a routine cytopathology laboratory for cervical cancer screening. The safety of the new method was equal, and its efficacy and prognostic value was superior to the control Pap test. We propose to study how the CAP-PAP test could be applied on thin and monolayers of cervical cells collected with any of the new liquid-based cervical specimen collection technologies. It is CAP-PAP test will help users of these technologies to improve the accuracy of cancer detection of the original CAP-PAP test procedure, will e considered for patient application. Recently, the business reports signaled that the FDA approved liquid- based specimen collection technologies have penetrated the Pap test market in the US up to 30%. This means that a modified CAPPAP test could face a market of 10-30 million test per year. PROPOSED COMMERCIAL APPLICATIONS: If approved as an in vitro diagnostic medical device, this test will face a market of 10-30 million Pap tests per year (specimen collected using any of the liquidbased specimen collection technologies). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CLINICAL MANAGEMENT OF UTERINE ATYPICAL SQUAMOUS CELLS Principal Investigator & Institution: Guido, Richard R.; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001 Summary: ALTS intends to determine the optimal management of mildly abnormal Pap smears (encompassing LSIL and ASCUS)in women. Specifically, the trial will evaluate three possible management strategies: (1) Immediate colposcopy, the most common management option currently, and the most invasive and expensive; (2) HPV triage, in which participants will be typed for the HPV virus via Hybrid Capture Microtiter testing and triaged to colposcopy based upon the identification of a high-risk (oncogenic) viral type; and (3) conservative management, in which participants will be followed by cytology results at 6 month intervals, and triaged to colposcopy in the event of high-grade cytologic diagnosis. All women enrolled into ALTS will be followed, after the initial visit, at 6 month intervals with cytologic testing for 2 years. Collection of cervical cells, masked HPV tests, and bloodwork and cervical secretions obtained through an immunological component will provide information about both the natural history of mild cervical dysplasia as well as differences among management arms, if they exist. Treatment acceptability and quality of life data will be collected as well. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: COMMUNITY TRIAL TO INCREASE CANCER SCREENING ADHERENCE Principal Investigator & Institution: Fox, Sarah A.; Rand Corporation 1700 Main St Santa Monica, Ca 90401 Timing: Fiscal Year 2001; Project Start 30-SEP-1998; Project End 31-MAR-2002 Summary: Certain cancer screening tests are effective in early detection, most notably, the tests used for breast, cervical, and colorectal cancers. These tests, all of which are endorsed by the U.S. Preventive Task Force for women over age 50, include mammography, clinical breast examination (CBE), Pap smear, and fecal occult blood test (FOBT). In spite of widespread endorsement, many women do not systematically receive these tests. This is especially true for certain subpopulations -- Hispanics, pooper women, and women without health insurance. For example, as recently as 1996, only 24 percent of Hispanic patients over age 50 in Los Angeles County reported receiving
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regular mammograms. This is a randomized trial involving a sample of primary care physicians drawn from 29 contiguous communities in Los Angeles. The trial has four specific aims: 1) develop, pretest, and implement a multifaceted physician intervention designed to increase physician use and referral rates for breast, cervical, and colorectal cancer screening for underscreened female patients, 2) identify and track for two years the screening rates of female patients over age 50 for mammography, CBE, Pap, and FOBT, 3) compare the intervention versus control to estimate the cost effectiveness ratio for the intervention relative to the control, and 4) evaluate the effectiveness of the proposed intervention in achieving its stated goals. The intervention to be tested is a CME workshop that incorporates cancer control content, communication skill training, and cultural competence training to increase patient adherence to screening; patient brochures for physicians practices; 3 post CME reminder/evaluations; and a 1 year and a 2 year post workshop patient chart audit feedback. The physician intervention will be evaluated using a randomized two-group design, while the patients' records and survey data will provide the behavioral data to assess patient adherence to screening for the three cancers. Although much is known about barriers to breast cancer screening relative to other cancers, we know far less about cultural and communication barriers to breast, cervical and colorectal cancer screening. We also need to learn about cultural and communication barriers that affect patients who otherwise have assess to care. This multifaceted physician intervention is highly exportable, especially to managed care settings. Since southern California is moving rapidly toward managed care predominance, this experiment has the potential to be highly marketable and influential with the majority of future providers who care about screening adherence. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: CORE--CLINICAL FACILITY Principal Investigator & Institution: Bonnez, William C.; University of Rochester Orpa Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2001 Summary: The Clinical Core unit is designed to procure serum, peripheral blood leukocytes (PBLs), and wart biopsies from patients with anogenital warts, both at baseline and as the wart is regressing. These samples as well as similar ones already from healthy volunteers immunized with an HPV-11 virus-like particle vaccine will be used to support the studies described in the three projects of the application. 18 to 65 year-old patients with anogenital warts will be enrolled in the wart procurement protocol if they have at least 6 warts at entry (two larger than 98 MM2). Patients will be excluded if they are unable to maintain the clinic visit schedule, unable to be reached by telephone, have had prior autogenous vaccination, topical or systemic antiviral or antiwart therapy within two weeks of enrollment, treatment with medications, altering the immune system within 4 weeks prior to study entry, immunodeficiency or autoimmune disease, diabetes mellitus, positive HIV serology, pregnancy, breastfeeding, and presence of cervical squamous intra-epithelial lesion or cancer by Pap smear. Patients will undergo biopsies of their warts and normal buttock skin for the preparation of an autogenous vaccine from the wart(s) and of a placebo from the normal skin, as well as for the recovery of wart infiltrating lymphocytes. In addition, serum and Pbls will be obtained. The patient will be then randomized to receive his/her autogenous vaccine or placebo in a 2:1 ratio. We plan to recruit 75 evaluable patients. The vaccine will be administered subcutaneously and weekly for six weeks. During that period, as well as seven weeks afterwards subcutaneously and weekly for six weeks. During that period, as well as seven weeks afterwards, patients will be monitored for wart response. Should
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they develop regressing warts, one of the largest lesions will be promptly biopsied, and serum and PBLs obtained. If there is no wart regression, these procedures will be done 12 weeks after the first vaccination. Patients who still have warts then will be offered cryotherapy. Those patients free of disease will be followed every week weeks for an additional 12 weeks. Follow-up will help establish the correlates between the immunologic events and the clinical outcomes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DEVELOPMENT OF A URINE PCR ASSAY FOR HPV DNA DETECTION Principal Investigator & Institution: Hagensee, Michael E.; Associate Professor of Clinical Medicine; Medicine; Louisiana State Univ Hsc New Orleans New Orleans, La 70112 Timing: Fiscal Year 2001; Project Start 05-APR-2000; Project End 31-MAR-2002 Summary: Human papillomavirus (HPV) is the most common virally sexually transmitted disease, and high-risk types of HPV have been implicated in over 90% of cervical cancers worldwide. Current preventative me measures of cervical cancer include routine Pap smear evaluation, which appears to be effective. Current preventative measures for cervical cancer include routine Pap smear evaluation, which appear to be effective. However, a small but significant proportion (>10%) of females in the United States have either never had a Pap smear or (>30%) do not have them on a routine basis. This may be due, in part, to the invasiveness and discomfort of the requirement pelvic examination. Although HPV cannot be routinely grown in the laboratory, its DNA can be deleted by amplification techniques such as PCR. Detection of HPV DNA from cervical swab or cervical lavage specimens has been used as an epidemiological tool to determine the prevalence rates of HPV infection. These procedures also require a pelvic examination that limits its widespread applicability. A method that is equally sensitive and efficient but does not require a pelvic examination to detect HPV infection will be able to identify more women at risk for cervical cancer and greatly aid in epidemiologic surveys. The recent advances in the diagnosis of gonorrhea and chlamydia infection by screening urine using amplification techniques demonstrate the feasibility of diagnosis a cervical infection by a urine test. Preliminary date have demonstrated the ability to detect HPV DNA in urine specimens from women at high risk for HPV infection. For these reasons, we hypothesize that a urine PCR test for the detection of HPV DNA will reflect the state of infection for the cervic. The goal of this proposal is to fully develop and validate a urine PCR test for HPV DNA detection that can be utilized for epidemiologic screening purposes. We propose to initially develop the urine PCR assay for HPV DNA detection by studying 20 women with no detectable HPV DNA in their urine. The ability to detect beta-globin DNA (internal control for the presence of cells) and known amounts of clon4ed HPV DNA spiked into these urine specimens will be measured and optimized. Next, urine will be obtained from 50 women previously tested to have HPV DNA detected in cervical/vaginal swabs. The extraction method by the initial experiments will be verified by testing these known HPV positive "field" specimens. Finally, utilizing the conditions optimized in specific aims #1 and verified in specific aim #2, a cohort of 250 women at high-risk and 250 women at low-risk for HPV infection will be enrolled. Paired urine and cervicovaginal swabs will be obtained and the ability to detect any HPV DNA, any high-risk HPV DNA and type-specific HPV DNA will be compared. A validated urine test for HPV DNA detection could be used to better define the epidemiology of HPV, to explore
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the natural history of HPV infection, and to identify women at higher risk for cervical cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DIAGNOSIS OF CERVICAL & VULVAR PRECANCERS Principal Investigator & Institution: Mahadevan-Jasen, Anita; Assistant Professor; Biomedical Engineering; Vanderbilt University 3319 West End Ave. Nashville, Tn 372036917 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 30-APR-2006 Summary: It was estimated that 4,400 deaths would occur in the United States alone from this disease and 12,900 new cases of invasive cervical cancer would be diagnosed in 2001. Existing screening and detection techniques, the Pap smear and colposcopy, have several deficiencies that prevent efficient management of an otherwise controllable disease. An automated diagnostic with improved sensitivity and specificity that could allow for a "See and Treat" protocol would significantly improve the management of the disease. Optical spectroscopy can provide automated, fast and non-intrusive characterization of normal and non-normal tissues. In particular, Raman spectroscopy can be used to provide accurate differential diagnosis of early disease. Preliminary results indicate the potential of using Raman spectroscopy for the diagnosis of cervical precancers and to translate its application for the detection of vulvar disease. In particular, in vitro studies show that Raman spectroscopy can differentiate between cervical precancers and all other tissue categories with a sensitivity and specificity of 91 percent and 90 percent, significantly better than fluorescence spectroscopy. More importantly, the results from the initial 13 patients studied in vivo, indicate that 1 it is possible to measure Raman spectra from cervical tissue in vivo and (2) Raman spectroscopy can identify cervical lesions in vivo I (with spectra similar to that observed in vitro). Thus this proposal seeks to develop a real-time, optical method for the differential diagnosis of cervical precancerous lesions by providing real-time, automated, non-intrusive information of the tissue biochemistry and pathology. In addition, this proposal seeks to extend the capability of this technique to include vulvar disease. The specific aims of the proposed project are as follows; (1) Characterize Raman signatures of cervical tissues in vivo. (2) Develop diagnostic algorithms that separate normal and non- precancerous tissues from precancerous tissues. (3) Study the basis of observed differences in the spectral characteristics using microspectroscopy, cytochemical analysis, and modeling. (4) Conduct retrospective and prospective evaluation of the algorithms developed to obtain estimates of their performance. (5) Assess the feasibility of using optical spectroscopy for vulvar disease and verify the performance capability of this technique for vulvar precancer detection. (6) Develop software interface to implement and automate data acquisition and provide real-time diagnosis and to develop a compact clinical Raman system to reduce the scale of the system while maintaining its accuracy. These objectives when achieved will yield a method of obtaining real-time, non intrusive detection of cervical precancers that will facilitate the immediate management of the disease with high sensitivity and specificity. In addition, the potential of translating the application of Raman spectroscopy to other organs and in the vulva, in particular, will be assessed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: EARLY DIAGNOSIS OF CERVICAL CANCER Principal Investigator & Institution: Mathur, Subbi P.; Professor; Obstetrics and Gynecology; Medical University of South Carolina 171 Ashley Ave Charleston, Sc 29425
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Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2004 Summary: {NCI pa: Exploratory Studies in Cancer Detection, Prognosis and Prediction (similarity to NCI-PA98-022); revised R21 application. Cervical cancer is a leading gynecologic malignancy with 14,500 new cases and 400 deaths yearly. Eighty to 90% of women with cervical cancer are infected with human papillomavirus (HPV). Cervical intra- epithelial neoplasia (CIN) markers the pre-cancerous stage. Ten to 20% of women develop cervical cancer. Paper smears and HPV testing have limitations in identifying women progressing to cancer, not helpful in the patients with ASCUS/AGUS (atypical squamous/glandular cells of undetermined significance) and for monitoring therapy efficacy (paucity of tissue after therapy) in recurrence. Our data-supported hypothesis is that progression of squamous cell cervical cancer from CIN is related to up-regulation of EGF-R and insulin-like growth factor-II (IGF-II) proteins in cervical epithelium, followed by significant increases in serum IGF-II levels (specific to cervical cancer; levels decrease after therapy. Our latter finding provides us with an excellent opportunity to develop a non-invasive screening test that gives an added value to Pap smear and HPV testing. We propose that: Serum IGF-II levels can be used to identify patients who are at risk of developing cervical cancer and, more importantly, to monitor therapy efficacy in the patients with cervical cancer. We shall obtain serum levels of IGF-II (ELISA) in women with: 1. Normal Pap smear; 2. Abnormal Pap smear with no CIN; 3. Endometrial or ovarian cancer; 4. CIN-I, II or III pre-treatment; 5. CIN-I, II or III, post-treatment; 6. Invasive cervical cancer pre- treatment or at a time of hysterectomy; and, 7. Invasive cervical cancer (6 months and a year) post-treatment. We shall correlate the levels of IGF-II with clinical diagnosis of CIN or cervical cancer, size of neoplasm and resolution or recurrence of the disease and the smoking history. We believe that serum IGF-II test could compliment the Pap test to reduce deaths by cervical cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ENHANCED INTERVENTION FOR MAMMOGRAM-RESISTANT WOMEN Principal Investigator & Institution: Costanza, Mary E.; Director, Division of Oncology; Medicine; Univ of Massachusetts Med Sch Worcester Office of Research Funding Worcester, Ma 01655 Timing: Fiscal Year 2003; Project Start 01-JUN-2003; Project End 31-MAY-2005 Summary: (provided by applicant): This is an exploratory behavioral research project, which focuses on the development of an effective outreach intervention for mammogram-resistant women. In our previous cancer control work, we identified a group of women who were not up to date with mammogram screening recommendations. This group was identified by their intentions: not planning to get a mammogram. The importance of this finding is twofold. 1) This is a mammoqramresistant group. These women have not responded to a public health climate of mammography recommendations, a strong reminder system (annual written reminders from their managed care organization and quarterly reports of their overdue status to their primary care physicians), or tailored telephone counseling. 2) These women are an at risk population. They are at risk for the development of advanced breast cancer, which is more lethal than cancers discovered by screening. At least 15 percent of women may be mammogram resistant. Because tailored telephone counseling is a cost-effective intervention and is easily integrated into health care systems, we wanted to explore whether enhancing the intervention would make it effective with mammogram-resistant women. In order to develop a meaningful improvement in tailored telephone counseling, we need to know more about this group. Our study begins with in-depth
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Pap Smear
qualitative research, designed to understand the reluctance, psychosocial characteristics and global feelings/beliefs about breast cancer and breast cancer screening. We will then develop an enhanced telephone-based counseling intervention. New strategies include: motivational interviewing, a technique developed to motivate classically resistant patients (alcoholics and tobacco/drug addicts); multiple calls; supplementary materials; and an effort to improve access and physician recommendation. This will be pre-tested on mammogram-resistant women and adjusted following evaluation of their responses and input. The enhanced intervention will then be pilot tested on 50 mammogram-resistant women and evaluated for its success in moving them towards mammography. Outcome measures include rate of mammography utilization by radiology billing records and by self-report. Secondary measures include changes in stage and other variables. The project is grounded in two strong behavioral theories: The Precaution Adoption Process Model of Weinstein and the Cognitive-Social Information Processing (C-SHIP) Model of Miller and Shoda. This study should increase scientific knowledge about an at-risk population and the limits of telephone based counseling. If successful, the enhanced intervention would be tested in a randomized controlled trial and could be modified to include groups resistant to other screenings (e.g. Pap smear or colon cancer screening). If not successful, one could avoid using telephone-counseling strategies in this resistant group. Alternative avenues of communication and motivation would need to be developed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: EVALUATION OF CLINICAL APPLICATIONS OF ELASTOGRAPHY Principal Investigator & Institution: Garra, Brian; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, Tx 77225 Timing: Fiscal Year 2001 Summary: The objectives of the project are to demonstrate in a statistically valid number of patients, the clinical utility of the new technique of ELASTOGRAPHY is an adjunct diagnostic tool for the diagnosis of benign and malignant breast masses. Currently, mammography is the primary screening tool for the diagnosis of breast cancer. It is sensitive but often not very specific with approximately 75% of the masses biopsied being non-cancerous. Recently sonography has been shown to be a useful tool for distinguishing solid from cystic masses and for diagnosis solid masses. But often the sonographic features that distinguish benign form malignant masses are subtle and subjective in nature. Elastography is a technique that uses the raw ultrasound signal to produce an image of HARDNESS of breast tissue rather than the normal sonographic image of backscatter intensity. Because breast cancers have long been known to be significantly harder than normal breast tissue and benign breast masses, elastography promises to be helpful in distinguishing benign from malignant masses. Preliminary studies in over 100 patients with biopsy proven breast masses has shown that elastography can reliable identify breast cancers and can distinguish cancers from benign masses in most cases. Using a subjective index of brightness on the elastogram plus the difference in transverse dimension on a mass on elastography and sonography, 11 of 15 benign masses could be classified as definitely benign without incorrectly classifying any cancers as benign. Using these two features, the area of the ROC curve (Az) was 0.86 performance similar to the PAP smear for cervical cancer. The number of cases in the preliminary study was small and only a single observer was used. The current proposal outlines a two center unblinded level of suspicion trial that will demonstrate whether elastography plus mammography and sonography increases the diagnostic confidence of readers for breast cancer and benign masses. Also, a blinded
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rereading study is proposed that will demonstrate the performance of each modality alone and in conjunction with the other modalities. The number of patients to be studied (about 750) will be sufficient to estimate Az to a standard deviation of 0.02. Since elastography also may be helpful in other organs such as the thyroid, renal transplants, lymph nodes and muscles, pilot studies to evaluate the potential value of elastography in those organs are also proposed. The overall hypothesis is: Elastography is capable of differentiating normal and abnormal tissues, including cancer, in an in vivo clinical environment. The overall hypothesis is: Elastography is capable of differentiating normal and abnormal tissues, including cancer, in an in vivo clinical environment. Specific Aims of the Project are: 1. Establish and define the elastographic properties of normal and abnormal breast tissue in vivo. 2. Conduct a clinical study to explore the potential role of elastography in breast cancer diagnosis. 3. Explore in vivo elastography animal models of normal and abnormal tissues. Specific studies will include normal canine prostate, canine prostate carcinoma, and woodchuck hepatoma models. 4. Explore the application of elastography to other superficial organs in humans such as thyroid, testicles, muscles, and renal transplants. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: FRIENDLY VOICES PROGRAM Principal Investigator & Institution: Ashford, Rowell S.; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 28-AUG-2001; Project End 30-JUN-2006 Summary: The goal of pap smears is not to detect invasive cancer, but to detect precancerous-abnormalities that might develop into invasive cancer. Lack of adherence to follow-up treatment protocols for an abnormal pap smear limits the effectiveness of a screening program. Among women with abnormal pap smears, failure to return for follow-up care can increase morbidity, mortality, and the cost of health care. Estimates of failing to return for follow-up care among women with abnormal cytology range as high as 80%. Certain groups of women, namely African-Americans and the elderly, have poorer utilization rates of screening tests and higher mortality rates from cervical cancer. The use of community persons as lay health workers ("lay health advisors" or "community health advisors") has gained increased recognition in the United States over the last two decades. They have been used to address a broad range of community health issues in various settings. Since indigenous persons know their environments and are usually highly trusted in the community. the are better able to address health and other issues within their networks as opposed to outsiders. In many instances, they receive some type of specialized training to enhance their existing skills and knowledge. This fosters cooperative relationships with health professionals, enhances the potential to mobilize community resources, and offers new services and programs to the community We propose a randomized trial to compare standard phone reminders, made by clinic staff members, versus tailored phone reminders, made by community health advisors. The target population for this study will be African American women from an urban clinical setting, who have abnormal pap smears. The community health advisors will utilize the case manager approach in effort to improve compliance with follow-up recommendations and decrease the number of patients lost to follow-up. Follow-up data will be collected at six-month intervals for a period of eighteen months. This randomized trial represents a novel approach to improving cervical cancerscreening behavior among African American women who have abnormal pap smears. If the tailored intervention is effective. it could be an inexpensive way for other urban
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hospitals across the nation to improve compliance with cervical cancer screening for African American patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: GENETIC PAPILLOMAVIRUSES
RESISTANCE
TO
ONCOGENIC
HUMAN
Principal Investigator & Institution: Tyring, Stephen K.; Professor; Microbiology and Immunology; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-MAR-2005 Summary: (provided by applicant): Infection with certain human papillomaviruses (HPV-16 and -18) has been associated with the development of invasive cervical cancer in women. To develop a vaccine to prevent HPV-16 and -18, the human immune response to HPV and its underlying genetic bases must be profiled. Important to the development of a vaccine is the documentation that some women have the capability to "clear" or eradicate HPV virus. Human leukocyte antigens (HLAs) may play a role in identifying biomarkers for the immune response to HPV infection. No one has ever reported typing of HLA in women who are seropositive for HPV-16 and/or-18, but who have negative Pap smears and no HPV DNA. There is also some indication that immune response to HPV-16 and -18 infections may vary by ethnic group. Hispanic women were selected for this study because they have one of the highest rates of cervical cancer. In Houston, Texas, the third largest city in the U.S., the rate for cervical cancer is one of the highest in the country. Our aim is to determine the HLA profile of women who have successfully cleared HPV infection. We will obtain HPV-infection rate and genetic profiles of 1250 Hispanic women undergoing their annual well-woman examination. By taking one additional cervical smear and drawing one additional vial of blood during the routine physical, additional risk to the patient is small. If a woman has a negative Pap smear, the additional cervical smear will be used to detect any presence of HPV-16 or 18. For those women with antibodies to HPV-16 and/or -18, but who have no HPV DNA and a negative Pap smear, HLA serotyping will be done using the lymphocytes from the vial of blood. This study will provide the preliminary data necessary to complete larger studies to compare ethnic diversity in the immune response to HPV infection and the genetics determining those immune responses. Standard statistical analyses will be used to estimate the association between HLA polymorphism and genetic resistance to monogenic HPV infection. Thus, this study is an important step in the development of an HPV vaccine to prevent infection. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HPV TESTING--SELF-COLLECTED SAMPLES FOR CERVICAL CANCER Principal Investigator & Institution: Koutsky, Laura A.; Professor; Epidemiology; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2002; Project Start 21-JUN-2002; Project End 31-MAY-2004 Summary: (provided by applicant): Human papillomaviruses (primarily HPV 16 and 18) play a central role in the development of in situ and invasive cervical cancer. The fact that most cervical intraepithelial lesions spontaneously resolve, along with the high costs incurred by follow-up of women with Pap smears showing atypical squamous cells of undetermined significance (ASCUS) or low grade squamous intraepithelial lesions (LSIL), has generated interest in the use of HPV DNA assays for managing
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women with cervical abnormalities. A large proportion of women in the United States do not undergo routine Pap smear screening according to recommended screening intervals, suggesting a need for an alternative, non-invasive method for cervical cancer screening. However, studies that have assessed the performance of self-collected screening methods for detection of high-grade cervical disease have been limited by generalizability, sample size, verification bias, and other methodological flaws. There has not been a large study in the United States to examine the possibility of using a selfcollected sample to test for HPV DNA as screening for CIN 2/3. The long term goal of the proposed study is to evaluate whether a self-collected test for oncogenic types of HPV could be used to screen women to detect CIN 2-3. Specifically, the study will (1) estimate the accuracy (e.g., sensitivity, specificity, detection rate, and false referral rate) of HPV DNA testing using self-collected vaginal samples relative to the accuracy of clinician-directed ThinPrep Pap smears for detecting biopsy-confirmed CIN 2-3, and (2) estimate the accuracy of HPV testing of self-collected samples relative to testing of clinician-directed samples for detecting biopsy-confirmed CIN 2-3. The study will be conducted as part of the ongoing Evaluation of Cervical Cancer Screening Methodologies (EVA) project among a population of women attending Planned Parenthood of Western Washington (PPWW) clinics (Tacoma, Lakewood, and Federal Way). Approximately 2,400 women ages 18-55 will be screened throughout the course of the study. Those with (1) ASCUS, LSIL, or HSIL on Pap smear, (2) high-risk HPV DNA detected in self-administered or clinician-administered sampling, and (3) a 10% random sample of women with normal Pap smears and negative HPV DNA test results at the screening visit will be asked to return for a follow-up visit, which will include specimens for a ThinPrep smear and HPV testing and colposcopically-directed biopsy of cervical lesions. An accurate self-test for high-risk HPV types could have several important public health implications, by offering women (1) an alternative cervical screening method, (2) triage for equivocal Pap smears, (3) surveillance for recurrence after treatment for CIN 2 or higher, (4) testing for other STDs, and (5) reduced costs associated with office visits. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: HUMAN PAPILLOVIRUS TESTING IN ADOLESCENTS Principal Investigator & Institution: Kahn, Jessica A.; Children's Hospital Med Ctr (Cincinnati) 3333 Burnet Ave Cincinnati, Oh 45229 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2007 Summary: (provided by applicant): Jessica Kahn, M.D., M.P.H., completed clinical training in Adolescent Medicine and Gynecology at Children's Hospital, Boston and an MPH degree at the Harvard School of Public Health in 1999. She then joined the faculty at Children's Hospital Medical Center to pursue a career in patent-oriented research. David Bernstein, MD, the project Sponsor, brings expertise in clinical research regarding viraI STI, has extensive NIH funding, and has experience mentoring new investigators. The Sponsor, Advisory Board Members and Collaborators form a multidisciplinary research team with diverse expertise. The research environment will support a didactic program that includes relevant courses in advanced qualitative and quantitative methods, training in research ethics, and interaction with other clinical investigators. Dr. Kahn's overall career goal is to become an independent clinical investigator whose work will focus on the prevention of HPV infection and cervical cancer. She plans to achieve this goal through the translation of data regarding 1) the biomedical aspects of HPV infection and 2) the psychological and behavioral impact of testing for HPV into adolescent- specific, effective clinical strategies for cervical cancer prevention at the
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individual and population levels. The objective of this research plan is to explore the potential role of HPV testing in cervical cancer prevention programs targeting adolescents. The specific aims and methods for achieving each aim follow. Aim 1 To determine predictors of Pap smear foIlow-up in adolescents. Aim 1 will be examined using existing prospective data from a sample of 490 urban, racially diverse adolescents. Aim 2 To examine the psychological and behavioral effects of positive HPV testing in female college students. Aim 2 will be examined using existing longitudinaI data from a sample of 608 racially diverse college women. Aim 3 To explore the psychological, behavioral, and relationship-related effects of positive HPV and Pap smear testing in adolescents. Aims 3, 4, and 5 will be examined using prospectively collected, qualitative and quantitative data in a sample of 250 urban adolescent girls at high risk for HPV infection. Aim 4 To determine the accuracy and acceptability of self-testing for HPV DNA in the above sample of urban adolescent girls. Aim 5 To determine the cumulative prevalence and rates of persistence and regression of HPV infection, and correlation of HPV test results with cervicaI cytology, in the above sample of urban adolescent girls. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: INTEGRATING AND PRIORITIZING CANCER PREVENTION IN MEDICAL PRACTICE Principal Investigator & Institution: Vogt, Thomas M.; Program Director; Kaiser Foundation Research Institute 1800 Harrison St, 16Th Fl Oakland, Ca 94612 Timing: Fiscal Year 2001 Summary: Prevention and early detection services often stumble over one another because there are multiple systems and sts of recommendations for delivering them. Consequently, systems designed to increase adherence to recommended for delivering them. Consequently, systems designed to increase adherence to recommended services often encourage over-use of some resources among some individuals while still leaving a substantial group of underserved persons. This project focuses on the benefit of a system for identifying high priority cancer prevention and early detection needs, integrating them into a single intervention, and delivering that intervention as a means of improving the delivery of services to the underserved. The intervention uses motivational interviewing and a personal models approach to encourage selective delivery of as many needed services as possible. The project focuses on women who fall into the mammography an pap smear safety nets (excessive interval since last tested) and women who smoke. The three intervention groups are methods for improving delivery of existing services to women in greatest need of them. We will also compare the delivery of unnecessary cancer control services in the groups compared to usual care, and assess the impact of the interventions on patient satisfaction with KP and cost to the system. The study has a 2X2 factorial design featuring the effects of a system Outreach (mail-phone), system In-reach (clinic based intervention at th time of primary cre service), and combined In-reach and Out-reach. Each of the three interventions will be compared to usual care with respect to the proportion of high priority needs that are met during a follow-up interval, and athe proportion of unnecessary services delivered. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: LATINAS: IMPACT OF CITIZENSHIP ON ACCESS TO PAP SMEARS Principal Investigator & Institution: Katzburg, Judith R.; Health Services; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2001; Project Start 01-JUL-2001; Project End 30-JUN-2002
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Summary: Some studies have found Latina women to be a particularly vulnerable population as regards underutilization of preventive services (Anderson and May, 1995, Kirkman-Liff and Kronenfeld, 1992). Given the importance of preventive services, including cancer-screening services to reduce morbidity and mortality, it is important to identify predictors of this under-utilization of services. Barriers specific to immigrant women have been investigated including issues of acculturation, language, and country of origin. However, one factor that has not been explored is the impact of citizenship status. The Expanded Andersen Behavioral Model of Health Services Use is a highly regarded model for explaining health care services utilization. To date, citizenship status has not been included in this model. Citizenship may increase the predictive ability of this model and should be considered for inclusion. The purpose of this research is to test, through applied research, the appropriateness of including a citizenship variable in the Andersen paradigm. This research is designed to examine utilization of preventive services by Latina women living in Los Angeles County with the intent of determining whether citizenship plays a significant role in access, especially for the large Latina immigrant population. Access/ utilization will be measured by appropriate use of the specific cancer-screening test for cancer of the cervix, the Pap smear. A cross-sectional study design using a secondary data source will examine the impact of citizenship on a sample of 1784 Latina women, ages 18 years or older, living in Los Angeles County. The data are from the 1997 Los Angeles County Health Survey which is a population-based, random digit dialing telephone survey of 8,004 households in Los Angeles County. Logistic regression will be performed separately for each of the empirical models. Stepwise regression will facilitate variables being added (forced in) according to the expansion of the initial, simple model. This modeling methodology allows for analysis of changes in the results as the conceptual model is expanded to include additional predictors of Pap smear utilization. The final model will control for approximately 40+ separate factors derived from the Andersen Model that might impact on access/utilization of this preventive service. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: LIGHT SCATTERING AND NORMAL TISSUE MODELS Principal Investigator & Institution: Mourant, Judith R.; Professor; None; University of Calif-Los Alamos Nat Lab Ms G758 Los Alamos, Nm 87545 Timing: Fiscal Year 2001; Project Start 15-MAY-1997; Project End 31-JUL-2006 Summary: Optical techniques for tissue diagnosis without the removal of tissue are now being developed which offer significant advantages over standard techniques, such as tissue biopsy, both in terms of patient care and medical costs. For example, optical techniques are faster, sedatives are not needed, and complications associated with tissue removal such as infection are eliminated. The aim of this proposal is to develop and test polarized elastic scattering spectroscopy. Elastic scattering spectroscopy (ESS) measures the wavelength dependence of light that has entered the tissue, been scattered within the tissue and re-emitted. In polarized ESS the delivered light is polarized and the detected light is measured through polarizers. The detected light can provide information about both the morphological properties and the hemoglobin concentration. For example, a sensitivity to the rate at which cells are replicating has been demonstrated and measurements of model systems have shown that scatterer size and concentration can be determined. In order for this technique to reach its full potential an understanding of the fundamental interactions of light with tissue is needed. The first specific aim of this proposal is to determine how specific structural features of cells contribute to light scattering. The next aim will be to examine light scattering differences
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Pap Smear
between tumorigenic and non-tumorigenic epithelial cells. Epithelial cells are particularly interesting, because most cancers originate from epithelial cells. Previous work demonstrated that the environment induced by cells in 3-D culture can cause a difference in light scattering from tumorigenic and non-tumorigenic cells. In parallel with the study of scattering properties improved measurement techniques will be developed and implemented for in vivo use. Finally, clinical trials will be performed to determine the utility of polarized elastic scattering spectroscopy to detect/diagnose squamous epithelium, reactive/repairing tissue, low grade dysplasia, high grade dysplasia and invasive carcinoma. Screening and diagnosis of cervical cancer is an ideal arena for the entry of optical techniques for cancer detection. The tissue is easily accessible and the low-accuracy Pap smear test has already demonstrated the utility of screening methods. ESS has the potentially to rapidly sample tissue and pinpoint locations of specific pathologies. Potentially ESS could replace Pap smears as a less frequent test or serve as an adjunct. If polarized ESS could be used to determine the significance of an ASCUS (atypical squamous cells of uncertain significance) Pap smear result, it could result in significant cost savings. ASCUS is the most common anomaly detected by Pan smears and annual follow up is estimated to cost 4.5 billion dollars per year. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PAPILLOMAVIRUS CONFERENCE 2001-06 Principal Investigator & Institution: Pirisi-Creek, Lucia A.; Professor; Pathology and Microbiology; University of South Carolina at Columbia Byrnes Bldg., Room 501 Columbia, Sc 29208 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-AUG-2006 Summary: (Provided by applicant): Cervical cancer is one of the leading causes of cancer death in underdeveloped regions, and remains a considerable problem, despite the fact that the Pap smear has reduced dramatically the incidence of invasive cervical carcinoma in developed countries. In addition, the management of cervical intraepithelial neoplasia is still in great need of improvement, both under a public health and a clinical point of view. High risk human papillomavirus (I-IPV) infection is necessary, although not sufficient, to produce cervical cancer. HPV also plays a causative role in at least a subset of cancers at other sites than the cervix. Interdisciplinary studies of I-IPV and cancer are pivotal to address all of the facets of this complex problem. Vital to the progress of this is the exchange of information that takes place, on average, once every 14-18 months, at the International Papillomavirus Conferences. These truly interdisciplinary conferences are the major forum for presentation of current results by all investigators in the field, from the epidemiologists to the basic virologists, molecular biologists, immunologists, clinical researchers, and those working on animal papillomaviruses. The International Papillomavirus Conference is where new directions in the field are determined, general problems identified and addressed, data from diverse areas are presented and discussed, and new avenues for translational research in the field are defined. Due to its optimal mix of interdisciplinary breadth and in-depth treatment of each discipline, the Conference is also an ideal training forum for young investigators in the field, students and postdoctoral fellows. This proposal is to request funds to cover registration fees, and to partially defray travel expenses, for 25 young investigators to attend the next five International Papillomavirus Conferences 2001-2006, and to partially cover organizational expenses for these five Papillomavirus Conferences. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PATIENT POPULATION
FOCUSED
CANCER
CONTROL
IN
AN
19
HMO
Principal Investigator & Institution: Hollis, Jack F.; Investigator; Kaiser Foundation Research Institute 1800 Harrison St, 16Th Fl Oakland, Ca 94612 Timing: Fiscal Year 2001; Project Start 22-AUG-1996; Project End 31-AUG-2002 Summary: The theme of the proposed CPRU is to improve the organization and delivery of cancer control services in manage care. The investigators propose a CPRU to extend the previous work, expand the collaboration of CHR and ORI, initiate development of work in two areas new to us that are important to managed care, to add new investigators to our cancer control research team including two young investigators without previous cancer control experience, and to enhance the opportunities for working with a large managed care organization to develop a rational approach to designing, testing, evaluating and implementing cancer control strategies. Project I will test an innovative expert systems model developed at the University of Rhode Island in a medical setting. No adolescent smoking prevention or cessation programs have had a demonstrable long-term impact on teenage smoking. This sophisticated, interactive video provides stage- appropriate smoking prevention/cessation interventions. For adults, we have already shown that the medical encounter is uniquely effective as a vehicle for delivering effective smoking interventions. This project will apply those lessons to adolescent interventions. Project 2 will use the successful outpatient TRACC 1 smoking intervention s a model for delivery of an intervention designed to reduce dietary fat. There are no low- intensity interventions proven to have a long-term impact on dietary fat consumption. We will determine whether an inexpensive, brief dietary counseling approach incorporated into routine primary care can reduce blood lipids and long-term risk of cancer. Project 3 examines the impact of coordinating integrating, and prioritizing the delivery of cancer prevention services ot a population of underserved health plan members. There are multiple, often conflicting, systems and recommendations for delivering cancer control services. This project focuses on women who fall into the mammography and pap smear safety nets and women who smoke. Two developmental projects will initiate new areas of research for us; genetic screening and its implications for cancer control, and quality of life studies among cancer patients. Both developmental projects involve young investigators new to cancer control. The projects will be served by a core that provides data management, quality control, economic analyses, biostatistics, and analysis support. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PREDICTING ADHERENCE TO FOLLOW UP OF ABNORMAL PAP SMEARS Principal Investigator & Institution: Radecki Breitkopf, Carmen; Assistant Professor; Obstetrics and Gynecology; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2003 Summary: ABSTRACT=Regular screening for cervical cancer via the Papanicolaou (Pap) smear and appropriate treatment when indicated can prevent over 90% of cervical cancer mortality. However, many women do not obtain regular Pap smears, and among those who do, a large percentage fail to return for follow-up when notified of abnormality. Consequently, cervical cancer remains one of the most common malignancies in the US today accounts for over 4,000 deaths per year. Among AfricanAmerican and Hispanic women rate of morbidity and mortality due to cervical cancer
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are 2 to 7 times that observed among Caucasian women. To decrease mortality due to this disease, clinicians must be able to identify women who are at risk of nonadherence and influence patient behavior. Few data are available to direct clinicians on how to assess patient reliability and little understood about factors that determine women's motivation to adhere to follow-up. The proposed research designed to identify psychological and behavioral determinants of women's motivation to adhere to followup recommendations for an abnormal Pap smear. We apply the unified theory of behavior to identify cognitive, normative, affective, environmental and social mechanisms underlying adherence to follow-up. Furthermore, this research is designed to understand sociocultural-based differences in motivation through the use of qualitative and quantitative methods of assessment. We propose to study 585 AfricanAmerican, Hispanic and white women between 25-50 yeas of age over the course of three phases of research. Using interview survey methodology, the proposed research will yield a rich corpus of qualitative information about the social psychological dynamics of Pap smear follow-up. Phase one is an elicitation study in which we empirically derive the nature and structure of the theory constructs. In phase two, we will develop psychometrically-sound survey instruments for use in a prospective examination of adherence to follow-up. In phase three, we will conduct a prospective pilot investigation of adherence to follow-up to collect preliminary data for a large-scale study in which we use the methodology and measures developed during phases one and two. This research will improve clinical outcomes by identifying women at risk of nonadherence so that clinicians can plan management of the abnormal Pap smear accordingly. Additionally, it will assist in the design of tailored interventions to improve adherence. By informing both clinicians and researchers who are involved with cervical cancer prevention, this research will ultimately reduce the morbidity and mortality due to this disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: PROSPECTIVE STUDY ON VIRAL LOAD OF CERVICAL CANCER Principal Investigator & Institution: Adami, Hans-Olov H.; Karolinska Institute Tomtebodavagen 11F Stockholm, Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2006 Summary: (provided by applicant): Our long-term objective is to bring about prevention of cervix cancer through improved biologic understanding and more cost-effective screening strategies. Although human papilloma virus (HPV) infection is an established cause of cervical cancer, it is incompletely known if viral load of HPV influences progression from cancer in situ (CIS) to invasive cancer and/or interacts with genetic factors. Since clinical intervention precludes direct observation of this progression. unconventional approaches are needed. Our main specific aims are to; 1) quantify the absolute and relative risks for CIS and invasive cancer as a function of time since detected HPV and HPV 16 high viral load, 2) assess whether persistent HPV 16 high viral load is a determinant for development of CIS and invasive cancer, 3) assess whether the specific HLA DQ6/DR15 haplotype is associated with risks for CIS and invasive cancer, and if the association is mediated via a higher viral load and/or persistence of HP V. and 4) assess whether Chlamydia infection is associated with risks for CIS and invasive cancer. Building on experience from an earlier study of CIS (funded by NCI). we will take advantage of unique prerequisites in Sweden created by extensive population-based PAP smear screening documented in computerised registers. ascertainment of all incident cases of CIS and invasive cancer. and access to archival smears and tissue specimens. Using a nested design in this large study base with up to
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25 years of complete follow-up, we will identify 600 women with invasive cancer, 600 women with CIS and 600 individually matched control women to each case-group. Using validated and sensitive PCR assays, the presence of viral DNA - and for HPV 16, also the viral load -will be analyzed in all available smears from each participant (on average four per individual, giving a total of about 9600 smears). HLA and C trachomatis will be analyzed in the first smear from all included women. Relative risks and interactions will be estimated by conditional logistic regression and absolute risk functions by non-parametric methods. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: REDUCING CERVICAL CANCER IN APPALACHIA Principal Investigator & Institution: Paskett, Electra D.; Marion N. Rowley Professor of Cancer Res; Comprehensive Cancer Center; Ohio State University 1960 Kenny Road Columbus, Oh 43210 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2008 Summary: In response to RFA ES-02-009, a multi-disciplinary group of investigators from the Ohio State University and the University of Michigan have collaborated to propose a Center for Population Health and Health Disparities focusing on an important health issue in underserved populations,cancer. The Center will initially focus on the goal of understanding why high rates of cervical cancer incidence and mortality are observed in Appalachia Ohio, a mainly rural area in Southern and Eastern Ohio. This goal will be accomplished using community-based participatory research within the framework of the Social Determinants of Health model in three inter-related projects and four supporting cores. All studies will be conducted in 16 clinics which represent the general population of women aged 18 and older in the region. We will utilize the Center's internal and external advisory committees and community partners organized into a community advisory board and Consortium of communityorganizations to facilitate the accomplishment of project goals. Project 1 will recruit 1600 women to an observational study to investigate multi-level (social, environmental, behavioral, and biological) correlates of "risk-appropriate" Pap smear utilization, in Phase I. From this cohort of women, those who smoke (30%) will be eligible to participate in Project 2, which tests the effectiveness of a lay health educator (social) intervention to promote smoking cessation (behavioral) and validate cessation endpoints with saliva cotinine measurements (biological) in a quasi-experimental trial design; those women who are in need of & Pap test (48% of 1600) will be eligible to participate in Phase II of Project 1 which will test the effectiveness of a lay health educator (social) intervention to promote "risk-appropriate" Pap smear utilization (behavioral) and follow-up for abnormalities (biological) detected in a quasi-experimental trial design. Project 3 will examine the contribution of HPV (biological) to cervical abnormalities in Appalachia in relation to individual-level behaviors (e.g. smoking, sexual activity) within the social and environmental region of Appalachia in a case-control observational study among women who have Pap smears in these 16 clinics.The research will be supported by four cores: A) Administration - fiscal and Center oversight; B) Biostatistics and Data Resources - sample selection, data management, data analysis, and population data resources; C) Clinical Correlative Sciences - collect, obtain and process biomarker specimens; and D) Behavioral Assessment and Intervention - train interviewers and lay health educators, conduct interviews, design intervention material, and facilitate communication amongst sites. The Center includes a mechanism for pilot project solicitation, review and funding. This Center has institutional commitment in terms of personnel, funds and space, as well as, a commitment to focus on the problem of health
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disparities in the region. Finally, members of the team have worked together in the past in various settings that focus on the goals of the proposed Center and have an established relationship in Appalachian Ohio for the purpose of improving the health of the population. Future work of this Center will focus on moving this type of multi-level observational and interventional community-based research, into other areas where health disparities exist in relation to cancer withinour region. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: ROLLING CIRCLE AMPLIFICATION ANALYSIS OF CERVICAL CELLS Principal Investigator & Institution: Piccoli, Steven P.; Molecular Staging, Inc. 300 George St, 7Th Fl New Haven, Ct 06511 Timing: Fiscal Year 2001; Project Start 10-SEP-2001; Project End 31-AUG-2002 Summary: A subset of human papillomavirus (HPV) types have been implicated in cervical cancer. The determination of the presence of the HPV types associated with cervical cancer may serve as adjunct to Pap smear screening of cervical samples. This analysis could reduce the incidence of invasive cervical cancer, while decreasing the human and economic costs associated with Pap smear screening and reflex histological analysis. HPV analysis could distinguish between transient infections that resolve without the development of high-grade cervical lesions, and the presence of rare cells that have been biologically altered by HPV, and are progressing from a localized intraepithelial lesion to invasive cancer. This project will develop a method using Rolling Circle Amplification to analyze individual cells within a cervical sample and establish the presence of HPV DNA and RNA sequences, and in Phase II, establish the relationship of other markers to the early stages of HPV-related cervical cancer. The majors goals of this project are to develop a means to detect rare HPV-transformed cells that are missed by conventional cytology and validate RCA protocols for molecular analyses of cells with respect to features of HPV gene expression that present a risk of neoplastic progression rather than a transient infection. PROPOSED COMMERCIAL APPLICATIONS: The successful completion of this project will provide two types of products. The first could serve as an adjunct Pap smears by providing an indication when a "second look" might reveal rare aberrant cervical cells missed by cytology. The ultimate product would enhance or replace the annual Pap smear by providing molecular information, predicting early cervical cancer lesions, that is not visible to a trained cytotechnologist or pathologist. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: SINGLE VISIT CERVICAL CANCER PREVENTION PROGRAM Principal Investigator & Institution: Manetta, Alberto; Professor; Medicine; University of California Irvine Irvine, Ca 926977600 Timing: Fiscal Year 2001; Project Start 01-SEP-1998; Project End 30-JUN-2003 Summary: (Applicant's Description) The barriers to cervix cancer screening and management are well described. A significant barrier to the diagnosis and management of cervical cancer is the loss to follow-up for those who undergo screening using the Pap smear. In addition, other barriers include lack of education, cultural-based attitudes and health behaviors, as well as, socioeconomic factors. We believe that the usual approach to cervix cancer screening diagnosis and management accentuates problems due to loss to follow-up and these barriers. The goal of this project is to implement and evaluate an innovative cancer control program that could revolutionize the approach to cervix
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cancer prevention. The study will determine the effectiveness of a single-visit program (SVP), including the diagnosis and treatment of patients with premalignant conditions, in decreasing the rate of loss to follow-up of women with abnormal Pap smears in comparison to a Usual Care Program (UCP). If successful, the proposed program will markedly decrease the proportion of women who have positive Pap smears and are lost to follow-up and thereby decrease the rates of invasive cervix cancer. Moreover, the program could be transported to communities in the United States and to other countries around the world where the incidence and mortality rates of this malignancy are increased. We have previously demonstrated the feasibility of a single-visit approach in a pilot study completed by our group that indicates that our approach is promising for the secondary prevention and control of cervix cancer The single-visit program (SVP) consists of an initial screening of patients with pelvic exams and Pap smears with immediate cytological analysis by a cytopathologist. All patients receive the results of their Pap smears during the visit. In addition, patients found to have severe cervix dysplasia undergo diathermy loop excision (DLE) of the transformation zone during the same visit. By combining immediate cytologic screening and DLE in the same visit, most barriers to follow-up for patients with cervix dysplasia can be overcome. The specific aims of this proposal are: 1) implement and evaluate a singlevisit program for cervix cancer prevention in clinics serving a multi-ethnic population of women; 1a) standardize the operating procedures regarding recruitment plans, personnel, patient flow patterns, and follow-up plans; 1b) set up an efficient system for Pap smear interpretation for patients in the SVP that will minimize waiting time; and, c) recruit 3,520 women (Hispanic and Non-Hispanic White women) and randomize them into the SVP or a usual care program (UCP); and, 2) evaluate the SVP in terms of followup rates for abnormal Pap smears, patient satisfaction, and cost-effectiveness. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: SMOKING CESSATION TO REDUCE CERVICAL CANCER RISK Principal Investigator & Institution: Greene, Paul G.; Associate Professor of Medicine and Publ; Medicine; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 30-SEP-1997; Project End 30-JUN-2003 Summary: Cervical cancer is a major source of morbidity and mortality among women, with a particularly high burden evidenced among women in Alabama. Although HPV has been identified as the major causative agent for cervical cancer, most women with HPV do not develop cervical neoplasia, suggesting that progression to cervical cancer may be influenced by other factors. Smoking has consistently been associated with increased risk for cervical cancer, even among women already at elevated risk due to cervical dysplasia and HPV infection. Further, available data suggest that smoking cessation may decrease cervical cancer risk. These data justify a prospective, controlled study, examining the efficacy of smoking cessation in halting the progression of cervical dysplasia. The proposed 5-year clinical trial will evaluate the effect of a theory-based smoking cessation intervention on progression from low-grade squamous intraepithelial lesions (LSIL) to high-grade squamous intraepithelial lesions (HSIL) in female smokers with HPV. The plan is to recruit 220 current smokers ((10 cigarettes/day) with oncogenic HPV from the University of Alabama at Birmingham Colposcopy Clinic and randomly assign them to one of two treatment conditions: 1)usual care (UC); or 2) smoking cessation intervention (SCI). Patients in both groups will receive standard conservative management for LSIL, biannual pap smears and more aggressive treatment, as needed. Additionally, patients in the SCI group will also participate in an
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intensive smoking cessation intervention which will include: 1) cognitive-behavioral strategies to facilitate changes in smoking behavior; 2) short-term nicotine replacement therapy to minimize discomfort associated with nicotine withdrawal; and 3) a motivational intervention to promote the optimal use of cognitive-behavioral strategies and nicotine replacement therapy. The primary outcome will be rate of biopsyconfirmed progression to HSIL over 18-month follow-up. The investigators also propose to collect self-report and biochemical measures of smoking status and dysplasia progression. Finally, perceptions about cancer risk and cancer control practices will be assessed to examine relationships with smoking cessation program participation and changes in smoking. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: DYSPLASIA
SPONTANEOUS
REGRESSION
BIOMARKERS
IN
CERVIX
Principal Investigator & Institution: Ho, Gloria Y.; Associate Professor; Epidemiology & Population Health; Yeshiva University 500 W 185Th St New York, Ny 10033 Timing: Fiscal Year 2001; Project Start 01-APR-1995; Project End 30-APR-2004 Summary: (Adapted from the Investigator's Abstract) The applicants propose to continue an ongoing prospective study in which women with CIN I or II are recruited and followed in order to identify biomarkers associated with regression of CIN. The following factors will be assessed: (1) humoral immune response to virus-like particles (VLPs) of HPV types 6, 16, 18, 31, 53, and 58, (2) cell-mediated immunity (CMI) to HPV 16 E6 and E7 peptides, (3) class II HLA DQB1 and DRB1 alleles, (4) plasma ascorbic acid level, and (5) red blood cell (RBC) folate level. Continuation of this existing study is necessary to increase sample size and thus provide sufficient statistical power to better understand how these host factors may interact to influence the outcome of CIN. Women will be recruited from the colposcopy clinics of 3 hospitals associated with the Albert Einstein College of Medicine and followed at 3-month intervals by Pap smear and colposcopy for 12 months. At this point, an endpoint biopsy will be performed to determine whether CIN lesions are present ('persistence') or absent ('regression'). At each visit, cervico-vaginal lavage specimens will be collected for HPV DNA analyses by Southern blot and polymerase chain reaction (PCR). Blood will be collected for HPV VLP serology, T cell proliferative response (CMI) assay, plasma reduced ascorbic acid by high pressure liquid chromatography, and RBC folate levels by immunoassay. DNA typing of class II HLA alleles by PCR will be performed using blood collected at baseline. Associations between these factors and regression of CIN will be assessed by appropriate univariate and multivariate analyses. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: STRATEGY TO IMPROVE PAP SMEAR FOLLOW-UP IN A HIGH RISK UNDERSERVED POPULATION Principal Investigator & Institution: Engelstad, Linda P.; Northern California Cancer Center 32960 Alvarado Niles Rd, Ste 600 Union City, Ca 94587 Timing: Fiscal Year 2001 Summary: Rates of follow-up of abnormal Pap smears vary greatly depending on characteristics of women screened and of the screening program, with the lowest rates of follow-up among women at the highest risk of having or developing cervical cancer. Effective strategies are needed to improve the rate of resolution among women typically lost to follow-up. Results from our study of follow-up in a multi-ethnic, under-served,
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inner city population show that, of 2,167 women screened over 21 months, 147 (6.8%) has an abnormal result of ASCUS or greater. 108 were eligible to be randomized to intervention or control. Despite intensive hospital-based efforts (including reduction of institutional barriers through establishment of a specialized clinic and use of a nurse follow-up coordinator), only 53% of women in the intervention group completed recommended follow-up by 18 months (compared with 14% in the control group), thus resolving their abnormality. The inability to bring women back for diagnostic evaluation and treatment undermines the potential benefits of a Pap smear and the costeffectiveness of screening. Yet in the absence of data demonstrating the costeffectiveness of more intensive efforts to pursue follow-up, such activities are unlikely to be adopted in light of diminishing resources in public health institutions. This study is a randomized controlled trial to evaluate the impact and cost- effectiveness of a culturallytailored community outreach intervention to improve rates of follow-up among 600 women with abnormal Pap smears. Formative research methods will include focus groups, key informant interviews. A conceptual adapted from the Trans-theoretic Model and other behavioral theories guide development of a culturally-tailored Community Health Outreach Worker (CHOW) intervention program. We will compare out intervention to the usual care condition, notification by telephone and letter. Over a sixmonth follow-up period we will (1) assess the time to the first follow-up appointment, (2) the proportion of women who have a resolution of their Pap smear abnormality, and (3) the time to resolution. Analysis will include a test of the hypothesis that the CHOW intervention is more cost-effective than the usual care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •
Project Title: TECHNOLOGY FOR DNA DAMAGE MARKERS IN CERVICAL CANCER Principal Investigator & Institution: Matson, Wayne R.; Esa, Inc. 22 Alpha Rd Chelmsford, Ma 01824 Timing: Fiscal Year 2001; Project Start 12-APR-2001; Project End 31-MAR-2002 Summary: Prototype carbon column switching (CCS) systems (1) have been applied to measuring free levels of DNA adducts in PAP smear and cervico vaginal lavage sample indicating a possible correlation with various risk factors and cancer. Preliminary work has defined some of the possible role of utility of such measurements in early diagnosis or therapy monitoring. The proposed work is directed at refining, extending and integrating the technology for the identification and routine measurement of relevant markers. The proposed approach is an iterative study between technology/methodology enchancements and marker significance identification from a cohort of ca. 400 cases spanning a wide range of sampling modalities, risk factors and diagnoses. PROPOSED COMMERCIAL APPLICATION: The proposed work is directed at developing research and clinical instrumentation for relating DNA damage to cercical cancer risk. The commercial markets are in biomedical research, therapy monitoring, and clinical screening. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: TELOMERASE AND HPV IN PAP SMEARS AND CERVICAL BIOPSIES Principal Investigator & Institution: Shroyer, Kenneth R.; Associate Professor; Pathology; University of Colorado Hlth Sciences Ctr P.O. Box 6508, Grants and Contracts Aurora, Co 800450508
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Timing: Fiscal Year 2001; Project Start 07-MAY-1999; Project End 05-MAY-2003 Summary: Squamous cell carcinoma (SCC) is the most common form of cervical cancer. The mortality rate for SCC has decreased dramatically over the past 30 years because of the success of cervical cytology in detecting potential precursor lesions, designated atypical squamous cells of undetermined significance (ASCUS) low grade squamous intraepithelial lesions (LSIL) and high grade squamous intraepithelial lesions (HSIL). Despite this success, however, cervical cytology has come under increasing attack in recent years due to problems of false negative diagnoses. The rate of false negative results will be decreased if sensitive molecular assays are developed to detect cytologically abnormal cells. Human papillomavirus (HPV) is the best known molecular marker of malignant and premalignant lesions of the cervix. Sensitive assay systems have detected HPV DNA in a high proportion of cases of LSIL, as well as in most cases of HSIL. HPV detection in cervical cytology specimens has been limited, however, by a low level of specificity for clinically significant cervical lesions, due in part to the high prevalence of HPV DNA in cervical smears from cytologically normal women. Telomerase expression, a marker of cellular immortalization, can be detected by the telomeric repeat amplification protocol (TRAP) in most malignant tissues but is present at low or undetectable levels in most normal somatic tissues. Preliminary studies from my laboratory have shown that the TRAP assay has a sensitivity of 65 percent and a specificity of 96 percent for the detection of LSIL/HSIL/SCC versus normal/benign reactive or ASCUS cytology of patients undergoing colposcopic examination. Furthermore, telomerase analysis detected 75 percent of cases of HSIL and 100 percent of SCCs. These initial studies, however, are limited by the small number of cases that have been evaluated to date. The goal of this proposal is to determine the potential of telomerase analysis to decrease false negative rates in cervical cytology, by investigation of the following specific aims: 1) correlate telomerase expression and the detection of HPV DNA with cytologic diagnosis of cervical smears collected at the time of colposcopic examination, as a marker of ASCUS, LSIL, HSIL and SCC; 2) correlate telomerase expression and detection of HPV DNA in cervical cytology preparations, from patients undergoing colposcopic evaluation, with a current cytologic diagnosis of normal/benign reactive changes, ASCUS, or LSIL with the concurrent or subsequent detection of HSIL or SCC; and 3) compare the cellular localization of telomerase with the localization of HPV DNA in normal/benign reactive cervical tissues, LSIL, HSIL and SCC. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “Pap smear” (or synonyms) into the search box. This search gives you access to 3 4
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.
With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.
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full-text articles. The following is a sample of items found for Pap smear in the PubMed Central database: •
Cervical cleaning improves Pap smear quality. by Kotaska AJ, Matisic JP.; 2003 Sep 30; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=202283
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Collection of Cervical Secretions Does Not Adversely Affect Pap Smears Taken Immediately Afterward. by Hildesheim A, Bratti MC, Edwards RP, Schiffman M, Rodriguez AC, Herrero R, Alfaro M, Morera LA, Ermatinger SV, Miller BT, CrowleyNowick PA.; 1998 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=95605
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Comparison of human papillomavirus DNA testing and repeat Papanicolaou test in women with low-grade cervical cytologic abnormalities: a randomized trial. by Lytwyn A, Sellors JW, Mahony JB, Daya D, Chapman W, Ellis N, Roth P, Lorincz AT, Gafni A.; 2000 Sep 19; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=80165
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Comparison of Methods for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae Using Commercially Available Nucleic Acid Amplification Tests and a Liquid Pap Smear Medium. by Koumans EH, Black CM, Markowitz LE, Unger E, Pierce A, Sawyer MK, Papp JR.; 2003 Apr; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=153886
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Effectiveness of follow up-letters to health care providers in triggering follow-up for women with abnormal results on Papanicolaou testing. by Wagner E, Duggan MA.; 2001 Jan 23; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=80681
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Factors related to the practice of breast self examination (BSE) and Pap smear screening among Malaysian women workers in selected electronics factories. by Chee HL, Rashidah S, Shamsuddin K, Intan O.; 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=165602
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The merits of new alternatives to the Papanicolaou test. by Ellison E.; 2001 Sep 18; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=81443
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with Pap smear, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “Pap smear” (or 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for Pap smear (hyperlinks lead to article summaries): •
A biographical disruption: the case of an abnormal pap smear. Author(s): Rajaram SS, Hill J, Rave C, Crabtree BF. Source: Health Care for Women International. 1997 November-December; 18(6): 521-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9416036&dopt=Abstract
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A clinician's guide to Pap smear interpretation. Author(s): Mashburn J, Scharbo-DeHaan M. Source: The Nurse Practitioner. 1997 April; 22(4): 115-8, 124-7, 130 Passim. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9128882&dopt=Abstract
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A consensus on Pap smear review. Author(s): Wood TP. Source: Cap Today. 1998 May; 12(5): 12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10181168&dopt=Abstract
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A current appraisal of the abnormal Pap smear. Author(s): Briggs R. Source: East Afr Med J. 1981 January; 58(1): 18-24. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7215270&dopt=Abstract
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A decade has passed.the Pap smear and cervical cancer. Author(s): Linder J. Source: American Journal of Clinical Pathology. 1997 November; 108(5): 492-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9353086&dopt=Abstract
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A new improvement in a successful screening test the Thin Prep Pap smear. Author(s): Barlow JF. Source: S D J Med. 1997 March; 50(3): 87-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9078860&dopt=Abstract
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A randomised controlled trial of strategies to prompt attendance for a Pap smear. Author(s): Bowman J, Sanson-Fisher R, Boyle C, Pope S, Redman S. Source: Journal of Medical Screening. 1995; 2(4): 211-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8719151&dopt=Abstract
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•
A study of women who appear to default from management of an abnormal Pap smear. Author(s): Mitchell H, Hoy J, Temple-Smith M, Quinn M. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1992 February; 32(1): 54-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1586337&dopt=Abstract
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A survey of state Medicaid policies for coverage of screening mammography and Pap smear services. Author(s): Moore KG. Source: Women's Health Issues : Official Publication of the Jacobs Institute of Women's Health. 1992 Spring; 2(1): 40-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1320973&dopt=Abstract
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Abnormal cervical PAP smear leading to the diagnosis of gastrointestinal cancer without cervico-vaginal metastases. Author(s): Selvaggi LE, Di Vagno G, Loverro G, Masotina A, Cramarossa D, Napoli A, Resta L. Source: Eur J Gynaecol Oncol. 1993; 14(5): 398-401. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8253100&dopt=Abstract
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Abnormal Pap smear follow-up in a high-risk population. Author(s): Engelstad LP, Stewart SL, Nguyen BH, Bedeian KL, Rubin MM, Pasick RJ, Hiatt RA. Source: Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. 2001 October; 10(10): 1015-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11588126&dopt=Abstract
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Acarina in Pap smear. Author(s): Lefer LG, Rosier RP. Source: Acta Cytol. 1978 September-October; 22(5): 285. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=281832&dopt=Abstract
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Acculturation and Pap smear screening practices among college-aged Vietnamese women in the United States. Author(s): Yi JK. Source: Cancer Nursing. 1998 October; 21(5): 335-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9775483&dopt=Abstract
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Accuracy of Pap smear and mammogram self-reports in a southwestern Native American tribe. Author(s): Johnson CS, Archer J, Campos-Outcalt D. Source: American Journal of Preventive Medicine. 1995 November-December; 11(6): 3603. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8775656&dopt=Abstract
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Accuracy of Pap smear screening--is community expectation unrealistic? Author(s): Yeoh GP, Russell P. Source: The Medical Journal of Australia. 1994 December 5-19; 161(11-12): 723. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7830650&dopt=Abstract
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Accuracy of self-report of mammography and Pap smear in a low-income urban population. Author(s): McGovern PG, Lurie N, Margolis KL, Slater JS. Source: American Journal of Preventive Medicine. 1998 April; 14(3): 201-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9569221&dopt=Abstract
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Accuracy of women's self-report of their last Pap smear. Author(s): Sawyer JA, Earp JA, Fletcher RH, Daye FF, Wynn TM. Source: American Journal of Public Health. 1989 August; 79(8): 1036-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2751021&dopt=Abstract
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Adjunctive testing for cervical cancer in low resource settings with visual inspection, HPV, and the Pap smear. Author(s): Blumenthal PD, Gaffikin L, Chirenje ZM, McGrath J, Womack S, Shah K. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 2001 January; 72(1): 47-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11146077&dopt=Abstract
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Adolescent pap smear screening: yes or no. Author(s): Hillard P. Source: Journal of Pediatric and Adolescent Gynecology. 1996 April; 9(2): 93-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8795784&dopt=Abstract
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Age and Pap smear history as a basis for intervention strategy. Author(s): Spurlock C, Nadel M, McManmon E. Source: Journal of Community Health. 1992 April; 17(2): 97-107. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1602047&dopt=Abstract
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Age at time of first intercourse v. chronologic age as a basis for Pap smear screening. Author(s): Wright VC, Riopelle MA. Source: Can Med Assoc J. 1982 July 15; 127(2): 127-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7093858&dopt=Abstract
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Agreement between patient self-reports and medical records for Pap smear histories. Author(s): McKenna MT, Speers M, Mallin K, Warnecke R. Source: American Journal of Preventive Medicine. 1992 September-October; 8(5): 287-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1419128&dopt=Abstract
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AmpliType PM and HLA DQ alpha typing from pap smear, semen smear, and postcoital slides. Author(s): Roy R, Reynolds R. Source: J Forensic Sci. 1995 March; 40(2): 266-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7602290&dopt=Abstract
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An “infobutton” for enabling patients to interpret on-line Pap smear reports. Author(s): Baorto DM, Cimino JJ. Source: Proceedings / Amia. Annual Symposium. Amia Symposium. 2000; : 47-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11079842&dopt=Abstract
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An at-home lifesaver? New research looks beyond the Pap smear to find cheaper, simpler tests to detect cervical cancer. Author(s): Check E. Source: Newsweek. 2000 January 17; 135(3): 62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10787982&dopt=Abstract
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ASCUS and LSIL Pap smear. Results: triage considerations. Author(s): Ferris DG. Source: American Family Physician. 1996 March; 53(4): 1057-8, 1060, 1064 Passim. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8629554&dopt=Abstract
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Aspergillosis of the human female genital tract demonstrated by endometrial jet washings and Pap smear. Author(s): Zablen M, Nieberg R. Source: Acta Cytol. 1977 May-June; 21(3): 367-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=268113&dopt=Abstract
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Assessment of knowledge, attitudes, and behaviors relative to cervical cancer and the Pap smear among adolescent girls in West Virginia. Author(s): Jubelirer SJ, Blanton MF, Blanton PD, Zhang J, Foster D, Monk J, Kuhn G, Hanshew D. Source: Journal of Cancer Education : the Official Journal of the American Association for Cancer Education. 1996 Winter; 11(4): 230-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8989638&dopt=Abstract
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Association between CBE, FOBT, and Pap smear adherence and mammography adherence among older low-income women. Author(s): Augustson EM, Vadaparampil ST, Paltoo DN, Kidd LR, O'Malley AS. Source: Preventive Medicine. 2003 June; 36(6): 734-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12744918&dopt=Abstract
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Augmentation of Pap smear screening of high risk aboriginal women. Use of a computerised process tool within the Broome Aboriginal Medical Service. Author(s): Couzos S, Wronski I, Murray R, Cox H. Source: Aust Fam Physician. 1998 April; 27(4): 269-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9581335&dopt=Abstract
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Barriers to mammography and Pap smear screening among women who recently had neither, one or both types of screening. Author(s): Glasgow RE, Whitlock EP, Valanis BG, Vogt TM. Source: Annals of Behavioral Medicine : a Publication of the Society of Behavioral Medicine. 2000 Summer; 22(3): 223-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11126467&dopt=Abstract
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Benign cellular changes in Pap smears. Causes and significance. Author(s): Malik SN, Wilkinson EJ, Drew PA, Hardt NS. Source: Acta Cytol. 2001 January-February; 45(1): 5-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11213504&dopt=Abstract
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Benign glandular and squamous metaplastic-like cells seen in vaginal Pap smears of post hysterectomy patients: incidence and patient profile. Author(s): Ramirez NC, Sastry LK, Pisharodi LR. Source: Eur J Gynaecol Oncol. 2000; 21(1): 43-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10726617&dopt=Abstract
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Beyond opportunistic Pap smears in general practice. Women's views of strategies to promote regular screening. Author(s): Ward J, D'Este C, Sanson-Fisher R. Source: Aust Fam Physician. 1993 November; 22(11): 2032-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8304859&dopt=Abstract
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Beyond the Pap. What you should know about a new gene test that could someday replace the Pap smear. Author(s): Gorman C. Source: Time. 2000 January 17; 155(2): 101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10787477&dopt=Abstract
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Biopsy-based comparison of liquid-based, thin-layer preparations to conventional Pap smears. Author(s): Vassilakos P, Schwartz D, de Marval F, Yousfi L, Broquet G, Mathez-Loic F, Campana A, Major A. Source: J Reprod Med. 2000 January; 45(1): 11-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10664941&dopt=Abstract
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Breast examinations with Pap smears. Author(s): Shipp RH. Source: American Family Physician. 1976 October; 14(4): 119-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=983917&dopt=Abstract
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Building outpatient volume through Pap smear testing. Author(s): Hatfield JD. Source: Mlo: Medical Laboratory Observer. 1989 March; 21(3): 77-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10318268&dopt=Abstract
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By the way, doctor. I read with interest your article regarding conventional Pap smears, PapNet, and AutoPap. Lately I've been reading about another test called ThinPrep. I'm not sure which one to request. Which of these techniques is better for detecting cervical cancer? Author(s): Robb-Nicholson C. Source: Harvard Women's Health Watch. 1999 August; 6(12): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10402327&dopt=Abstract
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By the way, doctor. I received a widely circulated e-mail message about use of the CA125 blood test in screening for ovarian cancer. The message suggested that the CA-125 test be used for routine screening, like a Pap smear. Do you agree? What's your opinion of this test? Author(s): Robb-Nicholson C. Source: Harvard Women's Health Watch. 2001 July; 8(11): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11511469&dopt=Abstract
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By the way, doctor. I recently read that a test for the virus linked to cervical cancer may be better than a Pap smear. Does this mean I can avoid a regular pelvic exam and Pap smear? Should I ask my doctor for this test? Author(s): Robb-Nicholson C. Source: Harvard Women's Health Watch. 2000 March; 7(7): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10677195&dopt=Abstract
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Can glandular lesions be diagnosed in pap smear cytology? Author(s): Raab SS. Source: Diagnostic Cytopathology. 2000 August; 23(2): 127-33. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10888760&dopt=Abstract
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Cancer, the pill and the Pap smear - again. Author(s): Wood C. Source: Br J Sex Med. 1976 October; 3(5): 37. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=992221&dopt=Abstract
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Cervical cancer and Pap smear screening in Botswana: knowledge and perceptions. Author(s): McFarland DM. Source: International Nursing Review. 2003 September; 50(3): 167-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12930285&dopt=Abstract
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Cervical cancer screening from Pap smear to human papillomavirus DNA testing. Author(s): Jin XW, Xu H. Source: Compr Ther. 2001 Fall; 27(3): 202-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11569320&dopt=Abstract
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Cervical cancer, Pap smear and HPV testing: an update of the role of organized Pap smear screening and HPV testing. Author(s): Sigurdsson K. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1999 July; 78(6): 467-77. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10376855&dopt=Abstract
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Cervical cancer: developments in screening and evaluation of the abnormal Pap smear. Author(s): Walsh JM. Source: The Western Journal of Medicine. 1998 November; 169(5): 304-10. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9830367&dopt=Abstract
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Cervical cleaning improves Pap smear quality. Author(s): Kotaska AJ, Matisic JP. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2003 September 30; 169(7): 666-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14517124&dopt=Abstract
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Cervical neoplasia risk in women provided hormonal contraception without a Pap smear. Author(s): Sawaya GF, Harper C, Balistreri E, Boggess J, Darney P. Source: Contraception. 2001 February; 63(2): 57-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11292467&dopt=Abstract
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Cervical Pap smear usage in Arkansas, resurvey, 1976. Author(s): Steinkamp RC, Meade JH Jr, Hunter WC, Riggs C. Source: J Ark Med Soc. 1978 June; 75(1): 55-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=149103&dopt=Abstract
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Cervicography and HPV DNA testing as triage criteria for patients with abnormal pap smear. Author(s): Costa S, Sideri M, Bucchi L, Schettino F, Maini I, Spinaci L, Bovicelli L, Terzano P. Source: Gynecologic Oncology. 1998 December; 71(3): 404-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9887239&dopt=Abstract
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Chinese women's experiences and images of the Pap smear examination. Author(s): Holroyd E, Twinn SF, Shia AT. Source: Cancer Nursing. 2001 February; 24(1): 68-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11219425&dopt=Abstract
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Chlamydia trachomatis diagnosis: a correlative study of pap smear and direct immunofluorescence. Author(s): Garozzo G, Lomeo E, La Greca M, Castiglione MG, Caruso M, Sorrenti M, Grillo S. Source: Clin Exp Obstet Gynecol. 1993; 20(4): 259-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8281710&dopt=Abstract
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Classics in cytology: IV. Traut and the “Pap smear”. Author(s): Long SR, Cohen MB. Source: Acta Cytol. 1991 January-February; 35(1): 140-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1994623&dopt=Abstract
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Clinical evaluation of the Pap smear and the importance of followup. Author(s): Lash AF. Source: Imj Ill Med J. 1969 April; 135(4): 408-11 Passim. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4388495&dopt=Abstract
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Clinical predictors of cervical intraepithelial neoplasia 2 or greater in women with mildly abnormal Pap smears. Author(s): Boardman LA, Adams AE, Peipert JF. Source: J Reprod Med. 2002 November; 47(11): 891-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12497676&dopt=Abstract
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Combined Pap smear, cervicography and HPV DNA testing in the detection of cervical intraepithelial neoplasia and cancer. Author(s): Costa S, Sideri M, Syrjanen K, Terzano P, De Nuzzo M, De Simone P, Cristiani P, Finarelli AC, Bovicelli A, Zamparelli A, Bovicelli L. Source: Acta Cytol. 2000 May-June; 44(3): 310-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10833984&dopt=Abstract
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Companies build Pap smear safety nets. Author(s): Scott L. Source: Modern Healthcare. 1995 May 8; 25(19): 70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10142267&dopt=Abstract
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Comparative cytologic yield and quality of three Pap smear instruments. Author(s): Toffler WL, Pluedeman CK, Sinclair AE, Ireland KM, Byrne BJ. Source: Family Medicine. 1993 June; 25(6): 403-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8349063&dopt=Abstract
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Comparing claims data and self-reported data with the medical record for Pap smear rates. Author(s): Fowles JB, Fowler E, Craft C, McCoy CE. Source: Evaluation & the Health Professions. 1997 September; 20(3): 324-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10183327&dopt=Abstract
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Comparison of Gram stain and Pap smear procedures in the diagnosis of bacterial vaginosis. Author(s): Vardar E, Maral I, Inal M, Ozguder O, Tasli F, Postaci H. Source: Infectious Diseases in Obstetrics and Gynecology. 2002; 10(4): 203-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12648314&dopt=Abstract
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Comparison of methods for detection of Chlamydia trachomatis and Neisseria gonorrhoeae using commercially available nucleic acid amplification tests and a liquid pap smear medium. Author(s): Koumans EH, Black CM, Markowitz LE, Unger E, Pierce A, Sawyer MK, Papp JR. Source: Journal of Clinical Microbiology. 2003 April; 41(4): 1507-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12682137&dopt=Abstract
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Comparison of ThinPrep and Pap smear in relation to prediction of adenocarcinoma in situ. Author(s): Roberts JM, Thurloe JK, Bowditch RC, Humcevic J, Laverty CR. Source: Acta Cytol. 1999 January-February; 43(1): 74-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9987454&dopt=Abstract
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Comparison of visual inspection of cervix and Pap smear for cervical cancer screening. Author(s): Tayyeb R, Khawaja NP, Malik N. Source: J Coll Physicians Surg Pak. 2003 April; 13(4): 201-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12718787&dopt=Abstract
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Computerized scanning devices for Pap smear screening: current status and critical review. Author(s): Rosenthal DL. Source: Clin Lab Med. 1997 June; 17(2): 263-84. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9243073&dopt=Abstract
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Consensus--more or less--on the Pap smear. Author(s): Marx JL. Source: Science. 1980 August 8; 209(4457): 672. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7394525&dopt=Abstract
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Consequences of current patterns of Pap smear and colposcopy use. Author(s): Kavanagh AM, Santow G, Mitchell H. Source: Journal of Medical Screening. 1996; 3(1): 29-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8861048&dopt=Abstract
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Cost analysis of PAPNET-assisted vs. conventional Pap smear evaluation in primary screening of cervical smears. Author(s): Meerding WJ, Doornewaard H, van Ballegooijen M, Bos A, van der Graaf Y, van den Tweel JG, van der Schouw YT, Habbema JD. Source: Acta Cytol. 2001 January-February; 45(1): 28-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11213501&dopt=Abstract
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Cryosurgery. Its use for the abnormal Pap smear. Author(s): Underwood PB Jr, Lutz MH, Van Fletcher R Jr. Source: Cancer. 1976 July; 38(1 Suppl): 546-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1277108&dopt=Abstract
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Current concepts in obstetrics and gynecology: The patient with an abnormal Pap smear--screening techniques and managment. Author(s): Richart RM. Source: The New England Journal of Medicine. 1980 February 7; 302(6): 332-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6985710&dopt=Abstract
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Cytologic predictors of cervical intraepithelial neoplasia in women with an ASCUS Pap smear. Author(s): Morin C, Bairati I, Bouchard C, Fortier M, Roy M, Moore L, Meisels A. Source: Acta Cytol. 2000 July-August; 44(4): 576-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10934951&dopt=Abstract
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Defending the pap smear: a proactive approach to the litigation threat in gynecologic cytology. Author(s): McCoy DR. Source: American Journal of Clinical Pathology. 2000 November; 114 Suppl: S52-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11996170&dopt=Abstract
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Delay times to definitive diagnosis after an abnormal Pap smear. Author(s): Mitchell H, Medley G. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1987 November; 27(4): 283-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3453664&dopt=Abstract
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Demographic predictors of mammography and Pap smear screening in US women. Author(s): Calle EE, Flanders WD, Thun MJ, Martin LM. Source: American Journal of Public Health. 1993 January; 83(1): 53-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8417607&dopt=Abstract
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Detecting abnormal cells from primary serous peritoneal carcinoma by Pap smear. Author(s): Wang PH, Yuan CC, Lai CR. Source: Acta Cytol. 1999 November-December; 43(6): 1200-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10579010&dopt=Abstract
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Detection of Candida cell forms in Pap smears during pregnancy. Author(s): Donders GG, van Straeten D, Hooft P, De Wet GH. Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1992 January 9; 43(1): 13-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1737603&dopt=Abstract
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Detection of false negative Pap smears by rapid reviewing. A metaanalysis. Author(s): Arbyn M, Schenck U. Source: Acta Cytol. 2000 November-December; 44(6): 949-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11127751&dopt=Abstract
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Detection of false-negative Pap smears using the PAPNET system. Author(s): Troni GM, Cipparrone I, Cariaggi MP, Ciatto S, Miccinesi G, Zappa M, Confortini M. Source: Tumori. 2000 November-December; 86(6): 455-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11218185&dopt=Abstract
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Determinants for genital human papillomavirus (HPV) infection in 1000 randomly chosen young Danish women with normal Pap smear: are there different risk profiles for oncogenic and nononcogenic HPV types? Author(s): Kjaer SK, van den Brule AJ, Bock JE, Poll PA, Engholm G, Sherman ME, Walboomers JM, Meijer CJ. Source: Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. 1997 October; 6(10): 799-805. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9332762&dopt=Abstract
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Determinants of squamous intraepithelial lesions (SIL) on Pap smear: the role of HPV infection and of HIV-1-induced immunosuppression. DIANAIDS Collaborative Study Group. Author(s): Rezza G, Giuliani M, Branca M, Benedetto A, Migliore G, Garbuglia AR, D'Ubaldo C, Pezzotti P, Cappiello G, Pomponi Formiconi D, Suligoi B, Schiesari A, Ippolito G, Giacomini G. Source: European Journal of Epidemiology. 1997 December; 13(8): 937-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9476825&dopt=Abstract
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Development of a Pap smear quality-assurance system in family practice. Author(s): Curtis P, Varenholt JJ, Skinner B, Addison L, Resnick J, Kebede M. Source: Family Medicine. 1993 February; 25(2): 135-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8458544&dopt=Abstract
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Diagnosing human papillomavirus of the female lower genital tract: failure of the Pap smear as a sole screening test. Author(s): Lonky NM, Mahoney A, Sauer MV. Source: J Gynecol Surg. 1991 Fall; 7(3): 183-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10150073&dopt=Abstract
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Diagnostic significance of endocervical glandular cells with “golden-yellow” mucin on pap smear. Author(s): Hata S, Mikami Y, Manabe T. Source: Diagnostic Cytopathology. 2002 August; 27(2): 80-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12203873&dopt=Abstract
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Do it yourself Pap smear kit. Author(s): Letton AH. Source: J Med Assoc Ga. 1966 November; 54(11): 379. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5978382&dopt=Abstract
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Do not neglect the Pap smear. Author(s): Mikuta JJ. Source: Pa Med. 1969 January; 72(1): 40-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5782485&dopt=Abstract
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Do you think yearly Pap smears should be done after a hysterectomy? Author(s): Mott JD, Gusberg SB. Source: Postgraduate Medicine. 1988 June; 83(8): 216-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3375152&dopt=Abstract
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Does contraceptive method change the Pap smear finding? Author(s): Kazerooni T, Mosalaee A. Source: Contraception. 2002 October; 66(4): 243-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12413619&dopt=Abstract
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Does cost-effectiveness analysis make a difference? Lessons from Pap smears. Symposium. Author(s): Hagen MD, Garber AM, Goldie SJ, Lafata JE, Mandelblatt J, Meltzer D, Neumann P, Siegel JE, Sox HC Jr, Tsevat J. Source: Medical Decision Making : an International Journal of the Society for Medical Decision Making. 2001 July-August; 21(4): 307-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11475387&dopt=Abstract
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Dr. Papanicolaou and the Pap smear. Author(s): Carmichael E. Source: Ala J Med Sci. 1984 January; 21(1): 101-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6367516&dopt=Abstract
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Duration of preclinical cervical cancer and reduction in incidence of invasive cancer following negative pap smears. Author(s): van Oortmarssen GJ, Habbema JD. Source: International Journal of Epidemiology. 1995 April; 24(2): 300-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7635589&dopt=Abstract
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Editorial: Reprise: the Pap smear. Author(s): Thomison JB. Source: J Tenn Med Assoc. 1972 November; 65(11): 1031. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4671710&dopt=Abstract
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Effect of educational brochures on Cherokee women with abnormal pap smears. Author(s): Pardini RS. Source: Public Health Reports (Washington, D.C. : 1974). 1996 November-December; 111(6): 546-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8955704&dopt=Abstract
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Effectiveness of campaigns to increase Pap smear screening. Author(s): Shelley J, Irwig L, Simpson JM, Laverty C. Source: The Medical Journal of Australia. 1993 March 1; 158(5): 359. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8474386&dopt=Abstract
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Effectiveness of thin-layer preparations vs. conventional Pap smears in a blinded, split-sample study. Extended cytologic evaluation. Author(s): Hessling JJ, Raso DS, Schiffer B, Callicott J Jr, Husain M, Taylor D. Source: J Reprod Med. 2001 October; 46(10): 880-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11725731&dopt=Abstract
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Effects of the Bethesda System on the rate of unsatisfactory Pap smears in spontaneous cervical screening. Author(s): Morini N, Bucchi L, Naldoni C, Schincaglia P, Capacci N, Fantozzi V, Buzzi G. Source: Tumori. 1996 September-October; 82(5): 437-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9063518&dopt=Abstract
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Endocervical cells on Pap smears. Author(s): Hawkins R. Source: The Journal of Family Practice. 1996 August; 43(2): 114. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8708612&dopt=Abstract
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Endometrial cells and the AutoPap System for primary screening of cervicovaginal Pap smears. Author(s): Walts AE, Thomas P. Source: Diagnostic Cytopathology. 2002 October; 27(4): 232-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12357502&dopt=Abstract
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Enhancing adherence following abnormal Pap smears among low-income minority women: a preventive telephone counseling strategy. Author(s): Miller SM, Siejak KK, Schroeder CM, Lerman C, Hernandez E, Helm CW. Source: Journal of the National Cancer Institute. 1997 May 21; 89(10): 703-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9168185&dopt=Abstract
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Errors in the use of the Pap smear. Author(s): Hughes RR. Source: Southern Medical Journal. 1972 May; 65(5): 575-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5027464&dopt=Abstract
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Estimation of the performance of an array-processor oriented system for automatic Pap smear analysis. Author(s): Abmayr W, Gais P, Rodenacker K, Burger G. Source: Cytometry : the Journal of the Society for Analytical Cytology. 1980 November; 1(3): 193-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7021103&dopt=Abstract
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Evaluation and follow-up of abnormal Pap smears. Author(s): Miller KE, Losh DP, Folley A. Source: American Family Physician. 1992 January; 45(1): 143-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1309403&dopt=Abstract
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Evaluation of a mass-media-led campaign to increase Pap smear screening. Author(s): Shelley JM, Irwig LM, Simpson JM, Macaskill P. Source: Health Education Research. 1991 September; 6(3): 267-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10148692&dopt=Abstract
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Evaluation of an abnormal Pap smear. Author(s): Meeks GR, Sampson CE Jr. Source: J Miss State Med Assoc. 1984 July; 25(7): 169-71. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6471099&dopt=Abstract
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Evaluation of patients with atypical Pap smears. Author(s): Shingleton HM. Source: Ala J Med Sci. 1972 July; 9(3): 248-55. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5074656&dopt=Abstract
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Evaluation of the abnormal PAP smear - colposcopy or conization? Author(s): Powell JL. Source: J Med Assoc Ga. 1980 May; 69(5): 399-402. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7373179&dopt=Abstract
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Evaluation of the abnormal Pap smear. Author(s): Homesley HD. Source: American Family Physician. 1977 September; 16(3): 190-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=900003&dopt=Abstract
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Evaluation of the atypical Pap smear. Author(s): Jones DE, Creasman WT, Dombroski RA, Lentz SS, Waeltz JL. Source: American Journal of Obstetrics and Gynecology. 1987 September; 157(3): 544-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3631155&dopt=Abstract
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Evaluation of the ThinPrep Pap test as an adjunct to the conventional Pap smear. Author(s): Roberts JM, Gurley AM, Thurloe JK, Bowditch R, Laverty CR. Source: The Medical Journal of Australia. 1997 November 3; 167(9): 466-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9397059&dopt=Abstract
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Experience with fifteen thousand consecutive Pap smears. Author(s): Sandmire HF. Source: Wis Med J. 1972 April; 71(4): 130-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5030521&dopt=Abstract
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Extrauterine malignancies. Role of Pap smears in diagnosis and management. Author(s): Gupta D, Balsara G. Source: Acta Cytol. 1999 September-October; 43(5): 806-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10518134&dopt=Abstract
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Factors affecting abnormal Pap smear follow-up among HIV-infected women. Author(s): Abercrombie PD. Source: The Journal of the Association of Nurses in Aids Care : Janac. 2003 May-June; 14(3): 41-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12800811&dopt=Abstract
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Factors affecting patient compliance among women with abnormal Pap smears. Author(s): Funke BL, Nicholson ME. Source: Patient Education and Counseling. 1993 January; 20(1): 5-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8386357&dopt=Abstract
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Factors affecting the cytology outcome of Pap smears--a brief approach to internal quality control in private cytopathology laboratory practice. Author(s): Linko S, Taskinen E, Sarna S, Karkkainen P. Source: Apmis : Acta Pathologica, Microbiologica, Et Immunologica Scandinavica. 2001 October; 109(10): 685-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11890572&dopt=Abstract
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Factors associated with Pap smear taking in general practice: focusing public health initiatives. Author(s): Heywood A, Firman D, Ring I. Source: Aust N Z J Public Health. 1996 June; 20(3): 260-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8768415&dopt=Abstract
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Factors predicting the persistence of genital human papillomavirus infections and PAP smear abnormality in HIV-positive and HIV-negative women during prospective follow-up. Author(s): Branca M, Garbuglia AR, Benedetto A, Cappiello T, Leoncini L, Migliore G, Agarossi A, Syrjanen K; DIANAIDS Collaborative Study Group. Source: International Journal of Std & Aids. 2003 June; 14(6): 417-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12816671&dopt=Abstract
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False-negative Pap smear in uterine malignancy. Author(s): Jafari K. Source: Gynecologic Oncology. 1978 February; 6(1): 76-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=620952&dopt=Abstract
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Finding the proper fit for Pap smear devices. Author(s): Check W. Source: Cap Today. 1998 December; 12(12): 18-20, 22, 25-6 Passim. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10339313&dopt=Abstract
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Follow-up of the minimally abnormal Pap smear. Author(s): Everett WD. Source: American Family Physician. 1997 July; 56(1): 56-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9225667&dopt=Abstract
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From simple technology to complex arena: classification of Pap smears, 1917-90. Author(s): Clarke AE, Casper MJ. Source: Medical Anthropology Quarterly. 1996 December; 10(4): 601-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8979241&dopt=Abstract
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Further discussion on the role of pap smear screening. Author(s): Littell JT. Source: American Family Physician. 2000 November 15; 62(10): 2232, 2235. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11126851&dopt=Abstract
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Getting a Pap smear: focus group responses of African American and Latina women. Author(s): Jennings KM. Source: Oncology Nursing Forum. 1997 June; 24(5): 827-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9201736&dopt=Abstract
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Good intentions (Ohio's PAP smear law). Author(s): Snyder R, Rini AG. Source: Nursing Management. 1996 June; 27(6): 59. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8788792&dopt=Abstract
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Gynaecological care of women with abnormal Pap smears: how varied is current practice? Author(s): Wain GV, Ward J, Towler BP. Source: The Medical Journal of Australia. 1995 April 3; 162(7): 348-9, 352-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7715514&dopt=Abstract
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Harvard HMO improves Pap smear screening. Author(s): Herman R. Source: Qa Rev. 1989 October; 1(3): 2-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10318359&dopt=Abstract
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Has the use of pap smears reduced the risk of invasive cervical cancer in Guadalajara, Mexico? Author(s): Jimenez-P rez M, Thomas DB. Source: International Journal of Cancer. Journal International Du Cancer. 1999 September 9; 82(6): 804-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10446445&dopt=Abstract
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Have the most recent Pap smear guidelines affected GP practices? Author(s): Wai D, Ferrier A, Collings S, Laverty C. Source: Aust Fam Physician. 1996 January; Suppl 1: S44-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9479800&dopt=Abstract
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Health beliefs and Pap smears among Thai women in Brisbane, Australia. Author(s): Jirojwong S, Maclennan R, Manderson L. Source: Asia Pac J Public Health. 2001; 13(1): 20-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12109255&dopt=Abstract
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Health education for adolescents with abnormal Pap smears. Author(s): Hamilton CA, Bauchman G. Source: J Am Med Womens Assoc. 1999 Summer; 54(3): 149-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10441922&dopt=Abstract
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Health policy: gaps in access, delivery, and utilization of the Pap smear in the United States. Author(s): Baquet C, Ringen K. Source: The Milbank Quarterly. 1987; 65 Suppl 2: 322-47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3451061&dopt=Abstract
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Histocytological study of squamous atypia on Pap smears. Author(s): Abu-Jawdeh GM, Trawinski G, Wang HH. Source: Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc. 1994 December; 7(9): 920-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7892161&dopt=Abstract
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Histologic follow-up of atypical endocervical cells. Liquid-based, thin-layer preparation vs. conventional Pap smear. Author(s): Wang N, Emancipator SN, Rose P, Rodriguez M, Abdul-Karim FW. Source: Acta Cytol. 2002 May-June; 46(3): 453-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12040636&dopt=Abstract
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Histology/cytology discrepancies in HIV-infected obstetric patients with normal pap smears. Author(s): Robinson WR, Barnes SE, Adams S, Perrin MS. Source: Gynecologic Oncology. 1997 June; 65(3): 430-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9190970&dopt=Abstract
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HMOs should stress quality tests in light of pap smear controversy. Author(s): Johnson DE. Source: Contract Healthc. 1988 February; : 27. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10318142&dopt=Abstract
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How good (or bad) is the Pap smear? Author(s): Creasman WT. Source: J S C Med Assoc. 1989 October; 85(10): 459-62. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2811306&dopt=Abstract
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How I do a Pap smear. Author(s): Franklin EW 3rd. Source: J Med Assoc Ga. 1978 September; 67(9): 741-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=756907&dopt=Abstract
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How reminders given to patients and physicians affected pap smear use in a health maintenance organization: results of a randomized controlled trial. Author(s): Burack RC, Gimotty PA, George J, McBride S, Moncrease A, Simon MS, Dews P, Coombs J. Source: Cancer. 1998 June 15; 82(12): 2391-400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9635532&dopt=Abstract
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How to take a Pap smear. Author(s): Liddell M. Source: Aust Fam Physician. 1995 February; 24(2): 266. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7880147&dopt=Abstract
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HPV and Pap smears. Author(s): Stine K. Source: The Nurse Practitioner. 1997 August; 22(8): 19, 22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9279841&dopt=Abstract
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HPV for cervical cancer screening: is the era of the molecular pap smear upon us? Author(s): Stoler MH. Source: The Journal of Histochemistry and Cytochemistry : Official Journal of the Histochemistry Society. 2001 September; 49(9): 1197-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11511693&dopt=Abstract
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Human papillomavirus (HPV) DNA assay as an adjunct to liquid-based Pap test in the diagnostic triage of women with an abnormal Pap smear. Author(s): Vassilakos P, de Marval F, Munoz M, Broquet G, Campana A. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1998 April; 61(1): 45-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9622172&dopt=Abstract
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Human papillomavirus (HPV) in an Icelandic population: the role of HPV DNA testing based on hybrid capture and PCR assays among women with screen-detected abnormal Pap smears. Author(s): Sigurdsson K, Arnadottir T, Snorradottir M, Benediktsdottir K, Saemundsson H. Source: International Journal of Cancer. Journal International Du Cancer. 1997 July 29; 72(3): 446-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9247288&dopt=Abstract
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Human papillomavirus, genital warts, Pap smears, and cervical cancer: knowledge and beliefs of adolescent and adult women. Author(s): Mays RM, Zimet GD, Winston Y, Kee R, Dickes J, Su L. Source: Health Care for Women International. 2000 July-August; 21(5): 361-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11261107&dopt=Abstract
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Hybrid Capture method for detection of human papillomavirus DNA in clinical specimens: a tool for clinical management of equivocal Pap smears and for population screening. Author(s): Lorincz AT. Source: The Journal of Obstetrics and Gynaecology Research. 1996 December; 22(6): 62936. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9037955&dopt=Abstract
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Hyperchromatic crowded groups: pitfalls in pap smear diagnosis. Author(s): Demay RM. Source: American Journal of Clinical Pathology. 2000 November; 114 Suppl: S36-43. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11996167&dopt=Abstract
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Identification of a skeleton using DNA from teeth and a PAP smear. Author(s): Sweet D, Hildebrand D, Phillips D. Source: J Forensic Sci. 1999 May; 44(3): 630-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10408121&dopt=Abstract
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Impact of a new cervical pap smear screening guideline on member perceptions and comfort levels. Author(s): Rolnick SJ, LaFerla JJ, Jackson J, Akkerman D, Compo R. Source: Preventive Medicine. 1999 May; 28(5): 530-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10329344&dopt=Abstract
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Improved quality-control detection of false-negative Pap smears using the Autopap 300 QC system. Author(s): Marshall CJ, Rowe L, Bentz JS. Source: Diagnostic Cytopathology. 1999 March; 20(3): 170-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10086244&dopt=Abstract
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Improvement of Pap smear sensitivity using a visual adjunctive procedure: a cooperative Italian study on speculoscopy (GISPE). Author(s): Loiudice L, Abbiati R, Boselli F, Cecchini G, Costa S, Grossi E, Piccoli R, Villani C. Source: European Journal of Cancer Prevention : the Official Journal of the European Cancer Prevention Organisation (Ecp). 1998 August; 7(4): 295-304. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9806118&dopt=Abstract
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Improving adherence to abnormal Pap smear follow-up. Author(s): Abercrombie PD. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 2001 January-February; 30(1): 80-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11277165&dopt=Abstract
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Improving adherence to screening follow-up among women with abnormal Pap smears: results from a large clinic-based trial of three intervention strategies. Author(s): Marcus AC, Crane LA, Kaplan CP, Reading AE, Savage E, Gunning J, Bernstein G, Berek JS. Source: Medical Care. 1992 March; 30(3): 216-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1538610&dopt=Abstract
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Improving follow-up after an abnormal Pap smear: a randomized controlled trial. Author(s): Paskett ED, White E, Carter WB, Chu J. Source: Preventive Medicine. 1990 November; 19(6): 630-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2263574&dopt=Abstract
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Improving follow-up after an abnormal pap smear: results from a quasi-experimental intervention study. Author(s): Kaplan CP, Bastani R, Belin TR, Marcus A, Nasseri K, Hu MY. Source: Journal of Women's Health & Gender-Based Medicine. 2000 September; 9(7): 779-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11025870&dopt=Abstract
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Improving rates of cervical cancer screening and Pap smear follow-up for low-income women with limited health literacy. Author(s): Lindau ST, Tomori C, McCarville MA, Bennett CL. Source: Cancer Investigation. 2001; 19(3): 316-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11338888&dopt=Abstract
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Improving the accuracy of Pap smears. Author(s): Evans TC. Source: Postgraduate Medicine. 1997 September; 102(3): 63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9300017&dopt=Abstract
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Improving the yield of endocervical elements in a Pap smear with the use of the cytology brush. Author(s): Ruffin MT 4th, Van Noord GR. Source: Family Medicine. 1991 July; 23(5): 365-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1884932&dopt=Abstract
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In defense of the Pap smear. Author(s): Noller KL. Source: Obstetrical & Gynecological Survey. 1998 May; 53(5): 261. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9589437&dopt=Abstract
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Inadequate follow-up for abnormal Pap smears in an urban population. Author(s): Peterson NB, Han J, Freund KM. Source: Journal of the National Medical Association. 2003 September; 95(9): 825-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14527050&dopt=Abstract
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Incidence of sexually transmitted diseases and Pap smear results in female homeless clients from the Chicago Health Outreach Project. Author(s): Johnstone H, Tornabene M, Marcinak J. Source: Health Care for Women International. 1993 May-June; 14(3): 293-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8407620&dopt=Abstract
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Increase Pap smear uptake. Author(s): Zardawi I. Source: The Medical Journal of Australia. 1998 March 2; 168(5): 252. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9539906&dopt=Abstract
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Increasing women's participation in Pap smear screening in Australia--how can we tell if the national policy is effective? Author(s): Shelley J, Street A. Source: Aust Health Rev. 1992; 15(2): 190-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10119050&dopt=Abstract
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Informed consent--Pap smear. Author(s): Thrasher JE, McNicholas AJ 3rd. Source: J Fla Med Assoc. 1980 September; 67(9): 795. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7411078&dopt=Abstract
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Interobserver and intraobserver variability in the cytologic diagnosis of normal and abnormal metaplastic squamous cells in pap smears. Author(s): Gupta DK, Komaromy-Hiller G, Raab SS, Nath ME. Source: Acta Cytol. 2001 September-October; 45(5): 697-703. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11575646&dopt=Abstract
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Invasive cancer of cervix: failures in prevention; I. Previous Pap smear tests and opportunities for screening. Author(s): Fruchter RG, Boyce J, Hunt M. Source: N Y State J Med. 1980 April; 80(5): 740-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6930548&dopt=Abstract
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Is a Pap smear enough? Author(s): Heley S. Source: Aust Fam Physician. 2001 June; 30(6): 535-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11458579&dopt=Abstract
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Is it feasible for women to perform their own Pap smears? A research question in progress. Author(s): Martin RE. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2000 March 7; 162(5): 666-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10738455&dopt=Abstract
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Is there an age at which we should stop performing screening pap smears and mammography? Author(s): Harris P, Carnes M. Source: Cleve Clin J Med. 2002 April; 69(4): 272-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11996198&dopt=Abstract
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Knowledge and attitudes about cervical cancer and the Pap smear among 10th-grade girls. Author(s): Sharp PC, Dignan MB, Dammers PM, Michielutte R, Jackson DS. Source: Southern Medical Journal. 1990 September; 83(9): 1016-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2402642&dopt=Abstract
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Learning about pap smears: an educational skit for Hispanic adolescents. Author(s): Richardson RA, Njoroge W, Wilcox GG, Chacko MR, Hergenroeder AC. Source: Journal of Pediatric and Adolescent Gynecology. 2002; 15(4): 197-204. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12459224&dopt=Abstract
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Loss to follow-up of patients with abnormal Pap smear: magnitude and reasons. Author(s): Thinkhamrop J, Lumbiganon P, Jitpakdeebodin S. Source: J Med Assoc Thai. 1998 November; 81(11): 862-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9803086&dopt=Abstract
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Making the Pap smear into the “right tool” for the job. Author(s): Casper MJ, Clarke AE. Source: Social Studies of Science. 1998 April; 28(2): 255-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11620085&dopt=Abstract
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Mammography and Pap smear screening of Yaqui Indian women. Author(s): Gordon PR, Campos-Outcalt D, Steele L, Gonzales C. Source: Public Health Reports (Washington, D.C. : 1974). 1994 January-February; 109(1): 99-103. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8303022&dopt=Abstract
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Mammography and pap smear use by older rural women. Author(s): Ives DG, Lave JR, Traven ND, Schulz R, Kuller LH. Source: Public Health Reports (Washington, D.C. : 1974). 1996 May-June; 111(3): 244-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8643816&dopt=Abstract
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Management of patients with atypical and low-grade Pap smear abnormalities. Author(s): Nuovo J, Melnikow J, Paliescheskey M. Source: American Family Physician. 1995 December; 52(8): 2243-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7484718&dopt=Abstract
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Management of the abnormal Pap smear. Author(s): Gearhart JG, Davey-Sullivan BJ, Fulton LJ. Source: J Miss State Med Assoc. 1991 May; 32(5): 159-64. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2067003&dopt=Abstract
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Management of the low-grade abnormal Pap smear: What are women's preferences? Author(s): Melnikow J, Kuppermann M, Birch S, Chan BK, Nuovo J. Source: The Journal of Family Practice. 2002 October; 51(10): 849-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12401153&dopt=Abstract
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Management of the mildly abnormal Pap smear: a conservative approach. Author(s): Brown MS, Phillips GL Jr. Source: Gynecologic Oncology. 1985 October; 22(2): 149-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2996992&dopt=Abstract
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Management of the suspicious Pap smear. Author(s): Scott WC. Source: Ariz Med. 1972 August; 29(8): 639-41. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4559071&dopt=Abstract
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Management of women with HPV change on Pap smears. Author(s): Mitchell H. Source: The Medical Journal of Australia. 1992 January 6; 156(1): 69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1310342&dopt=Abstract
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Managing abnormal Pap smears: comments on two articles. Author(s): Buck HW. Source: Journal of American College Health : J of Ach. 1989 September; 38(2): 101-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2778225&dopt=Abstract
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Managing the abnormal Pap smear. Author(s): Carlson JA Jr, Day TG Jr, Masterson BJ. Source: J Ky Med Assoc. 1982 September; 80(9): 590-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7130837&dopt=Abstract
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Mass Pap smear screening in Columbia, South Carolina. Author(s): Anderson MA, Payne S. Source: J S C Med Assoc. 1981 November; 77(11): 543-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6950184&dopt=Abstract
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Measurement of Brn-3a levels in Pap smears provides a novel diagnostic marker for the detection of cervical neoplasia. Author(s): Sindos M, Ndisang D, Pisal N, Chow C, Singer A, Latchman DS. Source: Gynecologic Oncology. 2003 August; 90(2): 366-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12893201&dopt=Abstract
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Mesonephric remnants or hyperplasia can cause abnormal pap smears: a study of three cases. Author(s): Welsh T, Fu YS, Chan J, Brundage HA, Rutgers JL. Source: International Journal of Gynecological Pathology : Official Journal of the International Society of Gynecological Pathologists. 2003 April; 22(2): 121-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12649665&dopt=Abstract
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Metaanalysis of the accuracy of rapid prescreening relative to full screening of pap smears. Author(s): Arbyn M, Schenck U, Ellison E, Hanselaar A. Source: Cancer. 2003 February 25; 99(1): 9-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12589640&dopt=Abstract
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Methods for collection of Pap smears. Author(s): Barr E, O'Connell KJ. Source: The Journal of Family Practice. 1987 June; 24(6): 578. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3585258&dopt=Abstract
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Microcolposcopy vs colposcopy in evaluating abnormal Pap smear. Comparison with histological findings. Author(s): Framarino dei Malatesta ML, Carraro C, Silvestrini I, Marzetti L, Vecchione A. Source: Clin Exp Obstet Gynecol. 1993; 20(4): 236-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8281705&dopt=Abstract
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Midwifery assessment of the well woman. The Pap smear. Author(s): Clay LS. Source: Journal of Nurse-Midwifery. 1990 November-December; 35(6): 341-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2286847&dopt=Abstract
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Neural network processing can provide means to catch errors that slip through human screening of pap smears. Author(s): Boon ME, Kok LP. Source: Diagnostic Cytopathology. 1993 August; 9(4): 411-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8261846&dopt=Abstract
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New procedure under study may replace Pap smear. Author(s): Solomon R. Source: Posit Living. 2001 April; 10(3): 34. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11548375&dopt=Abstract
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Nonadherence to follow-up treatment of an abnormal Pap smear: a case study. Author(s): Rajaram SS. Source: Cancer Nursing. 1998 October; 21(5): 342-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9775484&dopt=Abstract
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Nonneoplastic findings in loop electrical excision procedure specimens from patients with persistent atypical squamous cells of uncertain significance in two consecutive pap smears. Author(s): Pinto AP, Tuon FF, Tizzot EL, Torres LF, Collaco LM. Source: Diagnostic Cytopathology. 2002 August; 27(2): 123-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12203882&dopt=Abstract
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Notification of Pap smear results. A Victorian survey. Author(s): Mitchell H, Medley G. Source: Aust Fam Physician. 1998 January; 27 Suppl 1: S7-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9503728&dopt=Abstract
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Nuclear DNA content analysis by static cytometry in cervical intraepithelial lesions using retrospective series of previously stained PAP smears. Author(s): Shirata NK, Gomes NS, Garcia EA, Longatto Filho A. Source: Adv Clin Path. 2001 July; 5(3): 87-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11753880&dopt=Abstract
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Observations from the CDC. An assessment of Pap smears and hysterectomies among women in the United States. Author(s): Saraiya M, Lee NC, Blackman D, Smith MJ, Morrow B, McKenna MT. Source: Journal of Women's Health & Gender-Based Medicine. 2002 March; 11(2): 103-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11975858&dopt=Abstract
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Of Pap smears and managed care. Author(s): Strama T. Source: Tex Med. 1998 January; 94(1): 6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9448446&dopt=Abstract
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Oral contraceptive pills are associated with artifacts in ThinPrep Pap smears that mimic low-grade squamous intraepithelial lesions. Author(s): Morrison C, Prokorym P, Piquero C, Wakely PE Jr, Nuovo GJ. Source: Cancer. 2003 April 25; 99(2): 75-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12704686&dopt=Abstract
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Outcome after a pap smear report of low-grade abnormality: a longitudinal comparative study. Author(s): Zardawi IM. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2000 November; 40(4): 478-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11194448&dopt=Abstract
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Outcome after a Pap smear report of low-grade abnormality: a longitudinal comparative study. Author(s): Mitchell H. Source: The Australian & New Zealand Journal of Obstetrics & Gynaecology. 1999 August; 39(3): 345-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10554949&dopt=Abstract
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Ovarian cancer and Pap smears. Author(s): Curtis J. Source: Aust Fam Physician. 2001 September; 30(9): 831-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11676307&dopt=Abstract
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Pap smear adequacy: Is our understanding satisfactory.or limited? Author(s): Birdsong GG. Source: Diagnostic Cytopathology. 2001 February; 24(2): 79-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11169883&dopt=Abstract
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Pap smear adequacy--is the assessing criterion including endocervical cells really valid? Author(s): Pajtler M, Audy-Jurkovic S. Source: Coll Antropol. 2002 December; 26(2): 565-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528282&dopt=Abstract
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PAP smear after radiation therapy for cervical carcinoma. Author(s): Rintala MA, Rantanen VT, Salmi TA, Klemi PJ, Grenman SE. Source: Anticancer Res. 1997 September-October; 17(5B): 3747-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9427773&dopt=Abstract
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Pap smear brochures, misogyny and language: a discourse analysis and feminist critique. Author(s): Lane V, Lawler J. Source: Nursing Inquiry. 1997 December; 4(4): 262-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9437963&dopt=Abstract
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Pap smear concerns. Author(s): Moran T. Source: Tex Med. 1997 November; 93(11): 44-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9369088&dopt=Abstract
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Pap smear follow-up of possible role of mucopurulent exudate as a prognosticator of a negative pregnancy outcome. Author(s): Bedrossian UK, Fairfax MR, Ayers M. Source: Diagnostic Cytopathology. 1999 July; 21(1): 4-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10405798&dopt=Abstract
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Pap smear furor may derail Clinton changes. Author(s): Scott L. Source: Modern Healthcare. 1993 October 4; 23(40): 17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10171532&dopt=Abstract
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Pap smear noncompliance among female obstetrics-gynecology residents. Author(s): Williams JJ, Santoso JT, Ling FW, Przepiorka D. Source: Gynecologic Oncology. 2003 September; 90(3): 597-600. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13678731&dopt=Abstract
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Pap smear outreach: a randomized controlled trial in an HMO. Author(s): Binstock MA, Geiger AM, Hackett JR, Yao JF. Source: American Journal of Preventive Medicine. 1997 November-December; 13(6): 4256. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9415786&dopt=Abstract
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Pap smear participation rates, primary healthcare and Indigenous women. Author(s): Panaretto KS, Larkins SL, Manessis V. Source: The Medical Journal of Australia. 2003 May 19; 178(10): 525; Author Reply 525-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12741947&dopt=Abstract
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Pap smear risk management by process control. Author(s): Gill GW. Source: Cancer. 1997 August 25; 81(4): 198-211. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9292735&dopt=Abstract
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Pap smear screening after hysterectomy. Author(s): McIntosh DG. Source: Compr Ther. 1998 January; 24(1): 14-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9452896&dopt=Abstract
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Pap smear screening among urban Southwestern American Indian women. Author(s): Risendal B, DeZapien J, Fowler B, Papenfuss M, Giuliano A. Source: Preventive Medicine. 1999 December; 29(6 Pt 1): 510-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10600432&dopt=Abstract
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Pap smear screening at an urban aboriginal health service: report of a practice audit and an evaluation of recruitment strategies. Author(s): Hunt JM, Gless GL, Straton JA. Source: Aust N Z J Public Health. 1998 October; 22(6): 720-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9848971&dopt=Abstract
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Pap smear screening in an urban STD clinic. Yield of screening and predictors of abnormalities. Author(s): Shlay JC, McGill WL, Masloboeva HA, Douglas JM Jr. Source: Sexually Transmitted Diseases. 1998 October; 25(9): 468-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9800258&dopt=Abstract
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Pap smear utilization in Canada: estimates after adjusting the eligible population for hysterectomy status. Author(s): Snider JA, Beauvais JE. Source: Chronic Diseases in Canada. 1998; 19(1): 19-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9550731&dopt=Abstract
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Paracoccidioides brasiliensis in a postpartum Pap smear. A case report. Author(s): Sheyn I, Mira JL, Thompson MB. Source: Acta Cytol. 2001 January-February; 45(1): 79-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11213509&dopt=Abstract
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Performance of Massachusetts HMOs in providing Pap smear and sexually transmitted disease screening to adolescent females. Author(s): Thrall JS, McCloskey L, Spivak H, Ettner SL, Tighe JE, Emans SJ. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 1998 March; 22(3): 184-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9502004&dopt=Abstract
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Predicting intentions to obtain a Pap smear among African American and Latina women: testing the theory of planned behavior. Author(s): Jennings-Dozier K. Source: Nursing Research. 1999 July-August; 48(4): 198-205. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10414682&dopt=Abstract
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Probability of early repeat Pap smear in an integrated cervical screening programme. Author(s): Rosso A, Foglietta F, Naldoni C, Schincaglia P, Buzzi G, Camprincoli S, Serafini M, Busoli S, Leoni F, Grilli N, Bucchi L. Source: European Journal of Cancer Prevention : the Official Journal of the European Cancer Prevention Organisation (Ecp). 2000 August; 9(4): 269-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10958330&dopt=Abstract
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Quality improvement in family practice. Program for Pap smears. Author(s): Norton PG, Shaw PA, Murray MA. Source: Can Fam Physician. 1997 March; 43: 503-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9116522&dopt=Abstract
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Rates and independent correlates of Pap smear testing among Korean-American women. Author(s): Wismer BA, Moskowitz JM, Chen AM, Kang SH, Novotny TE, Min K, Lew R, Tager IB. Source: American Journal of Public Health. 1998 April; 88(4): 656-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9551013&dopt=Abstract
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Recall and treatment decisions of primary care providers in response to Pap smear reports. Author(s): Curtis P, Morrell D, Hendrix S, Mintzer M, Resnick JC, Qaqish BF. Source: American Journal of Preventive Medicine. 1997 November-December; 13(6): 42731. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9415787&dopt=Abstract
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Rehydrated air-dried Pap smears as an alternative to wet-fixed smears. Author(s): Sivaraman G, Iyengar KR. Source: Acta Cytol. 2002 July-August; 46(4): 713-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12146037&dopt=Abstract
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Relationship between Pap smear performance and physician ordering a mammogram. Author(s): Murata PJ, Li JE. Source: The Journal of Family Practice. 1992 December; 35(6): 644-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1453148&dopt=Abstract
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Reliability of Pap smear reports. Author(s): Ruffin MT 4th. Source: Fam Pract Res J. 1991 June; 11(2): 133-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2058406&dopt=Abstract
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Repeat Pap smear at the time of initial colposcopy--another view. Author(s): Korman J. Source: Gynecologic Oncology. 1998 June; 69(3): 269-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9648601&dopt=Abstract
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Repeated Pap smear screening among Mexican-American women. Author(s): Fernandez-Esquer ME, Espinoza P, Ramirez AG, McAlister AL. Source: Health Education Research. 2003 August; 18(4): 477-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12939129&dopt=Abstract
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Reporting normal endometrial cells in Pap smears: an outcome appraisal. Author(s): Gomez-Fernandez CR, Ganjei-Azar P, Capote-Dishaw J, Averette HE, Nadji M. Source: Gynecologic Oncology. 1999 September; 74(3): 381-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10479497&dopt=Abstract
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Rescreening of Pap smears. Author(s): Maughan KL. Source: The Journal of Family Practice. 1998 April; 46(4): 279-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9564365&dopt=Abstract
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Response to editorial on the Pap smear as a cancer screening test. Author(s): Carr RF. Source: Diagnostic Cytopathology. 1994; 10(1): 95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8005050&dopt=Abstract
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Results of Pap smear examinations in 1989. Author(s): Pairwuti S. Source: J Med Assoc Thai. 1991 January; 74(1): 30-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2026979&dopt=Abstract
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Results of Pap smear examinations in women with abnormal ovaries. Author(s): Pairwuti S. Source: J Med Assoc Thai. 1991 May; 74(5): 248-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1783872&dopt=Abstract
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Results of Pap smear mass screening in an urban setting. Author(s): Beckenhauer PE, Scott JC. Source: Nebr Med J. 1977 May; 62(5): 155-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=854127&dopt=Abstract
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Risk factors for HPV detection in archival Pap smears. A population-based study from Greenland and Denmark. Author(s): Svare EI, Kjaer SK, Smits HL, Poll P, Tjong-A-Hung SP, ter Schegget J. Source: European Journal of Cancer (Oxford, England : 1990). 1998 July; 34(8): 1230-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9849485&dopt=Abstract
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Risk factors for squamous intraepithelial lesions on Pap smear in women at risk for human immunodeficiency virus infection. Author(s): Klein RS, Ho GY, Vermund SH, Fleming I, Burk RD. Source: The Journal of Infectious Diseases. 1994 December; 170(6): 1404-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7995978&dopt=Abstract
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Risk of cervical cancer after a negative Pap smear. Author(s): Viikki M, Pukkala E, Hakama M. Source: Journal of Medical Screening. 1999; 6(2): 103-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10444730&dopt=Abstract
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Risk variables affecting high-grade Pap smears at second visit: effects of screening interval, year, age and low-grade smears. Author(s): Sigurdsson K, Adalsteinsson S. Source: International Journal of Cancer. Journal International Du Cancer. 2001 December 15; 94(6): 884-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11745493&dopt=Abstract
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Routine colposcopic evaluation of patients with persistent inflammatory cellular changes on Pap smear. Author(s): Seckin NC, Turhan NO, Ozmen S, Ersan F, Avsar F, Ustun H. Source: International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics. 1997 October; 59(1): 25-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9359442&dopt=Abstract
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Routine Pap smear on all female patients admitted to hospitals. Author(s): Wammock H. Source: J Med Assoc Ga. 1969 February; 58(2): 57. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5797828&dopt=Abstract
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Routine Pap smears for the diagnosis of bacterial vaginosis. Author(s): Prey M. Source: Diagnostic Cytopathology. 1999 July; 21(1): 10-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10405800&dopt=Abstract
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Scheduling Pap smears for asymptomatic women. Author(s): Gohagan JK, Swift JG. Source: Preventive Medicine. 1981 November; 10(6): 741-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6276879&dopt=Abstract
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Screening for cervical cancer by Pap smear. Author(s): Rehan N. Source: J Pak Med Assoc. 1989 April; 39(4): 116-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2501528&dopt=Abstract
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Screening for cervical cancer by Pap smear. Author(s): Rizvi JH, Hasan S, Rasul S, Ghazali B, Jamal A. Source: J Pak Med Assoc. 1988 September; 38(9): 229-31. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3149319&dopt=Abstract
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Screening for cervical cancer. Pap smears can save lives. Author(s): Wong JG, Feussner JR. Source: N C Med J. 1993 July; 54(7): 342-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8350931&dopt=Abstract
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Should we abandon pap smear testing? Author(s): DeMay RM. Source: American Journal of Clinical Pathology. 2000 November; 114 Suppl: S48-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11996169&dopt=Abstract
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Significance of AGUS Pap smears in pregnant and postpartum women. Author(s): Chhieng DC, Elgert P, Cangiarella JF, Cohen JM. Source: Acta Cytol. 2001 May-June; 45(3): 294-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11393057&dopt=Abstract
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Significance of benign endometrial cells in Pap smears from postmenopausal women. Author(s): Wu HH, Schuetz MJ 3rd, Cramer H. Source: J Reprod Med. 2001 September; 46(9): 795-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11584479&dopt=Abstract
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Single-slide Pap smear: an acceptable alternative to the double-slide Pap smear. Author(s): Quackenbush SR. Source: Diagnostic Cytopathology. 1999 May; 20(5): 317-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10319236&dopt=Abstract
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Single-slide versus double-slide Pap smear: a comparative study. Author(s): Saitas VL, Hawthorne C, Cater J, Bibbo M. Source: Diagnostic Cytopathology. 1995 June; 12(4): 320-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7656756&dopt=Abstract
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Social influences on Pap smear screening frequency. Author(s): Frisch LL, Allen GD, Padonu G, Dontje KJ, Burhansstipanov L. Source: Alaska Med. 2000 April-June; 42(2): 41-5, 47. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10916857&dopt=Abstract
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Social support and adherence behavior among women with abnormal Pap smears. Author(s): Crane LA. Source: Journal of Cancer Education : the Official Journal of the American Association for Cancer Education. 1996 Fall; 11(3): 164-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8877577&dopt=Abstract
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Sociodemographic and geographic aspects of Pap smear utilization in Arkansas. Author(s): McCoy JF, Steinkamp RC. Source: J Ark Med Soc. 1975 January; 71(8): 258-60. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=122826&dopt=Abstract
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Sociodemographic factors of Pap smear screening in Taiwan. Author(s): Wang PD, Lin RS. Source: Public Health. 1996 March; 110(2): 123-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8901257&dopt=Abstract
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Squamous atypia on a Pap smear. Author(s): Mittendorf R. Source: Gynecologic Oncology. 1993 December; 51(3): 424-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8112659&dopt=Abstract
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The accuracy of self-reported Pap smear utilisation. Author(s): Bowman JA, Sanson-Fisher R, Redman S. Source: Social Science & Medicine (1982). 1997 April; 44(7): 969-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9089918&dopt=Abstract
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The Bethesda system and Pap smear screening. Author(s): Miller K. Source: American Family Physician. 1995 February 1; 51(2): 331-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7840027&dopt=Abstract
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The cancer registry in the monitoring of cervical screening practice: the neglected value of the Pap smear in patients diagnosed with CIN3 on biopsy. Author(s): Serafini M, Bucchi L, Falcini F, Cordaro C, Montanari E, Amadori A, Amadori D. Source: European Journal of Cancer Prevention : the Official Journal of the European Cancer Prevention Organisation (Ecp). 1998 February; 7(1): 45-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9511850&dopt=Abstract
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The danger of only using a Pap smear. Author(s): Vazquez E. Source: Posit Aware. 1999 May-June; 10(3): 23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11366762&dopt=Abstract
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The effect of adding Pap smear information to a mammography reminder system in an HMO: results of randomized controlled trial. Author(s): Burack RC, Gimotty PA, Simon M, Moncrease A, Dews P. Source: Preventive Medicine. 2003 May; 36(5): 547-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12689799&dopt=Abstract
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The effect of the family physician on improving follow-up after an abnormal PAP smear. Author(s): Palm BT, Kant AC, Visser EA, Vooijs GP, van den Bosch WJ, van Weel C. Source: International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care / Isqua. 1997 August; 9(4): 277-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9304426&dopt=Abstract
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The elusive unequivocal Pap smear. Author(s): Nielsen ML, Frable WJ. Source: Diagnostic Cytopathology. 1996 February; 14(1): 92-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8834086&dopt=Abstract
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The elusive unequivocal Pap smear. Author(s): Allen KA. Source: Diagnostic Cytopathology. 1995 June; 12(4): 295-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7656754&dopt=Abstract
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The impact of intrauterine contraceptive devices on cytological findings from routine Pap smear testing. Author(s): Kaplan B, Orvieto R, Hirsch M, Rabinerson D, Braslavski D, Bar-Hava I, BenRafael Z. Source: The European Journal of Contraception & Reproductive Health Care : the Official Journal of the European Society of Contraception. 1998 June; 3(2): 75-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9710710&dopt=Abstract
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The minimally abnormal Pap smear. A conservative approach. Author(s): Zuber TJ. Source: American Family Physician. 1996 March; 53(4): 1042, 1048, 1050 Passim. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8629553&dopt=Abstract
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The new era of cervical cancer prevention: the end of the Pap smear? Author(s): Davey DD. Source: Diagnostic Cytopathology. 2003 June; 28(6): 289-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12768631&dopt=Abstract
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The Pap smear liability crisis. Author(s): McCoy DR, Sidoti MS. Source: American Journal of Clinical Pathology. 1999 August; 112(2): 274-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10439810&dopt=Abstract
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The Pap smear, an “endangered” species. Author(s): Spires SE. Source: J Ky Med Assoc. 1997 April; 95(4): 155-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9110540&dopt=Abstract
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The Pap smear, automated rescreening, and negligent nondisclosure. Author(s): Godfrey SE. Source: American Journal of Clinical Pathology. 1999 January; 111(1): 14-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9894449&dopt=Abstract
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The penurious Pap smear: will we ever see payment reflect costs? Author(s): Spires SE. Source: Diagnostic Cytopathology. 1998 August; 19(2): 81-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9702480&dopt=Abstract
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The relationship of human papillomavirus (HPV) detection to pap smear classification of cervical-scraped cells in asymptomatic women in northeast Thailand. Author(s): Ekalaksananan T, Pientong C, Kotimanusvanij D, Kongyingyoes B, Sriamporn S, Jintakanon D. Source: The Journal of Obstetrics and Gynaecology Research. 2001 June; 27(3): 117-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11561826&dopt=Abstract
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The uphill battle for higher Pap smear reimbursements. How the test was won. Author(s): Schneider I. Source: Mlo: Medical Laboratory Observer. 2000 November; 32(11): 28-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11117000&dopt=Abstract
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The value of repeat Pap smear at the time of initial colposcopy. Author(s): Spitzer M, Ryskin M, Chernys AE, Shifrin A. Source: Gynecologic Oncology. 1997 October; 67(1): 3-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9345348&dopt=Abstract
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Trends in mammography and Pap smear utilization in Canada. Author(s): Snider J, Beauvais J, Levy I, Villeneuve P, Pennock J. Source: Chronic Diseases in Canada. 1996; 17(3-4): 108-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9097011&dopt=Abstract
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Triage of women with ASCUS and LSIL on Pap smear reports: management by repeat Pap smear, HPV DNA testing, or colposcopy? Author(s): Ferris DG, Wright TC Jr, Litaker MS, Richart RM, Lorincz AT, Sun XW, Borgatta L, Buck H, Kramer L, Rubin R. Source: The Journal of Family Practice. 1998 February; 46(2): 125-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9487318&dopt=Abstract
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Understanding the abnormal Pap smear. Author(s): Whall M. Source: Lippincott's Primary Care Practice. 1998 May-June; 2(3): 315-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9644448&dopt=Abstract
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Understanding the financial impact of covering new screening technologies. The case of automated Pap smears. Author(s): McQuarrie HG, Ogden J, Costa M. Source: J Reprod Med. 2000 November; 45(11): 898-906. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11127101&dopt=Abstract
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Unreliability of PAP smears to diagnose female genital schistosomiasis. Author(s): Feldmeier H, Helling-Giese G, Poggensee G. Source: Tropical Medicine & International Health : Tm & Ih. 2001 January; 6(1): 31-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11263462&dopt=Abstract
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Use of Pap smear in general practice by case finding or screening programme. Author(s): Olesen F. Source: Scandinavian Journal of Primary Health Care. 1986 February; 4(1): 59-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3083494&dopt=Abstract
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Use of peer role models to increase Pap smear and mammogram screening in Mexican-American and black women. Author(s): Suarez L, Nichols DC, Brady CA. Source: American Journal of Preventive Medicine. 1993 September-October; 9(5): 290-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8257618&dopt=Abstract
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Utility of the in situ detection of HPV in Pap smears diagnosed as within normal limits. Author(s): Menezes G, Euscher E, Schwartz B, Catania F, Chancellor J, Nuovo GJ. Source: Acta Cytol. 2001 November-December; 45(6): 919-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11726118&dopt=Abstract
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Vaginal intraepithelial neoplasia and the Pap smear. Author(s): Davila RM, Miranda MC. Source: Acta Cytol. 2000 March-April; 44(2): 137-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10740596&dopt=Abstract
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Vaginitis emphysematosa associated with an abnormal Pap smear. Author(s): Escoffery CT, Sinclair PA, Guthrie W. Source: The West Indian Medical Journal. 2001 September; 50(3): 234-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11769034&dopt=Abstract
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Validity of Pap smear and mammogram self-reports in a low-income Hispanic population. Author(s): Suarez L, Goldman DA, Weiss NS. Source: American Journal of Preventive Medicine. 1995 March-April; 11(2): 94-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7632456&dopt=Abstract
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Value of histiocyte detection in Pap smears for predicting endometrial pathology. An institutional experience. Author(s): Nassar A, Fleisher SR, Nasuti JF. Source: Acta Cytol. 2003 September-October; 47(5): 762-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14526675&dopt=Abstract
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Vietnamese women and Pap smears: issues in promotion. Author(s): Cheek J, Fuller J, Gilchrist S, Maddock A, Ballantyne A. Source: Aust N Z J Public Health. 1999 February; 23(1): 72-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10083693&dopt=Abstract
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Vorticella in Pap smears as a contaminant. Author(s): Kumar PV, Bedayat GR, Mousavi A, Saraf Z. Source: Acta Cytol. 2001 July-August; 45(4): 655-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11480735&dopt=Abstract
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What are women told about Pap smears that lack endocervical cells? Author(s): Schofield MJ, Byles JE, Sanson-Fisher R. Source: Journal of Medical Screening. 1995; 2(2): 105-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7497154&dopt=Abstract
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What attendance rate can be achieved for Pap smear screening? A case-control study of the characteristics of non-attenders and results of reminder efforts. Author(s): Bergmann JB, Sigurdsson JA, Sigurdsson K. Source: Scandinavian Journal of Primary Health Care. 1996 September; 14(3): 152-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8885027&dopt=Abstract
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What do you recommend for a patient with a Pap smear indicating atypical cells? Author(s): Kennedy AW. Source: Cleve Clin J Med. 2000 September; 67(9): 610-1. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10992617&dopt=Abstract
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When one more Pap smear is one too many. Author(s): Noller KL. Source: Gynecologic Oncology. 1997 October; 67(1): 1-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9345347&dopt=Abstract
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When the cervical Pap smear is positive. Author(s): Sinykin MB. Source: Minn Med. 1966 July; 49(7): 1095. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5939748&dopt=Abstract
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When to refer. Abnormal Pap smears. Author(s): Edelin KC, Hamid MA. Source: Hosp Pract (Off Ed). 1985 May 30; 20(5A): 23, 26-7, 30. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3923001&dopt=Abstract
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When your patient asks: “Doctor, I read there have been serious Pap smear errors. Shouldn't I get one of those new computer Pap smears?”. Author(s): Boronow RC, Cavett JR 3rd. Source: J Miss State Med Assoc. 1998 April; 39(4): 136-41. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9585689&dopt=Abstract
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Which questionnaire to measure psychosocial effects of having an abnormal PAP smear? Author(s): Buntinx F, Neven P. Source: Journal of Clinical Epidemiology. 1996 December; 49(12): 1469. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8970499&dopt=Abstract
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Who has Pap smears in New South Wales? Patterns of screening across sociodemographic groups. Author(s): Shelley JM, Irwig LM, Simpson JM, Macaskill P. Source: Aust J Public Health. 1994 December; 18(4): 406-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7718654&dopt=Abstract
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Why do(n't) aboriginal women have Pap smears? Author(s): Mak D. Source: Aust Fam Physician. 1997 June; 26(6): 763. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9197065&dopt=Abstract
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Winning the Pap smear case. Author(s): Campbell JB. Source: Diagnostic Cytopathology. 1999 October; 21(4): 238-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10495315&dopt=Abstract
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Women and preventive health care: an exploratory study of the use of Pap smears in a potentially high-risk Appalachian population. Author(s): Fisher S, Page AL. Source: Women & Health. 1986 Fall-Winter; 11(3-4): 83-99. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3564508&dopt=Abstract
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Women's experience of coping with a positive Pap smear: A register-based study of women with two consecutive Pap smears reported as CIN 1. Author(s): Idestrom M, Milsom I, Andersson-Ellstrom A. Source: Acta Obstetricia Et Gynecologica Scandinavica. 2003 August; 82(8): 756-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12848648&dopt=Abstract
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Women's knowledge of Pap smears, risk factors for cervical cancer, and cervical cancer. Author(s): Reid J. Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing : Jognn / Naacog. 2001 May-June; 30(3): 299-305. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11383953&dopt=Abstract
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CHAPTER 2. NUTRITION AND PAP SMEAR Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and Pap smear.
Finding Nutrition Studies on Pap Smear The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail:
[email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “Pap smear” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.
7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
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The following information is typical of that found when using the “Full IBIDS Database” to search for “Pap smear” (or a synonym): •
Proliferation in “atypical” atrophic pap smears. Author(s): Department of Pathology, University Hospital Nijmegen, Nijmegen, 6500 HB, The Netherlands. Source: Bulten, J de Wilde, P C Boonstra, H Gemmink, J H Hanselaar, A G GynecolOncol. 2000 November; 79(2): 225-9 0090-8258
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.healthnotes.com/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
Nutrition
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WebMDHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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The following is a specific Web list relating to Pap smear; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
Vitamins Folic Acid Source: Healthnotes, Inc.; www.healthnotes.com Vitamin A Source: Healthnotes, Inc.; www.healthnotes.com
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Minerals Selenium Source: Healthnotes, Inc.; www.healthnotes.com
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Food and Diet Carrots Source: Healthnotes, Inc.; www.healthnotes.com Sweet Peppers Source: Healthnotes, Inc.; www.healthnotes.com Sweet Potatoes Source: Healthnotes, Inc.; www.healthnotes.com Tomatoes Source: Healthnotes, Inc.; www.healthnotes.com Winter Squash Source: Healthnotes, Inc.; www.healthnotes.com Yams Source: Healthnotes, Inc.; www.healthnotes.com
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CHAPTER 3. ALTERNATIVE MEDICINE AND PAP SMEAR Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to Pap smear. At the conclusion of this chapter, we will provide additional sources.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to Pap smear and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “Pap smear” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to Pap smear: •
A behaviour risk factor survey in Jamaica. Author(s): Figueroa JP, Fox K, Minor K. Source: The West Indian Medical Journal. 1999 March; 48(1): 9-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10375984&dopt=Abstract
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A breast and cervical cancer project in a native Hawaiian community: Wai'anae cancer research project. Author(s): Banner RO, DeCambra H, Enos R, Gotay C, Hammond OW, Hedlung N, Issell BF, Matsunaga DS, Tsark JA. Source: Preventive Medicine. 1995 September; 24(5): 447-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8524718&dopt=Abstract
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A cytologist's view of China--Citizen Ambassador Program Cytopathology Delegation to the People's Republic of China, February 1997. Author(s): Waddell CA.
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Source: Cytopathology : Official Journal of the British Society for Clinical Cytology. 1999 June; 10(3): 201-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10390069&dopt=Abstract •
A long term follow-up study of 1,055 cases of postpartum tubal ligation. Author(s): Lu T, Chun D. Source: J Obstet Gynaecol Br Commonw. 1967 December; 74(6): 875-80. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6066464&dopt=Abstract
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A procedure for dissociating Ayre scrape samples. Author(s): Leif RC, Nordqvist S, Clay S, Cayer M, Ingram D, Cameron BF, Bobbitt D, Gaddis R, Leif SB, Cabanas A. Source: The Journal of Histochemistry and Cytochemistry : Official Journal of the Histochemistry Society. 1977 July; 25(7): 525-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=894001&dopt=Abstract
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A randomized, double blind, Phase III trial using oral beta-carotene supplementation for women with high-grade cervical intraepithelial neoplasia. Author(s): Keefe KA, Schell MJ, Brewer C, McHale M, Brewster W, Chapman JA, Rose GS, McMeeken DS, Lagerberg W, Peng YM, Wilczynski SP, Anton-Culver H, Meyskens FL, Berman ML. Source: Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. 2001 October; 10(10): 1029-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11588128&dopt=Abstract
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A review of the literature: interventions to maximize capacity to consent and reduce anxiety of women with learning disabilities preparing for a cervical smear test. Author(s): Broughton S. Source: Health Services Management Research : an Official Journal of the Association of University Programs in Health Administration / Hsmc, Aupha. 2002 August; 15(3): 17385. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12184837&dopt=Abstract
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Alexithymia, immunity and cervical intraepithelial neoplasia: a pilot study. Author(s): Todarello O, Casamassima A, Marinaccio M, La Pesa MW, Caradonna L, Valentino L, Marinaccio L. Source: Psychotherapy and Psychosomatics. 1994; 61(3-4): 199-204. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8066158&dopt=Abstract
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American Indian women's talking circle. A cervical cancer screening and prevention project. Author(s): Hodge FS, Fredericks L, Rodriguez B.
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Source: Cancer. 1996 October 1; 78(7 Suppl): 1592-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8839577&dopt=Abstract •
Anogenital warts: epidemiology, treatment and association with cervical atypia. Author(s): Dinsmore WW, Horner T, Chambers H, Maw RD. Source: Ulster Med J. 1987 October; 56(2): 104-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2832994&dopt=Abstract
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Approaches to a biological basis of human behavior. Author(s): Daniels GE. Source: Dis Nerv Syst. 1971 April; 32(4): 227-40. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4326205&dopt=Abstract
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Beliefs and behaviors about Pap and breast self-examination among Thai immigrant women in Brisbane, Australia. Author(s): Jirojwong S, Manderson L. Source: Women & Health. 2001; 33(3-4): 47-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11527106&dopt=Abstract
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Cancer control knowledge and priorities among primary care physicians. Author(s): Brownson RC, Davis JR, Simms SG, Kern TG, Harmon RG. Source: Journal of Cancer Education : the Official Journal of the American Association for Cancer Education. 1993 Spring; 8(1): 35-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8489908&dopt=Abstract
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Cervical human papilloma virus infection: is treatment possible? Author(s): Benrubi GI, Shannon J, Glazer J, Nuss RC. Source: J Fla Med Assoc. 1988 December; 75(12): 799-800. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2850340&dopt=Abstract
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Childhood acute lymphoblastic leukemia relapse in the uterine cervix. Author(s): Tsuruchi N, Okamura J. Source: Journal of Pediatric Hematology/Oncology : Official Journal of the American Society of Pediatric Hematology/Oncology. 1996 August; 18(3): 311-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8689350&dopt=Abstract
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Colpocytologic studies in amenorrhea treated by transcerebral electrostimulation. Author(s): Toth F, Gimes R, Fornadi F. Source: Acta Cytol. 1965 September-October; 9(5): 347-50. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5214052&dopt=Abstract
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Community health screening as a teaching laboratory in physical diagnosis. Author(s): Boisvert CS, Thymius B, Hudgins PM. Source: J Am Osteopath Assoc. 1998 January; 98(1): 44-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9476442&dopt=Abstract
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Cytologic findings in female and male offspring of DES treated mothers. Author(s): Bibbo M, Ali I, Al-Naqeeb M, Baccarini I, Climaco LA, Gill W, Sonek M, Wied GL. Source: Acta Cytol. 1975 November-December; 19(6): 568-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1061475&dopt=Abstract
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Differences in cancer-risk-related behaviors in Latino and Anglo adults. Author(s): Elder JP, Castro FG, de Moor C, Mayer J, Candelaria JI, Campbell N, Talavera G, Ware LM. Source: Preventive Medicine. 1991 November; 20(6): 751-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1766946&dopt=Abstract
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Effects of ovarian steroid hormones on esterases in the rat endometrium. Author(s): Boshier DP, Katz JM. Source: The Journal of Endocrinology. 1975 March; 64(3): 465-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1169280&dopt=Abstract
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Effects of the pineal gland on reproductive organ growth and fertility in dual sensory deprived female rats. Author(s): Reiter RJ. Source: Endocrinol Exp. 1972; 6(1): 3-10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4536882&dopt=Abstract
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Electroacupuncture enhances activity of adrenal nucleolar organizer regions in ovariectomized rats. Author(s): Chen BY, He L. Source: Acupuncture & Electro-Therapeutics Research. 1992; 17(1): 15-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1351336&dopt=Abstract
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Electron microscopy of human vaginal epithelium under normal and experimental conditions. Author(s): Schuchner EB, Foix A, Borenstein CA, Marchese C. Source: Journal of Reproduction and Fertility. 1974 January; 36(1): 231-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4203601&dopt=Abstract
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Estrogen-like effects in the vaginal smears of postmenopausal women. Author(s): Stone DF, Sedlis A, Stone ML, Turkel WV.
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Source: Acta Cytol. 1967 September-October; 11(5): 349-52. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5234104&dopt=Abstract •
Filipino domestic workers in Hong Kong: health related behaviors, health locus of control and social support. Author(s): Holroyd EA, Molassiotis A, Taylo-Pilliae RE. Source: Women & Health. 2001; 33(1-2): 181-205. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11573743&dopt=Abstract
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Filipino domestic workers in Hong Kong: health related behaviors, health locus of control and social support. Author(s): Holroyd EA, Molassiotis A, Taylor-Pilliae RE. Source: Women & Health. 2001; 33(1-2): 181-205. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11523638&dopt=Abstract
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Gynecological health screening by means of questionnaire and cytology. Author(s): Kauraniemi T. Source: Acta Obstetricia Et Gynecologica Scandinavica. 1969; : Suppl 4: 1-224. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5393669&dopt=Abstract
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Health care services for lesbian and bisexual women: some Canadian data. Author(s): Mathieson CM, Bailey N, Gurevich M. Source: Health Care for Women International. 2002 February; 23(2): 185-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11868965&dopt=Abstract
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Investigations on Dieffenbachia amoena Gentil. I: Endocrine effects and contraceptive activity. Author(s): Costa de Pasquale R, Ragusa S, Circosta C, Forestieri AM. Source: Journal of Ethnopharmacology. 1984 December; 12(3): 293-303. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6442750&dopt=Abstract
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Learning about pap smears: an educational skit for Hispanic adolescents. Author(s): Richardson RA, Njoroge W, Wilcox GG, Chacko MR, Hergenroeder AC. Source: Journal of Pediatric and Adolescent Gynecology. 2002; 15(4): 197-204. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12459224&dopt=Abstract
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Loss to follow-up of patients with abnormal Pap smear: magnitude and reasons. Author(s): Thinkhamrop J, Lumbiganon P, Jitpakdeebodin S. Source: J Med Assoc Thai. 1998 November; 81(11): 862-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9803086&dopt=Abstract
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Management of condyloma acuminatum. Author(s): Silva PD, Micha JP, Silva DG. Source: Journal of the American Academy of Dermatology. 1985 September; 13(3): 45763. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2414346&dopt=Abstract
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Methods for managing pelvic examination anxiety: individual differences and relaxation techniques. Author(s): Hennigen L, Kollar LM, Rosenthal SL. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 2000 January-February; 14(1): 9-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11141829&dopt=Abstract
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New procedure under study may replace Pap smear. Author(s): Solomon R. Source: Posit Living. 2001 April; 10(3): 34. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11548375&dopt=Abstract
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Observation of the estrogen-like effect of “follicle-stimulating decoction”. Author(s): Xu JX, Zhou QG. Source: J Tradit Chin Med. 1982 September; 2(3): 179-81. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6765711&dopt=Abstract
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Office gynecology. Author(s): Weed JC. Source: Postgraduate Medicine. 1972 October; 52(4): 123-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5070951&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.healthnotes.com/
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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine
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Open Directory Project: http://dmoz.org/Health/Alternative/
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HealthGate: http://www.tnp.com/
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WebMDHealth: http://my.webmd.com/drugs_and_herbs
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
The following is a specific Web list relating to Pap smear; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •
General Overview Abnormal Pap Smear Source: Healthnotes, Inc.; www.healthnotes.com Cervical Dysplasia Source: Integrative Medicine Communications; www.drkoop.com Cervical Dysplasia Source: Prima Communications, Inc.www.personalhealthzone.com Menopause Source: Integrative Medicine Communications; www.drkoop.com Premenstrual Syndrome Source: Integrative Medicine Communications; www.drkoop.com Vaginal Inflammation Source: Integrative Medicine Communications; www.drkoop.com Vaginitis Source: Integrative Medicine Communications; www.drkoop.com
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Herbs and Supplements Echinacea Alternative names: Echinacea purpurea, Echinacea angustifolia, Echinacea pallida Source: Healthnotes, Inc.; www.healthnotes.com Goldenseal Alternative names: Hydrastis canadensis Source: Healthnotes, Inc.; www.healthnotes.com
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Marshmallow Alternative names: Althea officinalis Source: Healthnotes, Inc.; www.healthnotes.com Myrrh Alternative names: Commiphora molmol Source: Healthnotes, Inc.; www.healthnotes.com Usnea Alternative names: Usnea barbata Source: Healthnotes, Inc.; www.healthnotes.com Yarrow Alternative names: Achillea millefolium Source: Healthnotes, Inc.; www.healthnotes.com
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.
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CHAPTER 4. DISSERTATIONS ON PAP SMEAR Overview In this chapter, we will give you a bibliography on recent dissertations relating to Pap smear. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “Pap smear” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on Pap smear, we have not necessarily excluded non-medical dissertations in this bibliography.
Dissertations on Pap Smear ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to Pap smear. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •
Access to Pap Smears and Mammograms for Latina Women Living in Los Angeles County: the Impact of Citizenship Status and Acculturation (California) by Katzburg, Judith Roselyn; PhD from University of California, Los Angeles, 2002, 355 pages http://wwwlib.umi.com/dissertations/fullcit/3059549
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Influence of Postcard Reminders on Adherence to Follow-Up Pap Smears after Colposcopy by Lamb, Susan; MSN from University of Alaska Anchorage, 2002, 56 pages http://wwwlib.umi.com/dissertations/fullcit/1413749
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Social Integration and Preventive Health Behavior: an Exploratory Study on the Use of the Pap Smear Test for the Early Detection of Cervical Cancer (Cancer) by Straughan, Paulin Tay, PhD from University of Virginia, 1991, 305 pages http://wwwlib.umi.com/dissertations/fullcit/9223421
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Telecytology: the Virtual Pap Smear by Troncoso, Lisa Marie; MS from California State University, Dominguez Hills, 2002, 36 pages http://wwwlib.umi.com/dissertations/fullcit/1411340
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Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.
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CHAPTER 5. PATENTS ON PAP SMEAR Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “Pap smear” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on Pap smear, we have not necessarily excluded non-medical patents in this bibliography.
Patents on Pap Smear By performing a patent search focusing on Pap smear, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 8Adapted from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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example of the type of information that you can expect to obtain from a patent search on Pap smear: •
Apparatus for identification and integration of multiple cell patterns Inventor(s): Bannister; Wendy R. (Seattle, WA), Kuan; Chih-Chau L. (Redmond, WA), Lee; Shih-Jong J. (Bellevue, WA), Meyer; Michael G. (Seattle, WA), Wilhelm; Paul S. (Kirkland, WA) Assignee(s): NeoPath, Inc. (Redmond, WA) Patent Number: 5,828,776 Date filed: July 11, 1996 Abstract: A biological specimen classification strategy employs identification and integration of multiple cell patterns. An automated microscope acquires an image of a biological specimen such as a Pap smear and provides an image output to biological classifiers. The classifiers independently detect and classify a number of specimen types and provide classifications to an output field of view integrator. The integrator integrates the classifications. The integrated output then determines whether the classifiers should be reapplied to the image. Excerpt(s): The invention relates to integration of data obtained from a biological specimen analysis system, and more particularly to field of view integration of a single cell analysis, group analysis, and thick group analysis. The diagnostic information which exists in a Pap smear lies in both the characteristics of the individual cell and the arrangement of multiple cells in proximity to each other. Although isolated cells provide the most important features for a Pap smear specimen classification, groups or thick groups of cells provide additional clues to support the diagnostic decision. A Pap smear classification system based on isolated cells alone will not be able to achieve the same level of classification accuracy as a human observer who has available both the individual cell and cell group features for specimen classification. The prior art has attempted to solve the problem by improving the effectiveness of the features extracted from isolated cells. The approaches include monolayer preparation methods to increase the prevalence of the isolated cells and special DNA staining methods to improve discrimination power of the features extracted from isolated cells. However, these methods alter the current practice in Pap smear preparations and cannot be adapted readily. Additionally, these methods remove the additional clues which may be extracted from multiple cell patterns. Web site: http://www.delphion.com/details?pn=US05828776__
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Brush overlay Pap smear Inventor(s): Hicken; William J. (2205 Eastlake Rd., Timonium, MD 21093) Assignee(s): none reported Patent Number: 5,184,626 Date filed: May 21, 1991 Abstract: A brush overlay Pap smear method is provided for providing a single cytological sample representing specimens for two or more sites. An exocervical sample (20) is transferred from a scraper (40) to an end portion (16) of a surface (14) of a microscope slide (10). Subsequently, an endocervical sample is combined with the
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exocervical sample (20) and distributed across the surface (14) of slide (10) to provide a substantially uniform distribution of the combined samples into a substantially uniform film (22) on the surface (14) of slide (10). In an alternate embodiment, the application of the exocervical sample is preceded by the application of exfoliated cells obtained from the posterior fornix of the vagina, the exocervical sample being applied to the exfoliated cell sample (30) to form a combined sample (32). As in the first embodiment, an endocervical sample is combined with the combined sample pool (2) and substantially simultaneously distributed across the surface (14) of slide (10) by a rotative displacement of the cytological brush ( 50) on the surface (14) of slide (10). Excerpt(s): This invention directs itself to a method of preparing a Pap smear. In particular, this invention directs itself to a method for combining cytological samples from multiple sites into a single specimen. More in particular, this invention directs itself to a brush overlay method wherein the application of the final cytological sample is combined with samples which have been previously obtained and applied to a slide, wherein the sample contained within the interstices of the cytological brush are simultaneously combined with the other samples and distributed uniformly across the surface of the slide. Further, the means for combining and distributing the multiple samples utilizes a light downward pressure, normal to the surface of the slide, while simultaneously rotatively displacing the cytological brush in a single direction, or alternately the brush is reciprocated back and forth across the surface of the slide. Devices for collecting cytological samples, and methods of preparing Pap smears are well known in the art. The best prior art known to the Applicant include U.S. Pat. Nos. 3,640,268; 3,881,464; 4,127,113; 4,227,537; 4,620,548; 4,754,764; 4,759,376; 4,762,133; 4,873,992; and, 4,936,312. Some prior art systems, such as that shown in U.S. Pat. No. 4,754,764 are directed to cervical cytology devices for simultaneously sampling both the exocervical and endocervical areas. However, the device is formed as a two-part structure, such that subsequent to sampling the two parts are separated, and the cells collected by each portion are disposed on separate slides. Thus, while the collection of the cytological samples is made more efficient, the laboratory must still examine two separate specimens. The two slides must be separately screened and evaluated by the pathologist, thereby essentially doubling the cost to the patient. Web site: http://www.delphion.com/details?pn=US05184626__ •
Cap-pap test Inventor(s): Markovic; Nenad (259 Congressional La., #602, Rockville, MD 20852), Markovic; Olivera (259 Congressional La., #602, Rockville, MD 20852) Assignee(s): none reported Patent Number: 6,143,512 Date filed: June 10, 1999 Abstract: The CAP-PAP Test is a double-staining, single-slide microscopic method. An in vitro diagnostic medical device for manual and automatic staining and interpreting of the Pap smear for cervical cancer screening, cervical dysplasia and for follow-up therapy can be developed using this double-staining, single-slide microscopic method. Abnormal cervical cells are labeled with an intracellular acid phosphatase derived pigment (azo-dye) to improve visibility of abnormal cervical cells on conventionally stained Pap smears. The enzyme marker improves human perception and/or sensitivity of automatic instruments when distinguishing cell a abnormality and interpretation of Pap smears. Increased accuracy of CAP-PAP-vs-Pap test is expected to reduce false
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negative readings of the conventional Pap test. A rapid manual version of the test that is low cost, does not require additional personnel training and is instantly applicable in all cytopathology laboratories is provided. The invention further provides a diagnostic kit, an automatic stainer and an automatic evaluation device for performing the doublestaining, single-slide microscopic method. Excerpt(s): The CAP-PAP Test is a new double-staining, single-slide microscopic method that could be developed into an in vitro diagnostic medical device for manual and automatic staining and interpreting of Pap smears for cervical cancer screening, diagnosis of cervical dysplasia and follow-up of therapy. Our idea (novelty) is to use acid phosphatase to label abnormal cervical epithelial cells on Pap smears stained by conventional Papanicolaou technique and, by improving visibility of abnormal cells to improve human perception (sensitivity of automatic instruments) of abnormal cells and interpretation (specificity of automatic instruments) of Pap smears. Increasing accuracy (better sensitivity and at least equivalent specificity with Pap test) the CAP-PAP test could reduce false negative readings of the conventional Pap test--an achievement that could be of benefit to many women. We are not aware that anybody else has used our technique for the same purpose. The manual version of the test is a rapid, low cost assay, which does not require additional personnel training, and is instantly applicable in all cytopathology laboratories. The patent protects against infringement of the idea, a process (method, assay) and three products--a diagnostic kit, an automatic processor (stainer) and an automatic evaluation device (digitized image analyzer). Patent protection should cover all rights including manufacture, use and sale. Web site: http://www.delphion.com/details?pn=US06143512__ •
Cervical specimen self-sampling device Inventor(s): Fournier; Arthur M. (Miami, FL) Assignee(s): Bay Point Group, Inc. (Miami, FL) Patent Number: 6,475,165 Date filed: November 20, 2000 Abstract: A human female cervical specimen gathering device is disclosed which can be self administered by women. This device is an improvement over conventional cervical tissue sampling, which requires a speculum examination, and prior self-sampling devices, which are not compatible with thin-prep cytology easily adaptable to existing pap-smear technology, for thin smear cytology (automated or manual) microbial cultures and assays such as polymer-chain-reaction assays for human papilloma virus. The device consists of a cardboard tube that houses a retractable sponge. The handle is adapted to allow it to serve as a screw-cap lid, once the device is inserted into a conical tube containing fixative or preservative. After transport to the lab the tube can easily be agitated to liberate cells, centrifuged, and prepared as a thin smear for cytology or DNA probes. Excerpt(s): Screening for cervical cancer in women using cytological techniques has been possible for more than 40 years. The papanicolau test (pap test) has allowed for a significant reduction in mortality in women from cervical cancer. Prior to the pap test, cervical cancer was the most common cause of cancer deaths in women. In countries where pap smears are available, mortality from cervical cancer is negligible. In spite of this progress, there are several problems with the present technology. Conventional pap tests show a high percentage of smears of undetermined significance that requires
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further testing. This problem has led to the development of "thin prep" technology. Thin prep technology requires that cells be immersed in fixative and centrifuged prior to analysis. Other advances in diagnostic technology are the discovery of DNA probes for human papilloma virus (HPV), the causative agent of cervical cancer, and for chlamydia, a common infection in women. Tests for HPV may soon replace conventional pap smears as the initial screening test for cervical cancer. Collection of cytologic specimens currently requires a speculum examination which is frequently uncomfortable and embarrassing for women. It is also relatively expensive, since it requires the services of a physician or nurse practitioner. Finally, the specimen obtained is applied directly to a glass slide, which is not compatible with automated cytologic analysis or necessary for HPV assay. The same problems of discomfort, embarrassment, expense and processing also apply to the obtaining of specimens to diagnose vaginal infections such as candidiasis, gonorrhea, human papilloma virus and chlamydia. Prior self sampling devices (described in the next section) were either designed prior to the invention of thin prep and HPV assay technologies or designed specifically to obtain a specimen in the setting of a conventional speculum examination. Given these problems, there is a need for an improved, inexpensive self sampling device which asymptomatic women can use in the privacy of their home that is adaptable to automated cytology methods (thin smear), HPV assay and microbial culture. This application discloses just such an improvement. Web site: http://www.delphion.com/details?pn=US06475165__ •
Cervical tissue cell-gathering device Inventor(s): Kingsley; Warren K. (Bethlehem, PA), Schoenfeld; Stanley (Pound Ridge, NY) Assignee(s): Richardson-Merrell Inc. (Wilton, CT) Patent Number: 3,995,618 Date filed: June 16, 1975 Abstract: A cervical tissue cell-gathering device is provided which can be selfadministered, and which is so arranged as to protect the sample from contamination as it is inserted and withdrawn from the vagina. An improved method for the preparation of Pap smear slides using such a device is described. Excerpt(s): Cytologic screening using the Papanicalou test (Pap test) has been used for the past 20 years as an effective means for the early detection of cervical cancer. Although approximately 90 percent of American women are aware of the nature and purpose of the Pap test, about 36 percent of them will not use the test, notwithstanding the fact that symptoms of this cancer can be detected in the very early stages thereby facilitating and making treatment much more effective. The goal of the Uterine Cancer Task Force of the American Cancer Society is to have an annual Pap test for every woman over 20 years of age. There are two major problems in such a screening of mass populations. The first is the availability of physicians to conduct examinations and conduct the necessary Pap smears. The second problem concerns a reluctance on the part of the female population which is due in part to the time and effort involved in taking the test, the expense -- especially for lower socio-economic groups, and lastly, the natural reluctance of many women to have the examination conducted for reasons of modesty. The Pap test is generally administered by the physician in his office by inserting a speculum into the vagina, thereby exposing the cervix. The surface of the external os is scraped by means of rigid wooden or plastic sticks, and the detritus so
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obtained is placed upon a glass slide for cytological examination. The use of these probes is traumatic, not infrequently causing injury to the tissues and the risk of subsequent infection. These probes are non-porous in nature and are not capable of gathering or collecting exudates and secretions at the squamocolumnar junction of the uterine cervix which may be useful in indicating the presence of infectious microorganisms such as trichonomads, candida albicans, leptothrix, and other microorganisms of bacterial nature. Since these probes are rigid rather than being soft and flexible, they tend to destroy the friable, cervical cells when smeared against the rigid glass slide. In addition to destroying portions of the sample, the use of a rigid probe tends to smear the specimen non-uniformly onto the slide, making the interpretation of the slide more difficult and reducing the reliability of subsequent tests thereof. Web site: http://www.delphion.com/details?pn=US03995618__ •
Diagnostic method and apparatus for cervical squamous intraepithelial lesions in vitro and in vivo using fluorescence spectroscopy Inventor(s): Mahadevan-Jansen; Anita (Austin, TX), Mitchell; Michele Follen (Houston, TX), Ramanujam; Nirmala (Philadelphia, PA), Richards-Kortum; Rebecca (Austin, TX) Assignee(s): Board of Regents, the University of Texas System (Austin, TX) Patent Number: 6,258,576 Date filed: June 19, 1996 Abstract: The present invention involves the use of fluorescence spectroscopy in the diagnosis of cervical cancer and precancer. Using multiple illumination wavelengths, it is possible to (i) differentiate normal or inflamed tissue from squamous intraepithelial lesions (SILs) and (ii) to differentiate high grade SILs from non-high grade SILs. The detection may be performed in vitro or in vivo. Multivariate statistical analysis was employed to reduce the number of fluorescence excitation-emission wavelength pairs needed to re-develop algorithms that demonstrate a minimum decrease in classification accuracy. Fluorescence at excitation-emission wavelength pairs was used to redevelop and test screening and diagnostic algorithms that have a similar classification accuracy to those that employ fluorescence emission spectra at three excitation wavelengths. Both the full-parameter and reduced-parameter screening algorithms discriminate between SILs and non-SILs with a similar specificity and a substantially improved sensitivity relative to Pap smear screening and differentiate high grade SILs from non-high grade SILs. Excerpt(s): The invention relates to optical methods and apparatus used for the diagnosis of cervical precancers. There has been a significant decline in the incidence of advanced cervical cancer over the last 40 years, primarily due to the development of organized programs that target early detection of its curable precursor, cervical Squamous Intraepithelial Lesion (SIL) (SILs consist of Cervical Intraepithelial Neoplasia (CIN) and Human Papilloma Viral (HPV) infection) [1]. Even though organized screening (Pap smear) and diagnostic (colposcopy) programs are currently in place, approximately 15,900 new cases of cervical cancer and 4,900 cervical cancer related deaths were reported in 1995, in the United States alone [2]. Currently, 24.5% of women with cervical cancer are under the age of 35 years, and the incidence continues to increase for women in this age group [1]. The continuing morbidity and mortality rate related to cervical cancer necessitates an improvement in the accuracy and efficacy of current detection modalities. The Pap smear is the primary screening tool for the
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detection of cervical cancer and its precursor [3]. In a Pap test, a large number of cells obtained by scraping the cervical epithelium are smeared onto a slide which is then fixed and stained for cytologic examination. Each smear is then examined under a microscope for the presence of neoplastic cells [4]. The Pap smear's reported sensitivity and specificity range from 11-99% and 14-97%, respectively. Like many screening tests in an asymptomatic population, the Pap smear is unable to achieve a concurrently high sensitivity and high specificity [5]. The accuracy of the Pap smear is limited by both sampling and reading errors [6]. Approximately 60% of false-negative smears are attributed to insufficient sampling; the remaining 40% are due to reading errors. Because of the monotony and fatigue associated with reading Pap smears (50,000300,000 cells per slide), the American Society of Cytology has proposed that a cytotechnologist should be limited to evaluating no more than 12,000 smears annually [7]. As a result, accurate Pap smear screening is labor intensive and requires highly trained professionals. Web site: http://www.delphion.com/details?pn=US06258576__ •
Dual resolution method and apparatus for use in automated classification of pap smear and other samples Inventor(s): Bacus; James W. (Hinsdale, IL) Assignee(s): Rush-Presbyterian-St. Luke's Medical Center (Chicago, IL) Patent Number: 4,175,860 Date filed: May 31, 1977 Abstract: A method and apparatus is disclosed for use in performing automated classification of cells of a pap smear as well as other types of cells, such as red blood cells and blood cell neutrophiles. The apparatus generates an image that is split into two paths, (1) a high resolution image of primarily the nucleus of a cell, and (2) a low resolution image of the total cell, nucleus and cytoplasm. An image scanning device located in the first path provides output signals representing the image and circuitry performs measurement and analysis relating to texture of the nucleus. The image in the other path is demagnified which provides an enlarged, lower resolution image of the entire cell, including the nucleus and the cytoplasm and it is projected to a second image scanning device, which provides electrical signals that represent the image of the larger area and circuitry performs measurement and analysis relating to the size, density and color of the cytoplasm and the nucleus. The analysis obtained from each of the two circuits are applied to classification logic circuitry for the purpose of determining malignant cells. Excerpt(s): The present invention generally relates to a method and apparatus for automatically classifying cells and, more particularly, for use in automated pap smear analysis. There are presently in excess of 70 million women in the United States that are at risk for cervical cancer and such cancer occurs in approximately 46,000 of these women, of which about 12,000 die yearly. The pap smear test has been used for the past 30 years in the early detection of this type of cancer. In its essential form, this test is a highly subjective visual inspection involving the tedious examination of thousands of microscopic cell images by highly trained medical personnel which acquire, prepare and analyze the smears. These procedures are time-consuming and costly, but they have led to early detection and a drastic reduction in the death rate for women who have the test performed regularly. To further reduce the death rate through early detection, it is recommended that all women over the age of about 18 have a pap test once a year and
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that women over 40 have one twice a year. At the present time, about 16 million tests are performed each year which is, of course, far short of the number of tests that would be required to test the 70 million women who are at risk. It should be apparent that because of the high volume of tests that are and should be performed, that an automated or semi-automated cervical cancer detection technique would be extremely desirable in that it would lower the cost of the tests and enable clinical personnel to be used more efficiently. Automation techniques may also increase the accuracy and performance of the tests and allow for standardization of one screening laboratory to another. Because the use of automation offers so many significant advantages in the analysis of pap smears, researchers have attempted to construct apparatus for doing so for the last 20 years. Researchers have devised various classification strategies to process individual epithelial cell nuclei and to make normal versus abnormal screening decisions based on these strategies. These attempts have been unsuccessful. More current research efforts have been centered upon attempts to disaggregate the epithelial cell preparations and to analyze cells singly in suspension as they flow through various measurement orifices. These procedures have limited resolution in the microscopic morphological sense, but do measure properties of cells in terms of such features as increased DNA content, nuclear fluorescence and the ratio of the size of the nucleus to that of the cytoplasm. These attempts have also been unsuccessful. Other more recent research has attempted to classify individual cells using multiple features that are obtained from a high resolution digital image processing analysis. Web site: http://www.delphion.com/details?pn=US04175860__ •
Method and apparatus for cell analysis Inventor(s): Elmerick; Donald V. (Tallmadge, OH), Peters; Richard K. (Tallmadge, OH), Spayer; James L. (Brecksville, OH), Walter; Gerald E. (Cleveland, OH) Assignee(s): Accuron Corporation (Cleveland, OH) Patent Number: 5,073,857 Date filed: August 28, 1989 Abstract: A pap smear inspection apparatus and method for automated screening of cytological smears for dense, possibly malignant cells includes a specimen slide for receiving a cytological smear and a microscope for enlarging the image of the smear. The microscope is outfitted to receive a video camera for creating an analog video signal corresponding to an area enlarged by the microscope and being observed by the video camea. A video timer synchronizes operation of the smear analysis apparatus. An image window generator focuses the analysis of the apparatus on a sub-area of the entire video image. A converter is provided for converting a digital threshold level into a corresponding analog threshold level. A comparator is used for transforming the analog video input signal into a binary video signal according to the analog threshold levels. A pixel counter sums the number of ON pixels both in the transformed video signal, and within the designated window sub-area of said video signal. A microprocessor compares the digital count output with a user-defined limit on the number of ON pixels allowed to occur within each sub-area under study, and if the limit it exceeded, the current area has failed the test for acceptability. Excerpt(s): This invention relates to a cytological smear inspection apparatus which may be used to inspect a pap smear specimen for irregular cells. Manual inspection of cytological smears, in particular pap smears, involves an extensive number of lab technician man-hours every year. The high volume of such inspections done in many
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medical laboratories causes delay in their processing. Also, the backlogs which develop due to the high volume contribute to technician fatigue which in turn contributes to technician error. It is this possibility of error coupled with the perpetual backlog that demonstrates the industry need for automated inspection of cytological smears. The prior art includes a substantial collection of such automated cytological smear inspection constructions--especially such constructions which utilize digital computers; however, the complexity and specialization of the prior art restricts their usage. Specifically, the prior art discloses extensive dedicated machines, obviously requiring enormous amounts of money to produce, yet providing machinery with very limited applications. Obviously, there has been a longstanding need for a cytological smear inspection apparatus which incorporates functionality, affordability, and adaptability, so that an inspection apparatus that works well may be deployed without excessive expense and still be adaptable to inspect a variety of cell types. Web site: http://www.delphion.com/details?pn=US05073857__ •
Method and apparatus for sampling cervical tissue Inventor(s): Sak; Robert (9674 Colorado Ct., Boca Raton, FL 33434) Assignee(s): none reported Patent Number: 5,787,891 Date filed: March 16, 1995 Abstract: A cervical sampling system includes a vaginal insert tube, a removable swab sleeve, a sampling swab, and a stem for pushing the swab into contact with the cervical tissue. A kit using the sampling system for in-home Pap smear tests is also disclosed. Excerpt(s): The present invention relates to an apparatus for obtaining a sample of cervical tissue and/or vaginal secretions such that developing cancerous cells may be detected. The present invention also relates to a method of using the sampling apparatus in a home administered Pap smear test kit. The early detection of cervical, uterine and vaginal cancer is paramount to the effective treatment and recovery from the disease. A Papanicolaou smear test, commonly referred to as a Pap test, has long been established as a highly useful diagnostic tool which allows the identification of premalignant and malignant tissue at very early stages of the disease, as well as the identification of various inflammations and infections. A Pap test is a clinical procedure in which a speculum is inserted into the vagina and the cervix is exposed. A sample smear of cervical or vaginal secretions are then removed with a scraper, probe, brush or similar type of device. The collected smear is then placed upon microscopic slides and examined for exfoliated cells. The cells are examined for the early detection of cancer or to determine the presence of certain hormonal conditions or certain infections. Despite their broad diagnostic effectiveness for the early detection of cancer, Pap smear tests are performed almost exclusively by trained medical personnel, such as the gynecologist or internist, due to the complicity of the equipment. The natural reluctance of female patients to visit the gynecologist for such an intrusive procedure coupled with the financial burden of the doctor's bill and the time constraints of the work week, results in many women not receiving a Pap test examination as frequently as advised by the American Cancer Society, or even worse, not at all. Web site: http://www.delphion.com/details?pn=US05787891__
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Method for testing proficiency in screening images of biological slides Inventor(s): Lee; Shih-Jong James (Bellevue, WA), Nelson; Alan Caril (Redmond, WA) Assignee(s): NeoPath, Inc. (Redmond, WA) Patent Number: 5,797,130 Date filed: September 5, 1995 Abstract: An automatic screening apparatus that screens all pap smear slides called normal by cytotechnologist. These normal pap smears will contain the mistakes, false negatives, which must be recovered as a measure of the cytotechnologist's performance. Additionally, these mistakes must be discovered to improve the quality of the laboratory services. The automated screening machine after rescreening the normals, rank orders of the pap smears with those "normals" most likely to be missed ranked at the top. Another human screener re-examines those pap smears with high ranking to determine if the first human screener misclassified the pap smear. Mistakes are recovered and the performance of the first screener is assessed. Proficiency testing is accomplished with 100% quality control. Excerpt(s): This invention relates to a method and apparatus for testing the performance of human screeners who analyze images and, more particularly, to a system for testing the performance of cytotechnologists. Cytotechnologists screen pap smears for indications of abnormality. During screening, mistakes may occur at unacceptably high rates. These mistakes are called false negatives and are costly. The United States Government requires that cytotechnologists be proficiency tested to assess their screening accuracy. This requirement has been enacted as the Clinical Laboratory Improvement Amendment of 1988 ("CLIA Act of 1988"). The CLIA Act of 1988 specifies that 10% of all inspections be repeated as part of the quality control process and additionally that proficiency testing must be implemented. Even though retesting of 10% of those slides already screened is known and required, the problem caused by false negatives has not been solved. The prior art has attempted to use examination of standard sets of pap smear slides in such testing but the results are believed to be biased since the cytotechnologist is aware of being tested. Also, the prior art does not provide any method of recovering mistakes of the cytotechnologist. Web site: http://www.delphion.com/details?pn=US05797130__
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Operator independent image cytometer Inventor(s): Gough; David (1435 Big Canyon Ter., Cardiff, CA 92007), Price; Jeffrey H. (3881 Camino Lindo, San Diego, CA 92122) Assignee(s): none reported Patent Number: 5,548,661 Date filed: September 7, 1994 Abstract: An operator independent image cytometer having a method for image segmentation. Image segmentation comprises the steps of filtering a digital image of a cellular specimen and thresholding the resultant image. In addition, the thresholding may include the sorting of features extracted from the filtered image. The present invention also includes a method for cytometer autofocus that combines the benefits of sharpening and contrast metrics. The present invention further includes an arc lamp stabilization and intensity control system. The image cytometer has broad applications
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in determining DNA content and other cellular measurements on as many as 10.sup.5 individual cells, including specimens of living cells. Image segmentation applications include PAP smear analysis and particle recognition. Excerpt(s): The present invention relates to image processing systems and, more particularly, to an image cytometer which performs image separation on a specimen. An automated system for analysis of anchorage-dependent cells may contribute to improved understanding of many cellular functions. In vitro, anchorage-dependence is defined by the requirement that cells be attached to a substrate to proliferate. Many cell types exhibit anchorage-dependence and the loss of this requirement for attachment is usually associated with malignant transformation. (See, e.g., R. I. Freshney, "The Transformed Phenotype," in Culture of Animal Cells, a Manual of Basic Technique, 2nd ed., New York: Alan R. Liss, pp. 197-206, 1987.) In vitro, cell division, cell shape, cell migration, and control of cell growth and differentiation are all at least altered by interaction of cells with a substrate. For a fully automated cytometer to have the potential to analyze cellular parameters that depend on contact of cells with a substrate, the system would have to perform analyses in situ. The basis for such a system is analysis of images of the cells acquired from a computer-controlled microscope. The images acquired by scanning a specimen of cells would be analyzed to perform cytometry, the measurement of individual cells. The instrument that performs this task, the scanning or image cytometer, would ideally indicate: 1) the size and shape of cells, nuclei and key organelles; 2) the distributions and concentrations of important cellular substances; and 3) the organizational relationships of cells. Such an instrument should scan a specimen rapidly, nondestructively, and repeatedly to analyze the dynamics of large numbers of cells. There are many potential applications for scanning or image cytometry. Cell division, for example, could be analyzed directly by repeatedly scanning a large population of cells as they progress through the phases of the cell division cycle. Current methods for measuring durations of the cell cycle phases include bromodeoxyuridine pulse labeling in flow cytometry and time-lapse cinematography in microscopy. Flow cytometry permits rapid analysis of large numbers of cells, but cannot repeatedly measure a given cell, and time-lapse cinematography allows repeated measurements of the same cells, but cannot be used for more than one or a few cells. Web site: http://www.delphion.com/details?pn=US05548661__ •
Pap smear apparatus and method Inventor(s): Richards; Michael Owen (P.O. Box 2320, Waldron, AR 72958) Assignee(s): none reported Patent Number: 6,402,700 Date filed: November 21, 2000 Abstract: A personal PAP smear apparatus and method for collecting a non-intrusive cell or tissue sample for medical testing such as cervical cancer screening is provided. The apparatus includes an insertion handle, a flexible speculum ring, and a means for movably attaching the speculum ring to the insertion handle. The speculum ring includes two adjacent ring halves circumferentially divided to permit expansion of the collapsed speculum tube housed within the hollow ring halves. The method of the invention includes insertion of the flexible speculum assembly into the user's vagina, movement of the speculum ring to a raised position encircling the user's cervix, separating the ring halves to expand the tube and define the speculum bore, and
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inserting a sampling tool through the bore until it touches the cervix or surrounding surface areas for tissue sampling. Excerpt(s): Not Applicable. This invention relates to gynecological medical devices, and more particularly to a medical tool and method for enabling a woman to collect a personal cervical cell sample for use during a Papanicalou (PAP) test, commonly known as a PAP smear. The PAP smear is an important routine gynecological test usually done annually in sexually active females to screen for cervical cancer. The tests known in the art typically require an in office visit with a gynecologist where the doctor takes a sample of the cervix for lab analysis. Current medical practice requires a gynecologist to insert a speculum into the patient's vagina to access the cervix for tissue sample collection. Many women find this method an uncomfortable, intrusive exam, and opt to not have the routine screening performed. Web site: http://www.delphion.com/details?pn=US06402700__ •
Pap smear collection device with bristles oriented in a plane Inventor(s): Saccomanno; Geno (Grand Junction, CO), Strickland; Richard D. (Sandy, UT) Assignee(s): Baal Associates, Inc. (Sandy, UT) Patent Number: 5,191,899 Date filed: December 12, 1991 Abstract: A device for simultaneous collection of cells from the endocervical canal and the cervical face of the uterus and methods of use. The device is an elongated handle having one cell-collecting member projecting from the handle at an axis perpendicular to the axis of the handle for contacting with the cervical face of the uterus, and one cellcollecting member projecting from the handle along the same axis as the handle for contacting with the endocervical canal of the uterus. Along each member project sets of bristles which, because they are perpendicularly positioned on each member, provide mild abrasive action to the endocervical canal and the cervical face when the device is inserted into the uterus and rotated, so that cells from both regions are collected onto the bristles.The cells are removed from the bristles either by bending a flexible portion of the handle to enable parallel smearing of the cells onto a microscope slide, or by dislodging the cells from the bristles of the device into a fixative solution by manually rotating the device. After the solution is centrifuged, the cells form a cell pellet which is then smeared onto a microscope slide as a single layer of cells. Excerpt(s): The present invention relates generally to apparatus and methods for use in the collection of a Pap smear. More particularly, the present invention provides a novel design which permits simultaneous collection of cells from the cervical face and from the endocervical canal. The device also provides a method and means for securing a vaginal sample without reverting to a second sampling device. Over the last 40 years, the death rate from cervical cancer has dropped dramatically due to the widespread use of the Papanicolaou ("Pap") test. This test involves the collection of cells from the cervical face, the endocervical canal and occasionally from the vaginal wall. These cells are then microscopically examined for evidence of precancerous or cancerous growth. The periodic use of this test permits early detection of malignancy so that palliative therapy can be initiated at a time when it will yield the highest possible success rate. For many years the standard method for collection of these cells has been a wooden or plastic spatula. A variety of slightly different shapes have been used in an effort to allow
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the clinician to collect cells from the cervical face as well as the endocervical canal. In some cases, the opposite end of the spatula was designed to collect a vaginal scraping. Web site: http://www.delphion.com/details?pn=US05191899__ •
PAP smear glove Inventor(s): Villotti, Jr.; James P. (1832 Whispering Pines Cir., Englewood, FL 34223) Assignee(s): none reported Patent Number: 5,643,232 Date filed: January 19, 1996 Abstract: A glove for performing pap smear cell sampling is provided having a tapered surgical glove, with a tapered, feathered, or brush-like tip projecting from the index finger. The projection can have a variety of configurations, such as a cyto brush applique attached to the end of the glove. The device is used by a health care professional during a pelvic examination. The tip can be manipulated into and onto the endocervix and cervix and withdrawn after a half-turn circular motion and smeared in the traditional technique onto existing slides for pathological examination. Excerpt(s): The present invention pertains to a glove for use in performing pap smears. In particular, the present invention relates to a glove having an extension projecting from the index finger. Pap smear procedures are commonly performed on women as part of routine examinations. A speculum is the instrument of choice for such examinations. However, for women who have stenotic and atrophic vaginas, a speculum cannot be easily passed to perform a pap smear. The growing elderly female population, while needing pap smears as part of their regular check ups, present a difficult problem since a speculum cannot be easily passed to reach the cervix and endocervix. As a result, costly referrals or anesthesia, as well as, concurrent embarrassment and undue discomfort are incurred. As a consequence, many women who are difficult to sample do not get sampled as often as they should and avoid repeat follow-up tests. Web site: http://www.delphion.com/details?pn=US05643232__
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Pap smear T-zone sampler Inventor(s): Hasselbrack; Robert (Seattle, WA) Assignee(s): Accupap, Inc. (Seattle, WA) Patent Number: 4,620,548 Date filed: January 23, 1985 Abstract: An elongated plastic aspirator tube has a proximate end portion adapted for quick connection to a suction-generating device, such as a rubber squeeze bulb or a syringe, for collection of cell-containing mucus from the uterine endocervical canal, and a flattened distal end portion forming a spatulate scraper for collecting cells exfoliated from the transformation zone of the uterine cervix. The spatulate scraper includes a frontal lobe through which the bore of the aspirator tube opens, an adjacent lateral lobe abuttable against the ring of the cervix projecting into the vagina for positively positioning the apertured distal end of the frontal lobe at approximately the external os and a concave transition portion forming a scraping edge joining and faired into the
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adjacent edges of the two lobes. In a simple "one step" procedure, mucus from the endocervical canal is aspirated into the tube and the entire circumferential extent of the transformation zone scraped by rotation of the tube for collection of freshly exfoliated cells to be deposited on the flat surface of a slide. A circumferential rib divides the barrel of the tube into a long straight handle portion having longitudinally extending ridges assuring a slip-free grip and a shorter cylindrical stem carrying the spatulate scraper for spreading the collected samples uniformly and thinly on the slide surface. Excerpt(s): The present invention relates to a cytological sampling instrument for collecting cells exfoliated from the uterine cervix. In each of the known cervical cytological sampling methods the object is to collect a large number of cells that originated at the uterine cervix and, to a lesser degree, at the uterus, to be deposited on a slide and "fixed" by application of fixative for preservation of the cells. After suitable processing, subsequent microscopic examination in a medical laboratory reveals whether or not abnormal cells are present which are indicative of cancer or lesions accepted as being precursors of cancer. As early as 1947, the year in which the application resulting in Ayre U.S. Pat. No. 2,471,088 was filed, it was recognized that the vast majority of lesions resulting in invasive cervical cancer originate at the undulating circumferential border 5 between the squamous cells of the ectocervical epithelium 17 and the columnar cells of endocervical epithelium 18, which border is referred to as the squamo-columnar junction, the transformation zone or the "T-zone". Though the T-zone is variously located in different women, usually it is at or closely adjacent to the external os 6. It is extremely important that cells from this area be present in a sample. Web site: http://www.delphion.com/details?pn=US04620548__ •
Specimen preview and inspection system Inventor(s): Domanik; Richard A. (Libertyville, IL), Pressman; Norman J. (Glencoe, IL) Assignee(s): AccuMed International, Inc. (Chicago, IL) Patent Number: 6,148,096 Date filed: July 17, 1997 Abstract: A specimen preview and inspection system is disclosed. The system beneficially includes a preview stage, which provides a set of biasing-information for preview by a technician before the technician formally screens the specimen. The preview stage enables the technician to conveniently review information pertinent to the specimen at issue. The preview stage may thereby bias, or channel, the technician's attention during screening toward diagnostically significant aspects of the specimen. The invention is particularly useful in the context of Pap smear screening, although the invention may extend to inspection of other types of specimens or samples as well. Excerpt(s): The present invention relates to specimen or sample inspection systems and more particularly to systems in which human operators inspect a substantial number of individual specimens to locate a particular subset such as "suspicious" or irregular specimens. As used herein, the term "specimen" is not necessarily limited to a medical or biological specimen but may more generally extend to any sample item or portion of a group as a whole. The present invention may find particular use in a variety of contexts such as, for example, examining exfoliated tissue samples in a cervical Pap smear test, examining silicon wafers in an integrated circuit manufacturing process, and other materials inspection processes. In a typical scenario, a human inspector must inspect and analyze a substantial number of specimens each day to determine whether the
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specimens divert from some predetermined norm. Abnormal specimens are identified and are subject to further, more detailed review. The subsequent, more detailed review may require a reviewer with additional expertise, such as a pathologist in the case of the Pap test. In a usual case, most of the specimens are considered "normal," or "within normal limits," and therefore need not be rejected or subject to additional scrutiny. Depending on the detail and scope of this inspection and analysis, this additional scrutiny can unfortunately be a very slow, painstaking and costly process. For purposes of illustration, the present invention will be described in the context of cytological specimen analysis, such as cervical Pap smear analysis. Pap smears, which are routinely taken from women, facilitate the detection of pre-cancerous changes and/or the early stages of cancer, thus reducing the chances of any cancer or related abnormal condition from spreading or advancing with the resultant negative impact on the prognosis for the patient. A Pap smear is prepared by first collecting a vaginal, cervical and endocervical tissue sample from a patient. The sample is then fixed to a slide, for instance by alcohol fixation, and Pap-stained to enable microscopic analysis. Alternatively, rather than preparing a Pap smear, the specimen may take the form of a liquid-based or monolayer preparation, using instruments manufactured, for instance, by AutoCyte or Cytyc. In practice, the slide is then screened by a highly skilled technician ("cytotechnologist"), in an effort to identify possible cellular abnormalities in the specimen and to determine the specimen adequacy. The cytotechnologist generates notes regarding each specimen deemed to have possible abnormalities. The cytotechnologist then provides the specimen slide, together with notes of his or her findings, to an expert pathologist (i.e., specialized physician) for further review and final specimen diagnosis. Web site: http://www.delphion.com/details?pn=US06148096__ •
Technique for determining whether a cell is malignant as opposed to non-malignant using extrinsic fluorescence spectroscopy Inventor(s): Alfano; Robert R. (3777 Independence Ave., Bronx, NY 10463), Budansky; Yury (736 Ramapo Valley Rd., Oakland, NJ 07436), Liu; Cheng H. (140-25 Ash Ave. Apt. #3A, Flushing, NY 11355), Sha; Wei L. (501 W. 147th St., Apt. #3C, New York, NY 10031) Assignee(s): none reported Patent Number: 5,635,402 Date filed: April 29, 1994 Abstract: A technique for determining whether a cell is malignant as opposed to nonmalignant using extrinsic fluorescence spectroscopy. The technique is premised on the principle that certain fluorescent dyes preferentially stain malignant cells as opposed to non-malignant cells. Accordingly, by exposing a cell to the fluorescent dye, irradiating the cell with light of such a wavelength as to cause the dye to fluoresce, measuring the intensity of fluorescence at a wavelength indicative of fluorescence of the dye, and comparing the fluorescence intensity to standards obtained from malignant cells and non-malignant cells, it is possible for one to accurately classify the cell as being either malignant or non-malignant. The present invention also relates to an automated system which applies the principles of the aforementioned technique to depict the spatial distribution of cells within an area of a Pap smear-type sample and to characterize each of the cells as being malignant or non-malignant. Excerpt(s): The present invention relates generally to techniques for detecting cancer and more particularly to a novel technique for determining whether a cell is malignant as opposed to non-malignant using extrinsic fluorescence spectroscopy. Over the years,
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scientists have contributed to the many advances in our understanding of cancer. In 1775, Percivall Pott made his historic contribution to carcinogenesis when he described squamous cell carcinoma in chimney sweepers. Biopsies of cancer began to be accepted at the turn of the twentieth century. In 1895, Cullin described the frozen section technique, but it was not until the 1940's that pathological studies became accepted as a reliable way to diagnose malignancies. Cytology began in 1837 with Dunne's microscopic studies of body fluids. In 1847, Pouchet published the first study of the exfoliative cytology of the female genital tract. The first report of the usefulness of the smear technique as diagnostic aid in cancer of the cervix came with the work of George Papanicolaou (after whom the "Pap smear" test was named) in 1928. Cytological diagnoses for cancer of the stomach and respiratory tract were developed late in the 1950's and early in the 1960's. Treatments for carcinomas of the vulva, vagina, and cervix have greatly improved in the twentieth century due to the combination of advances including wide cervical excisions, radiotherapy, both external beam and implants, and the early diagnosis of cancer using Pap smears. Typically, Pap smears are inspected visually using a microscope. Over the years, the large volume of slides being read has resulted in errors in diagnosis, the errors most frequently being attributed to human error in reading the slides or to a collection of smear deposited on the slides. Accordingly, there is a need to analyze Pap smears by other means. Presently, computer-VIDEO software programs are being investigated to compare cell patterns to recognize cancer cells from normal cells in shape and size. Web site: http://www.delphion.com/details?pn=US05635402__
Patent Applications on Pap Smear As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to Pap smear: •
Cervical cytology instrument Inventor(s): Kobren, Myles S.; (Woodbury, NY), Menzin, Andrew W.; (Roslyn Heights, NY) Correspondence: Eliot S. Gerber; Fay, Kaplun & Marcin Llp; 100 Maiden Lane; New York; NY; 10038; US Patent Application Number: 20020068881 Date filed: December 4, 2000 Abstract: A gynecological instrument for collecting cell samples from the endocervix and exocervix and exocervix, e.g., a Pap Smear brush, has a handle portion carrying a brush base. The brush is connected to the brush base and comprises a central portion of stiff bristles which are generally perpendicular to the handle axis, and a line of softer bristles generally aligned with that axis. Excerpt(s): The present invention relates to medical devices and more particularly to gynecological instruments for collecting cell samples from the endocervix and exocervix, e.g., "Pap Smear" brushes. At the present time, the "Pap smear" (Papanicolou Smear) is
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This has been a common practice outside the United States prior to December 2000.
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one of the most important procedures in gynecology and one of the most effective cancer screening tests in history. It is non-invasive and without risk and provides many benefits to patients. If the cells are adequately collected and correctly analyzed, the Pap smear can detect cancers and pre-cancers of the lower genital wall, i.e., cancer of the cervix. This has been demonstrated to have led to a marked reduction in the incidence of cervical cancer and improved survival, which occurs because the cancers are caught early. Other treatable medical conditions may also be detected on a Pap smear. New technology has also allowed the coupling of other important medical tests (such as STD testing) to the material obtained for Pap smear examination. Various devices are commonly used to obtain a Pap smear. For example, a cotton swab at the end of a stick may be used to obtain cells from the outer surface of the cervix, that type of device being called a cervical swab smear. Another device, to obtain cells from the surface of the cervix (exocervical or ectocervical) and from the endocervix (cervical canal), is a wooden or plastic spatula (stick) having a flat broad edge and two lobes. However, such a spatula may not obtain a sufficient amount of vaginal wall cells. To obtain endocervical cells, it is common to use an endocervical aspirator or an endocervical brush having bristles at the end of a metal wire, like a pipe-cleaner brush. In addition, a widely used device to obtain both types of cells is a plastic brush called a "Pap broom" or a "Papette" (TM of Wallach Surgical Devices) having elongated vertical plastic bristles arranged in a fan shape. Such devices may, though, not penetrate the endocervical canal and retrieve sufficient endocervical cells. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
DIAGNOSTIC METHOD USING EXPRESSION OF MN/CA9 PROTEIN IN AGUS PAP SMEARS Inventor(s): LIAO, SHU-YUAN; (ANAHEIM, CA), STANBRIDGE, ERIC J.; (CORONA DEL MAR, CA) Correspondence: Fulbright And Jaworski L L P; Patent Docketing 29th Floor; 865 South Figueroa Street; Los Angeles; CA; 900172576 Patent Application Number: 20020058251 Date filed: December 15, 1999 Abstract: Determining the presence of cancerous or pre-cancerous cervical lesions from AGUS-diagnosed Pap smear cells by observing the distribution of MN/CA9 antigen expressed on atypical or normal cells and diagnosing (a) significant lesions when MN/CA9 antigen is observed on atypical cells, (b) low grade lesions when MN/CA9 antigen is absent from atypical cells but is present on normal endocervical cells, and (c) a benign condition when MN/CA9 antigen is absent from both atypical cells and normal endocervical cells. Excerpt(s): This application claims the benefit of Provisional Patent Application No. 60/147,556, filed Aug. 5, 1999. Carcinoma of the cervix is one of the most common malignancies in women, and worldwide it is second only to breast cancer in both incidence and mortality (NIH Consensus Statement (1) Cervical Cancer. 1996.14:1-18). In developed countries in general, and the United States in particular, the wide acceptance of the Pap smear screening program has resulted in dramatic decreases in the incidence of, and mortality from, cervical cancer. However, a recent survey conducted in United States still showed that an estimated 15,700 women were diagnosed with invasive cervical carcinoma, and an estimated 4,900 women died of cervical cancer per annum (NIH Consensus Statement (1) Cervical Cancer. 1996.14:1-18). Moreover, the incidence
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of adenocarcinorna has tripled in the past two decades (McGonigle K F, and Berek J S. Early stage squamous cell and adenocarcinoma of the cervix. Curr. Opin. Obstet. Gynecol., 1992. 4:109-119), and currently represents up to 25% of all cervical cancers diagnosed (Miller B E, Flax S D, Arheart K, Photopulos G. The presentation of adenocarcinoma of the uterine cervix. Cancer 1993. 72:1281-1285; and Crum C P, Cibas E S, Lee K R. Glandular precursors, adenocarcinomas, and their mimics. In: Pathology of early cervical neoplasia. New York: Churchill Living stone, 1997. 177-240). Many factors have been implicated in the relatively high incidence of cervical cancer but the inherently high rate of false negatives appears to be one of the major concerns in the current system of screening. The errors have been attributed, in part, to technical problems, but also may well be based primarily on human factors that are not remedied readily by rules and regulations (Kos L G. Cervical (Pap) smear. New directions. Cancer (Phial.), 71 (suppl.); 1993. 1406-1412). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •
Microscope glass slide for cytology PAP smears Inventor(s): Branch, Vellie; (Fort Washington, MD) Correspondence: Richard C. Litman; Litman Law Offices, LTD.; P.O. Box 15035; Arlington; VA; 22215; US Patent Application Number: 20030021021 Date filed: June 25, 2002 Abstract: A transparent elongated, rectangular glass microscope slide having a specimen observation spot defined by a removable border or frame. The border corresponds to the rectangular perimeter of the glass slide and includes a tab which may be grasped to peel off the border. In use, a cytological GYN PAP smear specimen is placed on the plain glass within the confines of the releasable paper border. The border is then removed after fixing the specimen. The slide also features a frosted end portion for marking identification data. The frosting may include permanent markings such as "NAME" to designate a certain frosted area for marking the desired information such as the patient's name and identification number. A tab is placed on the border end and overlaps a portion of the frosted area, and thus does not protrude outward from the side of the slide. Excerpt(s): This application claims the benefit of U.S. Provisional Patent Application Serial No. 60/307,611, filed Jul. 26, 2001. The present invention relates to microscope slides. More particularly, the invention relates to a slide having a specimen observation spot defined by a removable paper border and a frosted identification portion. Microscope slides are widely used in the health industry. Their use in PAP smear procedures is well known. In conventional slides during analysis or manipulation of the slide the sample or treatment fluid may run off or migrate onto other portions of the slide, "wick off" if the slide touches another object, or suffer cross contamination between slides. It would by desirable to provide a conveniently used slide which avoids these problems. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Spectral imaging system Inventor(s): Hoyt, Clifford C.; (Needham, MA), Miller, Peter J.; (Newburyport, MA) Correspondence: Eric L. Prahl; Fish & Richardson P.C.; 225 Franklin Street; Boston; MA; 02110-2804; US Patent Application Number: 20020001080 Date filed: August 2, 2001 Abstract: An imaging system is disclosed comprising an illuminator which produces illumination of any desired pure wavelength or of any selected mixture of pure wavelengths simultaneously, which illuminates a sample without spatio-spectral artifacts using illumination optics designed for that purpose; imaging optics, which form an image of the sample at a detector or viewing port; and a detector. This enables imaging the complete spectral image cube for a sample by taking sequential images while illuminating with a series of pure wavelengths, with greater ease and economy than by means of tunable filters, interferometers and the like. It further enables imaging while the sample is illuminated with a precisely controlled mixture of illuminant wavelengths, so that the image presented to the detector is a linear superposition of the sample properties at many wavelengths. This enables taking images of a sample' that directly measure the weighted spectral properties such as projection pursuit vectors, principal components, and the like. Data acquisition is enormously simplified, and speed is increased by one to two orders of magnitude over existing techniques. This is of great benefit in pathology, immunohistochemistry, Pap smear analysis, endoscopy, counterfeit detection, quality control, and other areas where one wishes to measure a spectral index of a living or inert sample. Excerpt(s): This application claims priority from U.S. Provisional Patent Application No. 60/147,636, the contents of which are incorporated herein by reference. In this application, a spectral weighting function that indicates the presence or amount of a certain trait in a sample is termed a spectral index, spectral weighted index or spectral measure for that trait. The term spectral measure is also sometimes used to denote the measurement value obtained at a given point or region according to a given spectral weighting function. Various spectral imaging systems are used to derive spectral information about samples, including imaging spectrometers, imaging interferometers, band-sequential cameras using e.g. filter wheels, and linear-variable filter imagers. Those systems which are based on linear-variable filters or on spectrometers generally acquire data about a single point or line at a time, and optical or mechanical means are used to develop a two-dimensional image of the sample. In many cases, a fullypopulated image cube is obtained, consisting of an image of the sample at each adjacent spectral band in the spectral region of interest. With interferomieters, linear-variable filters and most spectrometers, there is no way to avoid acquiring the full image cube, even if only a portion of the cube is desired. Data requirements are enormous: for highresolution images (2048.times.3072 pixels, 12 bits/pixel) with 32 spectral bands, nearly 400 megabytes of data must be acquired and processed. Filter wheels enable selective acquisition of the wavelengths of interest, so a sparsely populated cube may be obtained. However, if there are N bands of interest, a minimum of N exposures is still required. This is quite time-consuming and inefficient. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Vaginal speculum with insertable one-lens colposcope Inventor(s): Borodulin, German; (San Francisco, CA), Diokno, Ananias; (Ann Arbor, MI), Shkolnik, Alexander; (San Carlos, CA) Correspondence: Alexander Shkolnik; 485 Dartmouth Avenue; San Carlos; CA; 94070; US Patent Application Number: 20030225313 Date filed: June 4, 2002 Abstract: The invention relates to a combination of a vaginal speculum with a singlelens colposcope for use in a screening process for detecting mucosal abnormalities of cervical intraepithelial neoplasia or invasive cancer, e.g., in the vaginal cavity or on the external parts of the genitalia, as an addition to a Pap Smear screening process. The vaginal speculum is identical to a conventional speculum in its shape, dimensions, and function and differs from a conventional instrument only by having on the inner surface of the lower blade a small projection with a slot for guiding a single-loop colposcope. The latter consists of a tubular rod that can be slidingly inserted into the aforementioned slot and support on its distal end an optical lens. The lens may have a central opening for insertion of surgical instruments, e.g., a biopsy sampler. The proximal end of the tubular rod may support a rubber bulb for suction fluids from the distal end of the lower blade via the tubular rod. In use, the colposcope is inserted into the vaginal speculum through the guide slot so that the physician can manipulate with the colposcope by moving it in axial direction for focusing the lens and by turning the rod to the left or to the right for observing an area of interest. The vaginal speculum and the colposcope can be molded from plastic and can be disposable. Excerpt(s): The present invention relates to the field of medical devices for conducing close range physical medical examinations, in particular to colposcopes used for conducting gynecological and urological examinations. Two methods are used for earlier detection of cervical cancer and pre-cancer: cytology and colposcopy. Cytology is a screening method that is practical and economical, while colposcopy is a diagnostic method for clinical diagnosis of patients with abnormal cytology. Each method has its practical limitations and strength in cancer detection, and both methods complement each other. Currently a standard gynecological exam comprises the use of a speculum, visual examination of the vaginal interior cavity and related structures without any use of magnification, pulpation of the pelvic region and a Pap smear. If the abnormalities are not detected visually, they may be detected by the Pap smear or Pap test. The word "Pap" is short for Papanicolaou, which is the last name of the doctor who studied earlier detection of changing cervical cells. When conducting Pap smear screenings, the gynecologist gently scrapes and collects exfoliated cells from the surface of the cervix by a thin wooden stick and a tiny brush and places them on slides that are sent to a cytologist for further examination. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with Pap smear, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent,
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and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “Pap smear” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on Pap smear. You can also use this procedure to view pending patent applications concerning Pap smear. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.
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CHAPTER 6. BOOKS ON PAP SMEAR Overview This chapter provides bibliographic book references relating to Pap smear. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on Pap smear include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “Pap smear” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on Pap smear: •
Ethical Considerations for Providing Health Care to HIV-Infected Individuals Source: Perspectives on Oral Manifestations of AIDS: Diagnosis and Management of HIV-Associated Infections. San Diego, CA, January 18-20, 1988. Contact: PSG Publishing Company, 545 Great Rd, Littleton, MA, 01460, (508) 486-8971. Summary: This chapter of the Conference Perspectives on Oral Manifestations of AIDS: Diagnosis and Management of HIV-Associated Infections held in San Diego, CA, on January 18-20, 1988, on diagnosing lesions associated with infection by the Human immunodeficiency virus (HIV), which causes Acquired immunodeficiency syndrome (AIDS), concentrates on case studies of oral Kaposi's sarcoma, herpetic lesions in HIVpositive persons, and HIV-associated gingivitis and periodontal diseases. The incidence of hairy leukoplakia in lower socioeconomic groups, particularly the drug-using population, is appraised. Demonstrations of the HIV in gland saliva are discussed. Among oral manifestations of pediatric AIDS, candidiasis, HIV-associated gingivitis,
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herpes simplex, herpes zoster, and a number of parotid enlargements have been observed. However, pediatric Kaposi's sarcoma or other neoplasms have not been observed. Differentiating between perinatal versus transplacental transmission of pediatric AIDS is also a topic of discussion. Squamous cell carcinoma in homosexual males and HIV-positive women is compared, as well as pap smears on HIV-positive women who are sexual partners of HIV-positive men and HIV negative women who are sexual partners of HIV-positive men. •
Women's health under 40: What you should know Source: Cincinnati, OH: Betterway Books. 2000. 184 pp. Contact: Available from Betterway Books, 1507 Dana Avenue, Cincinnati, OH 452071005. $6.99. Summary: This illustrated book gives an explanation of some common health issues women age 40 and younger can experience. The information is presented in an easy to read format. Subjects covered include: anatomy; pap smears and cervical cancer; abnormal periods; painful periods; vaginal infections; sexually transmitted diseases; birth control; breast cancer; staying healthy; and exercise. There is place to record questions to take to a doctor. A bibliography is included.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “Pap smear” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “Pap smear” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “Pap smear” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •
Abnormal Pap Smears: What Every Woman Needs to Know by Lynda Rushing M.D., Nancy Joste M.D. (2001); ISBN: 1573929298; http://www.amazon.com/exec/obidos/ASIN/1573929298/icongroupinterna
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Pap Smear by Mathilde E. Boon, Albert J.H. Suurmeijer; ISBN: 3718658577; http://www.amazon.com/exec/obidos/ASIN/3718658577/icongroupinterna
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Questions and answers about the pap smear (SuDoc HE 20.3152:P 19/3) by U.S. Dept of Health and Human Services; ISBN: B00010605I; http://www.amazon.com/exec/obidos/ASIN/B00010605I/icongroupinterna
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The Pap Smear: Controversies in Practice by Barbara S. Ducatman (Editor), Helen H. Wang (Editor) (2002); ISBN: 0340759283; http://www.amazon.com/exec/obidos/ASIN/0340759283/icongroupinterna
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The Pap Smear: Life of George N. Papanicolaou by Erskine D. Carmichael; ISBN: 0398027161; http://www.amazon.com/exec/obidos/ASIN/0398027161/icongroupinterna
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What an Abnormal Pap Smear Means by Margaret Wilson (1995); ISBN: 0855722436; http://www.amazon.com/exec/obidos/ASIN/0855722436/icongroupinterna
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What Hmos Don't Want You to Know About Your Pap Smear: And What Every Woman Should Know by Clyde›A.››› Ellis, Leslie E. Ellis (Contributor) (2003); ISBN: 0595280331; http://www.amazon.com/exec/obidos/ASIN/0595280331/icongroupinterna
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What Your Doctor May Not Tell You about HPV and Abnormal Pap Smears by Joel M.D./Handley Palefsky (Author); ISBN: 0446677876; http://www.amazon.com/exec/obidos/ASIN/0446677876/icongroupinterna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “Pap smear” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:10 •
Automated monolayer slide preparation systems for Pap smear screening: ThinPrep 2000® Author: ECRI (Organization). Health Technology Assessment Information Service.; Year: 1999; Plymouth Meeting, PA: ECRI, 1999
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Cervix cancer and pap smear screening: a survey of knowledge, attitudes, and behaviour of women resident in the Kalgoorlie and Boulder townships of Western Australia Author: Fitzgerald, Patrick E. B.; Year: 1990; Subiaco, W.A.: Women's Cancer Prevention Unit, Disease Control Branch, Health Dept. of Western Australia, [1990]; ISBN: 0730938727
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Factors associated with actinomyces-like organisms on Pap smear in IUD users Author: Petitti, D. B.; Year: 1981; Oakland, California, Kaiser Permanente Medical Care Program, Dept. of Medical Methods Research and Dept. of Pathology, [1981]
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Health care guideline: management of initial abnormal pap smear Author: Institute for Clinical Systems Improvement.; Year: 2003; [Bloomington, Minn.]: ICSI, c2003
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Improving the quality of clinican pap smear technique and management, client Pap smear education, and the evaluation of pap smear laboratory testing: a resource guide for Title X, Family planning projects. Author: United States. Public Health Service. Office of Population Affairs.; Year: 1989; Washington, DC: U.S. Department of Health and Human Services, Public Health Service, Office of Population Affairs, Office of Family Planning, [1989]
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The Pap smear; life of George N. Papanicolaou. Author: Carmichael, D. Erskine,; Year: 1973; Springfield, Ill., Thomas [c1973]
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In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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Chapters on Pap Smear In order to find chapters that specifically relate to Pap smear, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and Pap smear using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “Pap smear” (or synonyms) into the “For these words:” box.
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CHAPTER 7. MULTIMEDIA ON PAP SMEAR Overview In this chapter, we show you how to keep current on multimedia sources of information on Pap smear. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.
Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” Type “Pap smear” (or synonyms) into the “For these words:” box. The following is a typical result when searching for sound recordings on Pap smear: •
Gyn Manifestations: National Conference on Women and AIDS/HIV Infection; Washington, D.C., December 13 - 14, 1990 Contact: Triad Media Group, PO Box 778, Frederick, MD, 21701, (301) 663-1471. Summary: This sound recording offers a presentation from the National Conference on Women and AIDS/HIV Infection held December 13-14, 1990, in Washington, D.C., that deals with gynecological manifestations of H uman immunodeficiency virus (HIV) infection. HIV is the cause of Acquired immunodeficiency syndrome (AIDS). The first speaker explains a variety of fungal infections and treatment for them. The second speaker discusses human papilloma virus and its connection with cervical neoplasia. Pap smears should be done frequently on women who are HIV positive because of the possible increased risk of cervical cancer. Colposcopy is seen as an increasingly necessary diagnostic tool for such women. The next speaker analyzes the carcinogenicity of Azidothymidine (AZT) in rats and mice. It appears to increase substantially the number of malignant vaginal tumors. The final speaker describes Sexually transmitted disease (STD) manifestations in women with HIV.
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Clinical Epidemiology in HIV - Infected Women. National Con ference on Women and AIDS/HIV Infection; Washington, D.C., December 13-14, 1990 Contact: Triad Media Group, PO Box 778, Frederick, MD, 21701, (301) 663-1471. Summary: This sound recording presents a workshop from the National Conference on Women and AIDS/HIV Infection held December 13-14, 1990, in Washington, D.C., on the epidemiology of HIV among women. The panel participants focused on various cofactors and variables associated with HIV infection and disease progression among this population. Understanding of cofactors is essential in designing effective interventions targeted toward high-risk groups. The moderator reviewed the epidemiological data on seropositivity among women in San Francisco, pointing out potential cofactors. Other speakers discussed the relationship between other sexually transmitted diseases (STDs) and HIV infection, including cofactors in acquisition and transmission of HIV; mortality and survival rates of HIV-positive women as compared to other groups; preventive measures, including regular pelvic examinations and Pap smears for women; and financial issues involved with providing preventive gynecological care.
Bibliography: Multimedia on Pap Smear The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in Pap smear (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on Pap smear: •
Abnormal Pap smear [videorecording] Source: [presented by] Marshfield Medical Foundation, in cooperation with Marshfield Clinic and St. Joseph's Hospital; Year: 1985; Format: Videorecording; Marshfield, WI: Marshfield Video Network, [1985]
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Can STD be diagnosed by Pap smear? [videorecording] Source: by David A. Grimes; Year: 1986; Format: Videorecording; Atlanta, Ga.: Emory University, c1986
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Management of the abnormal PAP smear [videorecording]. Year: 1983; Format: Videorecording; [Houston, Tex.]: University of Texas System Cancer Center, M.D. Anderson Hospital and Tumor Institute, c1983
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Pap smear [videorecording]: collection, handling & quality assurance Source: [presented by] ASCP Press; Year: 1998; Format: Videorecording; Chicago, IL: ASCP Press, c1998
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Pap smear [videorecording]: collection, handling, and QA Source: [presented by] ASCP; Year: 1990; Format: Videorecording; [Chicago, Ill.]: American Society of Clinical Pathologists, 1990
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Pap smear diagnosis of herpes [videorecording]: cytology and histopathology Source: presented by the Department of Pediatrics, Division of Infectious Diseases, Emory University, School of Medicine; Year: 1984; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, 1984
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Procedure for obtaining a Pap smear [slide]: aspiration technique Source: Sharon Wallace, Kathy Woolpert, Joan Cornett; consultation by William Scott; produced by Biomedical Communications, University of Arizona Health Sciences Center; Year: 1978;
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Format: Slide; Tucson, Ariz.: The Center: [for sale by its Biomedical Communications], c1978 •
The pelvic examination and pap smear [videorecording] Source: written by Jaroslav Hulka; produced by the Annenberg Center for Health Sciences at Eisenhower; Year: 1988; Format: Videorecording; [Rancho Mirage, Calif.]: The Center, c1988
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CHAPTER 8. PERIODICALS AND NEWS ON PAP SMEAR Overview In this chapter, we suggest a number of news sources and present various periodicals that cover Pap smear.
News Services and Press Releases One of the simplest ways of tracking press releases on Pap smear is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “Pap smear” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to Pap smear. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “Pap smear” (or synonyms). The following was recently listed in this archive for Pap smear: •
Poor quality Pap smears tied to precancer changes Source: Reuters Health eLine Date: August 06, 2003
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Most 'abnormal' Pap smears won't lead to cancer Source: Reuters Health eLine Date: April 25, 2003
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Quick partial scanning of Pap smears can improve quality of cytology programs Source: Reuters Medical News Date: March 12, 2003
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Pap smears detect adenocarcinoma as well as squamous carcinoma Source: Reuters Medical News Date: January 24, 2003
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ThinPrep Pap test more sensitive than conventional Pap smear Source: Reuters Industry Breifing Date: January 23, 2003
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Aberrant expression of adhesion molecules may explain false-negative Pap smears Source: Reuters Medical News Date: July 05, 2002
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Low literacy a barrier to understanding Pap smear Source: Reuters Health eLine Date: June 10, 2002
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Pap smears every three years recommended in Australia Source: Reuters Medical News Date: June 04, 2002
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Benign endometrial cells in Pap smears associated with endometrial diseases Source: Reuters Industry Breifing Date: October 19, 2001
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Digene seeks approval of HPV test as adjunct to Pap smear Source: Reuters Industry Breifing Date: October 02, 2001
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Risks for HPV, abnormal Pap smears investigated Source: Reuters Health eLine Date: June 20, 2001
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"Normal pap smear result" requires explanation Source: Reuters Medical News Date: March 01, 2001
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Device offers alternative to Pap smear pain Source: Reuters Health eLine Date: January 23, 2001
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Hong Kong physicians recommend annual Pap smears Source: Reuters Medical News Date: January 17, 2001
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Pap smear unnecessary within 2 years of normal smear after menopause Source: Reuters Medical News Date: December 19, 2000
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Annual Pap smears may not be needed after menopause Source: Reuters Health eLine Date: December 18, 2000
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Annual Pap smears may cause unnecessary stress Source: Reuters Health eLine Date: November 09, 2000
Periodicals and News
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Breast exam, Pap smear predict mammography uptake Source: Reuters Medical News Date: October 24, 2000
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Urgent care clinic good setting for Pap smears Source: Reuters Medical News Date: July 13, 2000
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Pap smears should remain the primary method of cervical cancer screening Source: Reuters Medical News Date: June 09, 2000
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Pap smear still best way to screen for cervical cancer Source: Reuters Health eLine Date: June 08, 2000
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Endocervical curettage aids evaluation of women with abnormal Pap smears Source: Reuters Medical News Date: May 24, 2000
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Obese and overweight women less likely to receive mammograms and Pap smears Source: Reuters Medical News Date: May 02, 2000
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Wart virus test adds little to Pap smear diagnosis Source: Reuters Health eLine Date: February 29, 2000
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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “Pap smear” (or synonyms) into the search box, and click on “Search News.” As this service is technology
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oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “Pap smear” (or synonyms). If you know the name of a company that is relevant to Pap smear, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “Pap smear” (or synonyms).
Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “Pap smear” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on Pap smear: •
Pelvic Muscle Rehabilitation Source: Quality Care. 16(3): 1-2. Summer 1998. Contact: Available from National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337 or (864) 579-7900. Fax (864) 579-7902. Summary: This newsletter article reviews the use of pelvic floor muscle exercises (Kegel exercises) to prevent or treat urinary incontinence. The author notes that exercising the muscles of the pelvic floor on a regular basis should be as much a part of a woman's preventive health care routine as an annual Pap smear and monthly breast self examination. Pelvic muscles are frequently damaged during childbirth and sometimes by surgery in the pelvic area (hysterectomy or prolapse surgeries for women and prostatectomy for men). The author describes the purpose of pelvic muscle rehabilitation and then details how the exercises are done. The author notes that some people may only need written directions to undertake these exercises, but some people may need help from a health care professional to locate and exercise the pelvic muscles. Biofeedback, electrical stimulation, and vaginal weights are the most common methods used to help individuals locate and begin to use their pelvic muscles. The author
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concludes that, whichever method is prescribed, successful pelvic muscle rehabilitation depends on a consistent effort by the individual. 1 figure.
Academic Periodicals covering Pap Smear Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to Pap smear. In addition to these sources, you can search for articles covering Pap smear that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”
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APPENDICES
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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.
NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25
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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm
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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375
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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
11
These publications are typically written by one or more of the various NIH Institutes.
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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:13 •
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
12 Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 13 See http://www.nlm.nih.gov/databases/databases.html.
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database
A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “Pap smear” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “Pap smear” (or synonyms) into the “For these words:” box. The following is a sample result: •
HIV Treatment Strategy, Overview Contact: Carl Vogel Center, 1012 14th St NW Ste 707, Washington, DC, 20005, (202) 6380750. Summary: This paper gives an overview of treatment protocols outlined in detail in separate materials and targeted to patients in varying stages of HIV infection. For asymptomatic and stable patients, it recommends a combination of nutrition therapy, immune modulators, and stress reduction; it also suggests a tuberculosis (TB) test and for women, regular Pap smears and exams. The paper then expands this protocol to cover patients in more advanced stages of HIV infection, adding tests and treatments for other opportunistic infections.
•
HIV Treatment Strategy, Part III: Drug Information for People Living With AIDS Contact: Carl Vogel Center, 1012 14th St NW Ste 707, Washington, DC, 20005, (202) 6380750. Summary: This paper provides prescriptive drug treatment information for Persons With AIDS (PWA's). It is important for HIV-positive individuals to talk to a physician about a complete antiviral, immunomodulatory, and prophylactic drug program. Antivirals/antibiotics include AZT, ddc, and/or ddi; Combination of the three is thought to increase overall effectiveness. D4T either alone or with ddi looks promising. Many physicians include acyclovir to prevent HIV activation by herpes viruses. Some physicians recommend IV Compound Q for individuals with CD-4's over 100. Doxycycline is used as an anti-mycoplasma agent, Peptide-T seems most useful for neuropathy and cognitive dysfunction problems. Bitter melon is being tried with CD-4 increases is also looking promising. Some immune modulators include: Antioxidants, antabuse/disulfiram, coenzyme Q10, DNCB, glutathione, isoprinosine, naltrexone, pentoxifylline/trental, recombinant gp 160 vaccine, and thymus derivatives. Pap smears and vaginal exams should be conducted regularly for women. Extra nutrients for women should be implemented.
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The NLM Gateway14 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “Pap smear” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total
Items Found 12948 247 909 337 7 14448
HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.18 Simply search by “Pap smear” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
Coffee Break: Tutorials for Biologists19 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI 14
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
15
The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 16 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 17 18
The HSTAT URL is http://hstat.nlm.nih.gov/.
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 19 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.
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staff.20 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.21 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
•
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
20 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 21 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on Pap smear can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to Pap smear. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to Pap smear. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “Pap smear”:
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Other guides Breast Cancer http://www.nlm.nih.gov/medlineplus/breastcancer.html Cancer http://www.nlm.nih.gov/medlineplus/cancer.html Cervical Cancer http://www.nlm.nih.gov/medlineplus/cervicalcancer.html HPV http://www.nlm.nih.gov/medlineplus/hpv.html Preventing Disease and Staying Healthy http://www.nlm.nih.gov/medlineplus/preventingdiseaseandstayinghealthy.html Uterine Cancer http://www.nlm.nih.gov/medlineplus/uterinecancer.html Vaginal Cancer http://www.nlm.nih.gov/medlineplus/vaginalcancer.html Vaginal Diseases http://www.nlm.nih.gov/medlineplus/vaginaldiseases.html Women's Health Issues http://www.nlm.nih.gov/medlineplus/womenshealthissues.html
Within the health topic page dedicated to Pap smear, the following was listed: •
General/Overviews Cervical Cancer http://www.4woman.gov/faq/ccervix.htm Cervical Cancer Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00167 What Is Cervical Cancer? Source: American Cancer Society http://www.cancer.org/docroot/cri/content/cri_2_4_1x_what_is_cervical_cancer_ 8.asp?sitearea=cri
•
Diagnosis/Symptoms Colposcopy http://www.nlm.nih.gov/medlineplus/tutorials/colposcopyloader.html Colposcopy Source: American Academy of Family Physicians http://familydoctor.org/082.xml How Is Cervical Cancer Diagnosed? Source: American Cancer Society http://www.cancer.org/docroot/cri/content/cri_2_4_3x_how_is_cervical_cancer_ diagnosed_8.asp?sitearea=cri
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How Is Cervical Cancer Staged? Source: American Cancer Society http://www.cancer.org/docroot/cri/content/cri_2_4_3x_how_is_cervical_cancer_s taged_8.asp?sitearea=cri •
Treatment Cervical Cancer (PDQ): Treatment Source: National Cancer Institute http://www.cancer.gov/cancerinfo/pdq/treatment/cervical/patient/ Dilation and Curettage http://www.nlm.nih.gov/medlineplus/tutorials/dilationandcurettageloader.html Loop Electrosurgical Excision Procedure (LEEP) Source: American College of Obstetricians and Gynecologists http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZD6NJ687C&s ub_cat=2006
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Coping Active Coping Helps Gynecologic Cancer Patients' Quality of Life: Lowers Anxiety, Depression, and Confusion Source: American Cancer Society http://www.cancer.org/docroot/NWS/content/NWS_2_1x_Active_Coping_Helps _Gynecologic_Cancer_Patients_Quality_of_Life.asp Female Sexuality After Cancer: What You and Your Partner Need to Know Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=SA00071 Where to Seek Professional Help: Sexuality and Cancer Source: American Cancer Society http://www.cancer.org/docroot/mit/content/mit_7_2x_where_to_seek_professio nal_help_women.asp
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Specific Conditions/Aspects Cervical Cancer and Specific Populations Source: National Center for Chronic Disease Prevention and Health Promotion http://www.cdc.gov/cancer/nbccedp/cc-strategies/index.htm Cervical Cancer in Pregnancy Source: American Cancer Society http://www.cancer.org/docroot/cri/content/cri_2_4_4x_cervical_cancer_in_pregn ancy_8.asp?sitearea=cri Cervical Dysplasia Source: American Medical Association http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZIY13X59C& sub_cat=9 DES: Questions and Answers Source: National Cancer Institute http://cis.nci.nih.gov/fact/3_4.htm
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Human Papillomaviruses and Cancer Source: National Cancer Institute http://cis.nci.nih.gov/fact/3_20.htm Known Health Effects for DES (Diethylstilbestrol) Daughters Source: Centers for Disease Control and Prevention http://www.cdc.gov/DES/consumers/about/effects_daughters.html Oral Contraceptives and Cancer Risk Source: National Cancer Institute http://cis.nci.nih.gov/fact/3_13.htm What Should You Ask Your Doctor about Cervical Cancer? Source: American Cancer Society http://www.cancer.org/docroot/cri/content/cri_2_4_5x_what_should_you_ask_y our_doctor_about_cervical_cancer_8.asp?sitearea=cri •
From the National Institutes of Health What You Need to Know about Cancer of the Cervix Source: National Cancer Institute http://www.cancer.gov/cancerinfo/wyntk/cervix
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Latest News Virus Test May Improve Detection of Cervical Cancer Source: 12/05/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14998 .html Women Distrust Risk-based Cervical Cancer Screening Source: 12/05/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14990 .html Women Want to Learn About Cervical Cancer Virus Source: 12/01/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14910 .html
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Law and Policy Guidance and Summary of Actions on the Breast and Cervical Cancer Prevention and Treatment Act of 2000 Source: National Center for Chronic Disease Prevention and Health Promotion http://www.cdc.gov/cancer/nbccedp/law106-354.htm
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Organizations American Cancer Society http://www.cancer.org/ National Cancer Institute http://www.cancer.gov/
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Prevention/Screening Cervical Cancer (PDQ): Prevention Source: National Cancer Institute http://www.cancer.gov/cancerinfo/pdq/prevention/cervical/patient/ Cervical Cancer (PDQ): Screening Source: National Cancer Institute http://www.cancer.gov/cancerinfo/pdq/screening/cervical/patient/ Cervical Cancer and Pap Test Information Source: National Center for Chronic Disease Prevention and Health Promotion http://www.cdc.gov/cancer/nbccedp/info-cc.htm Cervical Cancer Questionnaire Source: Harvard Center for Cancer Prevention http://www.yourcancerrisk.harvard.edu/hccpquiz.pl?func=start&quiz=cervical National Breast and Cervical Cancer Early Detection Program: Reducing Mortality Through Screening Source: National Center for Chronic Disease Prevention and Health Promotion http://www.cdc.gov/cancer/nbccedp/about.htm Pap Smear http://www.nlm.nih.gov/medlineplus/tutorials/papsmearloader.html PAP Test Source: National Women's Health Information Center http://www.4woman.gov/faq/pap.htm Pap Test: Questions and Answers Source: National Cancer Institute http://cis.nci.nih.gov/fact/5_16.htm Task Force Announces New Cervical Cancer Screening Guidelines Source: National Cancer Institute http://www.cancer.gov/newscenter/pressreleases/cervicalscreen What Are the Risk Factors for Cervical Cancer? Source: American Cancer Society http://www.cancer.org/docroot/cri/content/cri_2_4_2x_what_are_the_risk_factor s_for_cervical_cancer_8.asp?sitearea=cri
•
Research Study Links Obesity to Cervical Cancer, Excess Weight May Be a Co-factor, Along with HPV Source: American Cancer Society http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Study_Links_Obesity _to_Cervical_Cancer.asp What's New in Cervical Cancer Research and Treatment? Source: American Cancer Society http://www.cancer.org/docroot/cri/content/cri_2_4_6x_whats_new_in_cervical_c ancer_research_and_treatment_8.asp?sitearea=cri
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•
Statistics CDC Releases First Cervical Cancer Detection Rates by Race and Ethnicity Source: Centers for Disease Control and Prevention http://www.cdc.gov/od/oc/media/pressrel/r010116a.htm Cervical Cancer Facts Source: American Society for Clinical Pathology http://www.ascp.org/general/pub_resources/papsmear/facts.asp What Are the Key Statistics for Cervical Cancer? Source: American Cancer Society http://www.cancer.org/docroot/cri/content/cri_2_4_1x_what_are_the_key_statist ics_for_cervical_cancer_8.asp?sitearea=cri
You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on Pap smear. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •
What is a Pap smear? Source: Rockville, MD: Office of Population Affairs, U.S. Department of Health and Human Services. 1994. 2 pp. Contact: Available from U.S. Office of Population Affairs Clearinghouse, P.O. Box 30686, Bethesda, MD 20824-0686. Telephone: (301) 654-6190 / fax: (301) 215-7731 / Web site: http://dhhs.gov/progorg/opa/. Available at no charge. Summary: This brochure provides general information on Pap smears, including what a Pap smear is, how to prevent cancer of the cervix, and how readers can use the Pap smear to protect themselves. It includes a section for recording test results and the date the next test is due. It was developed by grantees and technical consultants in Public Health Service Region X with support from the U.S. Office of Population Affairs. It was reviewed by Title X family planning clinicians; nurse practitioners and physicians attending colposcopy training; and Title X client focus groups. The reading level has been kept as low as possible, while still maintaining accuracy.
Patient Resources
•
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Abnormal Pap Smear? Contact: American Social Health Association, PO Box 13827, Research Triangle Park, NC, 27709, (919) 361-8400. Summary: Using a question-and-answer format, this brochure provides information about the Pap smear test and the meaning of an abnormal test result. The Pap smear is a test performed on the cervix using a swab or some other device to collect a sample of cells that is later sent to a lab and viewed under a microscope. Many things can cause an abnormal Pap smear such as a sample that does not show the cells clearly, a mild infection that can be treated or that will go away naturally, or infection with the human papillomavirus (HPV), a virus, a few types of which can slowly lead to cancer of the cervix if not treated. The brochure recommends steps that should be taken by women before getting a Pap smear, differentiates between a Pap smear and a pelvic exam, and describes what happens if a woman receives an abnormal Pap smear. It is recommended that women should get a Pap smear at least once a year once they start having sex or turn eighteen. The brochure supplies the readers with a form they can use to keep track of their next Pap smear appointment. The brochure provides contact information for services from which individuals can learn more about sexually transmitted diseases (STDs) and HPV. Healthfinder™
Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •
Having a Pelvic Exam and Pap Test Summary: A consumer health information document that discusses the steps you need to take to prepare for a Pap smear and pelvic examination, and what you should experience during the procedure. Source: National Cancer Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3735
•
Should I Have a Pap Smear? Summary: This educational program was produced and developed by representatives to the Cytopathology Education Consortium to create a public awareness of the importance of gynecologic cytology in the promotion Source: American Society for Clinical Pathology http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2307
•
Things To Know About Getting a Pap Smear Source: Asian Pacific American Network http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7266
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The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to Pap smear. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
•
Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDHealth: http://my.webmd.com/health_topics
Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to Pap smear. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with Pap smear. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about Pap smear. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at
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http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “Pap smear” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “Pap smear”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “Pap smear” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “Pap smear” (or a synonym) into the search box, and click “Submit Query.”
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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.22
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of
22
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)23: •
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
23
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
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•
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
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•
Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
•
New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
•
New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
•
New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
•
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
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•
South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
145
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
•
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
•
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
•
On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
•
Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
•
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on Pap smear: •
Basic Guidelines for Pap Smear Pap smear Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003911.htm
•
Diagnostics and Tests for Pap Smear Colposcopy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003913.htm
•
Background Topics for Pap Smear Cervix Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002317.htm Vagina Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002342.htm
146 Pap Smear
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
•
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
•
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
•
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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PAP SMEAR DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Abortion: 1. The premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. Premature stoppage of a natural or a pathological process. [EU] Absolute risk: The observed or calculated probability of an event in a population under study, as contrasted with the relative risk. [NIH] Acculturation: Process of cultural change in which one group or members of a group assimilates various cultural patterns from another. [NIH] Acid Phosphatase: An enzyme that catalyzes the conversion of an orthophosphoric monoester and water to an alcohol and orthophosphate. EC 3.1.3.2. [NIH] Acrylonitrile: A highly poisonous compound used widely in the manufacture of plastics, adhesives and synthetic rubber. [NIH] Actinomyces: A genus of gram-positive, rod-shaped bacteria whose organisms are nonmotile. Filaments that may be present in certain species are either straight or wavy and may have swollen or clubbed heads. [NIH] Acute lymphoblastic leukemia: ALL. A quickly progressing disease in which too many immature white blood cells called lymphoblasts are found in the blood and bone marrow. Also called acute lymphocytic leukemia. [NIH] Acute lymphocytic leukemia: ALL. A quickly progressing disease in which too many immature white blood cells called lymphoblasts are found in the blood and bone marrow. Also called acute lymphoblastic leukemia. [NIH] Acyclovir: Functional analog of the nucleoside guanosine. It acts as an antimetabolite, especially in viruses. It is used as an antiviral agent, especially in herpes infections. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Aldehyde Dehydrogenase: An enzyme that oxidizes an aldehyde in the presence of NAD+ and water to an acid and NADH. EC 1.2.1.3. Before 1978, it was classified as EC 1.1.1.70. [NIH]
Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps
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to calculate or determine a given task. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Anaerobic: 1. Lacking molecular oxygen. 2. Growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anchorage: In dentistry, points of retention of fillings and artificial restorations and appliances. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH]
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Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]
Anogenital: Pertaining to the anus and external genitals. [EU] Antibiotics: Substances produced by microorganisms that can inhibit or suppress the growth of other microorganisms. [NIH] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Artifacts: Any visible result of a procedure which is caused by the procedure itself and not by the entity being analyzed. Common examples include histological structures introduced by tissue processing, radiographic images of structures that are not naturally present in living tissue, and products of chemical reactions that occur during analysis. [NIH] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus
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fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]
Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example,
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in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blot: To transfer DNA, RNA, or proteins to an immobilizing matrix such as nitrocellulose. [NIH]
Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]
Breast Self-Examination: The inspection of one's breasts, usually for signs of disease, especially neoplastic disease. [NIH] Bromodeoxyuridine: A nucleoside that substitutes for thymidine in DNA and thus acts as an antimetabolite. It causes breaks in chromosomes and has been proposed as an antiviral and antineoplastic agent. It has been given orphan drug status for use in the treatment of primary brain tumors. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Candida albicans: A unicellular budding fungus which is the principal pathogenic species causing candidiasis (moniliasis). [NIH] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Candidosis: An infection caused by an opportunistic yeasts that tends to proliferate and become pathologic when the environment is favorable and the host resistance is weakened. [NIH]
Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinogenicity: The ability to cause cancer. [NIH]
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Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]
Cardiac: Having to do with the heart. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell Size: The physical dimensions of a cell. It refers mainly to changes in dimensions correlated with physiological or pathological changes in cells. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervical intraepithelial neoplasia: CIN. A general term for the growth of abnormal cells on the surface of the cervix. Numbers from 1 to 3 may be used to describe how much of the cervix contains abnormal cells. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Cervix Dysplasia: A spectrum of histologic changes in the epithelium of the cervix uteri which may begin as a superficial lesion and progress to invasive carcinoma. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially
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the brain and spinal cord, and in animal fats and oils. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Citrus: Any tree or shrub of the Rue family or the fruit of these plants. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]
Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colorectal: Having to do with the colon or the rectum. [NIH] Colorectal Cancer: Cancer that occurs in the colon (large intestine) or the rectum (the end of the large intestine). A number of digestive diseases may increase a person's risk of colorectal cancer, including polyposis and Zollinger-Ellison Syndrome. [NIH] Colposcope: A lighted magnifying instrument used for examination of the vagina and cervix. [NIH] Communication Barriers: Those factors, such as language or sociocultural relationships, which interfere in the meaningful interpretation and transmission of ideas between individuals or groups. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols
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C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Condyloma: C. acuminatum; a papilloma with a central core of connective tissue in a treelike structure covered with epithelium, usually occurring on the mucous membrane or skin of the external genitals or in the perianal region. [EU] Cone: One of the special retinal receptor elements which are presumed to be primarily concerned with perception of light and color stimuli when the eye is adapted to light. [NIH] Conization: The excision of a cone of tissue, especially of the cervix uteri. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH]
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Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]
Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer. [NIH] Cotinine: 1-Methyl-5-(3-pyridyl)-2-pyrrolidinone antidepressant. Synonym: Scotine. [NIH]
fumarate.
Stimulant
proposed
as
Criterion: A standard by which something may be judged. [EU] Cryotherapy: Any method that uses cold temperature to treat disease. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Curettage: Removal of tissue with a curette, a spoon-shaped instrument with a sharp edge. [NIH]
Curette: A spoon-shaped instrument with a sharp edge. [NIH] Cutaneous: Having to do with the skin. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Developed Countries: Countries that have reached a level of economic achievement through an increase of production, per capita income and consumption, and utilization of natural and human resources. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH]
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Diagnostic procedure: A method used to identify a disease. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diathermy: The induction of local hyperthermia by either short radio waves or highfrequency sound waves. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Disulfiram: A carbamate derivative used as an alcohol deterrent. It is a relatively nontoxic substance when administered alone, but markedly alters the intermediary metabolism of alcohol. When alcohol is ingested after administration of disulfiram, blood acetaldehyde concentrations are increased, followed by flushing, systemic vasodilation, respiratory difficulties, nausea, hypotension, and other symptoms (acetaldehyde syndrome). It acts by inhibiting aldehyde dehydrogenase. [NIH] Domestic Violence: Deliberate, often repetitive, physical abuse by one family member against another: marital partners, parents, children, siblings, or any other member of a household. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Ejaculation: The release of semen through the penis during orgasm. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Embryo: The prenatal stage of mammalian development characterized by rapid
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morphological changes and the differentiation of basic structures. [NIH] Embryo Transfer: Removal of a mammalian embryo from one environment and replacement in the same or a new environment. The embryo is usually in the pre-nidation phase, i.e., a blastocyst. The process includes embryo or blastocyst transplantation or transfer after in vitro fertilization and transfer of the inner cell mass of the blastocyst. It is not used for transfer of differentiated embryonic tissue, e.g., germ layer cells. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocrine Glands: Ductless glands that secrete substances which are released directly into the circulation and which influence metabolism and other body functions. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]
Endometrium: The layer of tissue that lines the uterus. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermoid carcinoma: A type of cancer in which the cells are flat and look like fish scales. Also called squamous cell carcinoma. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH]
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Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Estrogen: One of the two female sex hormones. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Evaluable patients: Patients whose response to a treatment can be measured because enough information has been collected. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Expert Systems: Computer programs based on knowledge developed from consultation with experts on a problem, and the processing and/or formalizing of this knowledge using these programs in such a manner that the problems may be solved. [NIH] Exploratory Behavior: The tendency to explore or investigate a novel environment. It is considered a motivation not clearly distinguishable from curiosity. [NIH] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Exudate: Material, such as fluid, cells, or cellular debris, which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a result of inflammation. An exudate, in contrast to a transudate, is characterized by a high content of protein, cells, or solid materials derived from cells. [EU] Facial: Of or pertaining to the face. [EU] Facial Nerve: The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and salivary glands, and convey afferent information for taste from the anterior two-thirds of the tongue and for touch from the external ear. [NIH] Fallopian tube: The oviduct, a muscular tube about 10 cm long, lying in the upper border of the broad ligament. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Family Practice: A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]
Fecal occult blood test: A test to check for blood in stool. (Fecal refers to stool; occult means hidden.) [NIH] Fertilization in Vitro: Fertilization of an egg outside the body when the egg is normally fertilized in the body. [NIH]
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Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flow Cytometry: Technique using an instrument system for making, processing, and displaying one or more measurements on individual cells obtained from a cell suspension. Cells are usually stained with one or more fluorescent dyes specific to cell components of interest, e.g., DNA, and fluorescence of each cell is measured as it rapidly transverses the excitation beam (laser or mercury arc lamp). Fluorescence provides a quantitative measure of various biochemical and biophysical properties of the cell, as well as a basis for cell sorting. Other measurable optical parameters include light absorption and light scattering, the latter being applicable to the measurement of cell size, shape, density, granularity, and stain uptake. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluorescent Dyes: Dyes that emit light when exposed to light. The wave length of the emitted light is usually longer than that of the incident light. Fluorochromes are substances that cause fluorescence in other substances, i.e., dyes used to mark or label other compounds with fluorescent tags. They are used as markers in biochemistry and immunology. [NIH] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Fornix: A bundle of nerves connected to the hippocampus. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Frontal Lobe: The anterior part of the cerebral hemisphere. [NIH]
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Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Generator: Any system incorporating a fixed parent radionuclide from which is produced a daughter radionuclide which is to be removed by elution or by any other method and used in a radiopharmaceutical. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic Screening: Searching a population or individuals for persons possessing certain genotypes or karyotypes that: (1) are already associated with disease or predispose to disease; (2) may lead to disease in their descendants; or (3) produce other variations not known to be associated with disease. Genetic screening may be directed toward identifying phenotypic expression of genetic traits. It includes prenatal genetic screening. [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration
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following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Gonadal: Pertaining to a gonad. [EU] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, Neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Gynecology: A medical-surgical specialty concerned with the physiology and disorders primarily of the female genital tract, as well as female endocrinology and reproductive physiology. [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system. [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hepatoma: A liver tumor. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU]
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Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes virus: A member of the herpes family of viruses. [NIH] Herpes Zoster: Acute vesicular inflammation. [NIH] Hippocampus: A curved elevation of gray matter extending the entire length of the floor of the temporal horn of the lateral ventricle (Dorland, 28th ed). The hippocampus, subiculum, and dentate gyrus constitute the hippocampal formation. Sometimes authors include the entorhinal cortex in the hippocampal formation. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Human papillomavirus: HPV. A virus that causes abnormal tissue growth (warts) and is often associated with some types of cancer. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour - now often used of endocrine factors as opposed to neural or somatic. [EU] Humour: 1. A normal functioning fluid or semifluid of the body (as the blood, lymph or bile) especially of vertebrates. 2. A secretion that is itself an excitant of activity (as certain hormones). [EU] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthermia: A type of treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Hysterectomy: Excision of the uterus. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Image Cytometry: A technique encompassing morphometry, densitometry, neural
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networks, and expert systems that has numerous clinical and research applications and is particularly useful in anatomic pathology for the study of malignant lesions. The most common current application of image cytometry is for DNA analysis, followed by quantitation of immunohistochemical staining. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]
effects
of
foreign
Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]
Immunofluorescence: A technique for identifying molecules present on the surfaces of cells or in tissues using a highly fluorescent substance coupled to a specific antibody. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic
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clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
Infiltrating cancer: Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called invasive cancer. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insulin-like: Muscular growth factor. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intraepithelial: Within the layer of cells that form the surface or lining of an organ. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]
Invasive cancer: Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called infiltrating cancer. [NIH] Invasive cervical cancer: Cancer that has spread from the surface of the cervix to tissue deeper in the cervix or to other parts of the body. [NIH] Involuntary: Reaction occurring without intention or volition. [NIH] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2.
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Chemically unstable. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Lavage: A cleaning of the stomach and colon. Uses a special drink and enemas. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lethal: Deadly, fatal. [EU] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukoplakia: A white patch that may develop on mucous membranes such as the cheek, gums, or tongue and may become cancerous. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]
Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligation: Application of a ligature to tie a vessel or strangulate a part. [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]
Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphoblastic: One of the most aggressive types of non-Hodgkin lymphoma. [NIH]
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Lymphoblasts: Interferon produced predominantly by leucocyte cells. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mammogram: An x-ray of the breast. [NIH] Mammography: Radiographic examination of the breast. [NIH] Mass Screening: Organized periodic procedures performed on large groups of people for the purpose of detecting disease. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Health: The state wherein the person is well adjusted. [NIH] Mercury: A silver metallic element that exists as a liquid at room temperature. It has the atomic symbol Hg (from hydrargyrum, liquid silver), atomic number 80, and atomic weight 200.59. Mercury is used in many industrial applications and its salts have been employed therapeutically as purgatives, antisyphilitics, disinfectants, and astringents. It can be absorbed through the skin and mucous membranes which leads to mercury poisoning. Because of its toxicity, the clinical use of mercury and mercurials is diminishing. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Modeling: A treatment procedure whereby the therapist presents the target behavior which
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the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Monogenic: A human disease caused by a mutation in a single gene. [NIH] Morphological: Relating to the configuration or the structure of live organs. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucopurulent: Containing both mucus and pus. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Mycoplasma: A genus of gram-negative, facultatively anaerobic bacteria bounded by a plasma membrane only. Its organisms are parasites and pathogens, found on the mucous membranes of humans, animals, and birds. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action
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toward a goal he believes will satisfy the impulse. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nurse Practitioners: Nurses who are specially trained to assume an expanded role in
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providing medical care under the supervision of a physician. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Obstetrics: A medical-surgical specialty concerned with management and care of women during pregnancy, parturition, and the puerperium. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Occult Blood: Chemical, spectroscopic, or microscopic detection of extremely small amounts of blood. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Office Visits: Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up. [NIH] Oncogenic: Chemical, viral, radioactive or other agent that causes cancer; carcinogenic. [NIH] On-line: A sexually-reproducing population derived from a common parentage. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opportunistic Infections: An infection caused by an organism which becomes pathogenic under certain conditions, e.g., during immunosuppression. [NIH] Oral Manifestations: Disorders of the mouth attendant upon non-oral disease or injury. [NIH]
Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palliative therapy: Treatment given to relieve symptoms caused by advanced cancer. Palliative therapy does not alter the course of a disease but improves the quality of life. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH]
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Pap test: The collection of cells from the cervix for examination under a microscope. It is used to detect changes that may be cancer or may lead to cancer, and can show noncancerous conditions, such as infection or inflammation. Also called a Pap smear. [NIH] Papilloma: A benign epithelial neoplasm which may arise from the skin, mucous membranes or glandular ducts. [NIH] Papillomavirus: A genus of Papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH] Parotid: The space that contains the parotid gland, the facial nerve, the external carotid artery, and the retromandibular vein. [NIH] Parturition: The act or process of given birth to a child. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathologist: A doctor who identifies diseases by studying cells and tissues under a microscope. [NIH] Patient Compliance: Voluntary cooperation of the patient in following a prescribed regimen. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] PDQ: Physician Data Query. PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information is available on the CancerNet Web site, and more specific information about PDQ can be found at http://cancernet.nci.nih.gov/pdq.html. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Pentoxifylline: A methylxanthine derivative that inhibits phosphodiesterase and affects blood rheology. It improves blood flow by increasing erythrocyte and leukocyte flexibility. It also inhibits platelet aggregation. Pentoxifylline modulates immunologic activity by stimulating cytokine production. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perianal: Located around the anus. [EU]
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Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontitis: Inflammation of the periodontal membrane; also called periodontitis simplex. [NIH]
Peripheral blood: Blood circulating throughout the body. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Phallic: Pertaining to the phallus, or penis. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phosphodiesterase: Effector enzyme that regulates the levels of a second messenger, the cyclic GMP. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorylated: Attached to a phosphate group. [NIH] Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]
Pilot study: The initial study examining a new method or treatment. [NIH] Pineal Body: A small conical midline body attached to the posterior part of the third ventricle and lying between the superior colliculi, below the splenium of the corpus callosum. [NIH] Pineal gland: A tiny organ located in the cerebrum that produces melatonin. Also called pineal body or pineal organ. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plastids: Self-replicating cytoplasmic organelles of plant and algal cells that contain pigments and may synthesize and accumulate various substances. Plastids are used in phylogenetic studies. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH]
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Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]
Pneumonia: Inflammation of the lungs. [NIH] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polyposis: The development of numerous polyps (growths that protrude from a mucous membrane). [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Pregnancy Outcome: Results of conception and ensuing pregnancy, including live birth, stillbirth, spontaneous abortion, induced abortion. The outcome may follow natural or artificial insemination or any of the various reproduction techniques, such as embryo transfer or fertilization in vitro. [NIH]
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Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]
Prophylaxis: An attempt to prevent disease. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostatectomy: Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus
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of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Puerperium: Period from delivery of the placenta until return of the reproductive organs to their normal nonpregnant morphologic state. In humans, the puerperium generally lasts for six to eight weeks. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]
Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radio Waves: That portion of the electromagnetic spectrum beyond the microwaves, with wavelengths as high as 30 KM. They are used in communications, including television. Short Wave or HF (high frequency), UHF (ultrahigh frequency) and VHF (very high frequency) waves are used in citizen's band communication. [NIH] Radioactive: Giving off radiation. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in
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the diagnosis and treatment of disease. [NIH] Radiopharmaceutical: Any medicinal product which, when ready for use, contains one or more radionuclides (radioactive isotopes) included for a medicinal purpose. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Relaxation Techniques: The use of muscular relaxation techniques in treatment. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]
Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Reproduction Techniques: Methods pertaining to the generation of new individuals. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Resolving: The ability of the eye or of a lens to make small objects that are close together, separately visible; thus revealing the structure of an object. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into
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the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retropubic: A potential space between the urinary bladder and the symphisis and body of the pubis. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Rheology: The study of the deformation and flow of matter, usually liquids or fluids, and of the plastic flow of solids. The concept covers consistency, dilatancy, liquefaction, resistance to flow, shearing, thixotrophy, and viscosity. [NIH] Ribosome: A granule of protein and RNA, synthesized in the nucleolus and found in the cytoplasm of cells. Ribosomes are the main sites of protein synthesis. Messenger RNA attaches to them and there receives molecules of transfer RNA bearing amino acids. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Rubber: A high-molecular-weight polymeric elastomer derived from the milk juice (latex) of Hevea brasiliensis and other trees. It is a substance that can be stretched at room temperature to atleast twice its original length and after releasing the stress, retractrapidly, and recover its original dimensions fully. Synthetic rubber is made from many different chemicals, including styrene, acrylonitrile, ethylene, propylene, and isoprene. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH]
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Screening: Checking for disease when there are no symptoms. [NIH] Scrotum: In males, the external sac that contains the testicles. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sexual Partners: Married or single individuals who share sexual relations. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Silicon: A trace element that constitutes about 27.6% of the earth's crust in the form of silicon dioxide. It does not occur free in nature. Silicon has the atomic symbol Si, atomic number 14, and atomic weight 28.09. [NIH] Silicon Dioxide: Silica. Transparent, tasteless crystals found in nature as agate, amethyst, chalcedony, cristobalite, flint, sand, quartz, and tridymite. The compound is insoluble in water or acids except hydrofluoric acid. [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Smoking Cessation: Discontinuation of the habit of smoking, the inhaling and exhaling of tobacco smoke. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Socioeconomic Factors: Social and economic factors that characterize the individual or group within the social structure. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the
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axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spontaneous Abortion: The non-induced birth of an embryo or of fetus prior to the stage of viability at about 20 weeks of gestation. [NIH] Squamous: Scaly, or platelike. [EU] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cells: Flat cells that look like fish scales under a microscope. These cells cover internal and external surfaces of the body. [NIH] Squamous Epithelium: Tissue in an organ such as the esophagus. Consists of layers of flat, scaly cells. [NIH] Squamous intraepithelial lesion: SIL. A general term for the abnormal growth of squamous cells on the surface of the cervix. The changes in the cells are described as low grade or high grade, depending on how much of the cervix is affected and how abnormal the cells appear. [NIH]
Stabilization: The creation of a stable state. [EU] Standardize: To compare with or conform to a standard; to establish standards. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones,
Dictionary 179
bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Styrene: A colorless, toxic liquid with a strong aromatic odor. It is used to make rubbers, polymers and copolymers, and polystyrene plastics. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substrate: A substance upon which an enzyme acts. [EU] Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Supportive care: Treatment given to prevent, control, or relieve complications and side effects and to improve the comfort and quality of life of people who have cancer. [NIH] Surgical Instruments: Hand-held tools or implements used by health professionals for the performance of surgical tasks. [NIH] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH]
180 Pap Smear
Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Telomerase: Essential ribonucleoprotein reverse transcriptase that adds telomeric DNA to the ends of eukaryotic chromosomes. Telomerase appears to be repressed in normal human somatic tissues but reactivated in cancer, and thus may be necessary for malignant transformation. EC 2.7.7.-. [NIH] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrush: A disease due to infection with species of fungi of the genus Candida. [NIH] Thymidine: A chemical compound found in DNA. Also used as treatment for mucositis. [NIH]
Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transcriptase: An enzyme which catalyses the synthesis of a complementary mRNA molecule from a DNA template in the presence of a mixture of the four ribonucleotides
Dictionary 181
(ATP, UTP, GTP and CTP). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translating: Conversion from one language to another language. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translational: The cleavage of signal sequence that directs the passage of the protein through a cell or organelle membrane. [NIH] Transurethral: Performed through the urethra. [EU] Transurethral resection: Surgery performed with a special instrument inserted through the urethra. Also called TUR. [NIH] Transurethral Resection of Prostate: Resection of the prostate using a cystoscope passed through the urethra. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Triage: The sorting out and classification of patients or casualties to determine priority of need and proper place of treatment. [NIH] Tubal ligation: An operation to tie the fallopian tubes closed. This procedure prevents pregnancy by blocking the passage of eggs from the ovaries to the uterus. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Tumorigenic: Chemical, viral, radioactive or other agent that causes cancer; carcinogenic. [NIH]
Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urban Population: The inhabitants of a city or town, including metropolitan areas and suburban areas. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]
Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urogenital: Pertaining to the urinary and genital apparatus; genitourinary. [EU] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vacuoles: Any spaces or cavities within a cell. They may function in digestion, storage,
182 Pap Smear
secretion, or excretion. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginal: Of or having to do with the vagina, the birth canal. [NIH] Vaginal Smears: Collection of pooled secretions of the posterior vaginal fornix for cytologic examination. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vial: A small bottle. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Load: The quantity of measurable virus in the blood. Change in viral load, measured in plasma, is used as a surrogate marker in HIV disease progression. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Vulva: The external female genital organs, including the clitoris, vaginal lips, and the opening to the vagina. [NIH] Wart: A raised growth on the surface of the skin or other organ. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]
Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as
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may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Womb: A hollow, thick-walled, muscular organ in which the impregnated ovum is developed into a child. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH]
185
INDEX A Abdominal, 147, 169, 171 Aberrant, 22, 116, 147 Abortion, 147, 172 Absolute risk, 21, 147 Acculturation, 17, 29, 83, 147 Acid Phosphatase, 87, 88, 147 Acrylonitrile, 147, 176 Actinomyces, 109, 147 Acute lymphoblastic leukemia, 77, 147 Acute lymphocytic leukemia, 147 Acyclovir, 126, 147 Adaptability, 93, 147 Adenocarcinoma, 37, 102, 116, 147 Adverse Effect, 147, 177 Agonist, 147, 167, 168 Aldehyde Dehydrogenase, 147, 156 Algorithms, 10, 90, 147, 150 Alkaloid, 148, 168 Alleles, 24, 148 Alpha Particles, 148, 174 Alternative medicine, 117, 148 Amenorrhea, 77, 148 Amino acid, 148, 149, 160, 170, 173, 176, 181 Amino Acid Sequence, 148, 149, 160 Amplification, 9, 22, 26, 27, 37, 148 Anaerobic, 148, 167 Anal, 148, 159 Analog, 92, 147, 148 Anaphylatoxins, 148, 154 Anchorage, 83, 95, 148 Anesthesia, 97, 148 Animal model, 13, 148 Annealing, 149, 172 Anogenital, 8, 77, 149 Antibiotics, 126, 149 Antibodies, 14, 149, 163, 166, 171, 174 Antibody, 149, 153, 162, 163, 167, 174, 175, 177, 178 Antidepressant, 149, 155 Antigen, 101, 149, 154, 162, 163, 177 Antigen-Antibody Complex, 149, 154 Antimetabolite, 147, 149, 151 Antineoplastic, 149, 151 Antioxidant, 149, 150 Antiviral, 8, 126, 147, 149, 151 Anus, 148, 149, 153, 170
Anxiety, 76, 80, 131, 149 Applicability, 9, 149 Aqueous, 149, 150, 155, 157, 165 Arterial, 149, 162, 173, 180 Arteries, 149, 150, 151, 155, 166 Artery, 149, 150, 155, 170, 174, 182 Artifacts, 56, 103, 149 Ascorbic Acid, 24, 149 Aspiration, 112, 150 Assay, 9, 24, 26, 48, 88, 89, 150, 163 Asymptomatic, 62, 66, 89, 91, 126, 150 Atypical, 11, 14, 18, 26, 43, 46, 52, 55, 68, 72, 101, 150 Autoimmune disease, 8, 150 B Bacteria, 147, 149, 150, 161, 166, 167, 178, 181 Base, 20, 100, 150, 155, 160, 164 Basophils, 150, 165 Benign, 12, 26, 32, 62, 101, 116, 150, 168, 170, 175 Bile, 150, 162, 165, 179 Biochemical, 24, 148, 149, 150, 159 Biomarkers, 14, 24, 29, 39, 76, 150 Biopsy, 12, 15, 17, 24, 33, 64, 104, 150 Biotechnology, 26, 27, 109, 117, 125, 150 Bladder, 150, 154, 163, 173, 176, 181 Blood Glucose, 4, 150, 161, 164 Blood pressure, 150, 162, 167 Blood vessel, 150, 151, 152, 158, 165, 177, 180, 182 Blot, 24, 151 Body Fluids, 100, 150, 151, 181 Body Mass Index, 151, 169 Bone Marrow, 147, 151, 165, 167 Brachytherapy, 151, 164, 174 Branch, 102, 109, 143, 151, 165, 170, 174, 178, 180 Breast Self-Examination, 77, 151 Bromodeoxyuridine, 95, 151 C Calcium, 151, 154 Candida albicans, 90, 151 Candidiasis, 89, 107, 151 Candidosis, 151 Carbon Dioxide, 151, 159, 176 Carcinogenesis, 100, 151 Carcinogenic, 151, 169, 179, 181
186 Pap Smear
Carcinogenicity, 111, 151 Carcinoma, 13, 18, 38, 56, 101, 116, 151, 152 Cardiac, 152, 157, 167, 178 Carotene, 76, 152 Case report, 58, 152, 153 Case series, 152, 153 Caudal, 152, 172 Cell Division, 95, 150, 152 Cell Size, 152, 159 Cerebral, 152, 159 Cerebrum, 152, 171 Cervical intraepithelial neoplasia, 18, 36, 38, 76, 104, 152 Cervix Dysplasia, 23, 152 Chemotactic Factors, 152, 154 Chin, 80, 152, 166 Cholesterol, 150, 152, 179 Cholinergic, 153, 168 Chromatin, 153, 157, 168 Chromosomal, 148, 153 Chronic, 4, 58, 66, 131, 132, 133, 153, 156, 163, 164, 179 CIS, 20, 131, 132, 133, 153 Citrus, 149, 153 Clinical Medicine, 9, 153, 172 Clinical study, 13, 153 Clinical trial, 4, 18, 23, 125, 153, 155, 170, 173, 175 Cloning, 150, 153 Coenzyme, 126, 150, 153 Cofactor, 153, 173 Colon, 12, 153, 165 Colorectal, 7, 153 Colorectal Cancer, 7, 153 Colposcope, 104, 153 Communication Barriers, 8, 153 Complement, 104, 148, 153, 154 Complementary and alternative medicine, 75, 82, 154 Complementary medicine, 75, 154 Compliance, 13, 154 Computational Biology, 125, 154 Conception, 147, 154, 155, 159, 172 Condyloma, 80, 154 Cone, 154 Conization, 43, 154 Connective Tissue, 150, 151, 154, 165, 176 Consultation, 112, 154, 158 Consumption, 19, 154, 155, 176 Contamination, 89, 102, 155 Contraception, 35, 40, 65, 155
Contraindications, ii, 155 Control group, 6, 25, 155 Controlled study, 23, 155 Coronary, 155, 166 Coronary Thrombosis, 155, 166 Corpus, 20, 155, 171, 173, 182 Cost Savings, 18, 155 Cotinine, 21, 155 Criterion, 56, 155 Cryotherapy, 9, 155 Curative, 155, 180 Curettage, 117, 131, 155 Curette, 155 Cutaneous, 151, 155 Cytokine, 155, 170 Cytoplasm, 91, 92, 150, 155, 157, 167, 168, 176 Cytotoxic, 155, 174, 175 D Data Collection, 155, 159 Denaturation, 155, 172 Density, 91, 151, 155, 159, 169, 178 Developed Countries, 18, 101, 155 Diabetes Mellitus, 8, 155, 161 Diagnostic procedure, 85, 118, 156 Diastolic, 156, 162 Diathermy, 23, 156 Digestion, 150, 156, 164, 165, 179, 181 Digestive tract, 156, 178 Dilatation, 147, 156, 173, 182 Direct, iii, 20, 35, 153, 156, 175 Discrimination, 86, 156 Disease Progression, 112, 156, 182 Distal, 97, 104, 156, 174 Disulfiram, 126, 156 Domestic Violence, 6, 156 Dorsal, 156, 172 Drug Interactions, 156 Duodenum, 150, 156, 179 Dyes, 150, 156, 159, 168 Dysplasia, 7, 18, 23, 81, 87, 88, 131, 156 E Effector, 153, 156, 171 Efficacy, 7, 11, 23, 90, 156 Ejaculation, 156, 177 Elastic, 17, 156, 178 Embryo, 147, 156, 157, 163, 172, 178 Embryo Transfer, 157, 172 Empirical, 17, 157 Emulsion, 157, 159 Endocarditis, 151, 157 Endocrine Glands, 157
Index 187
Endocrinology, 78, 157, 161 Endometrial, 11, 31, 42, 60, 62, 68, 116, 157 Endometrium, 78, 157 Endoscopy, 103, 157 Endotoxins, 154, 157 Environmental Health, 124, 126, 157 Enzymatic, 148, 151, 152, 154, 157, 172 Enzyme, 87, 147, 153, 156, 157, 171, 172, 173, 179, 180, 182 Eosinophils, 157, 165 Epidemiological, 6, 9, 112, 157 Epidermoid carcinoma, 157, 178 Epithelial, 8, 11, 18, 88, 92, 147, 157, 158, 170 Epithelial Cells, 18, 88, 157, 158 Epithelium, 11, 78, 91, 98, 152, 154, 158, 170 Erythrocytes, 151, 158, 175 Esophagus, 156, 158, 178, 179 Estrogen, 78, 80, 158 Eukaryotic Cells, 158, 169 Evaluable patients, 8, 158 Excitation, 90, 158, 159 Expert Systems, 19, 158, 163 Exploratory Behavior, 11, 158 External-beam radiation, 158, 174 Extraction, 9, 158 Exudate, 57, 158 F Facial, 158, 170 Facial Nerve, 158, 170 Fallopian tube, 158, 181 Family Planning, 109, 125, 134, 158 Family Practice, 39, 42, 53, 54, 59, 60, 66, 158 Fat, 19, 151, 152, 158, 165, 169, 177 Fatigue, 91, 93, 158 Fecal occult blood test, 5, 7, 158 Fertilization in Vitro, 158, 172 Fetus, 147, 159, 173, 178, 179, 181 Fixation, 99, 159 Flow Cytometry, 95, 159 Fluorescence, 10, 90, 92, 99, 159 Fluorescent Dyes, 99, 159 Flushing, 99, 156, 159 Focus Groups, 5, 25, 134, 159 Folate, 24, 159 Folic Acid, 73, 159 Fornix, 87, 159, 182 Fovea, 159 Frontal Lobe, 97, 159 Fungus, 151, 160
G Gamma Rays, 160, 174, 175 Gas, 151, 160, 162, 168, 179, 182 Gastrointestinal, 29, 160, 181 Gene, 22, 33, 109, 148, 150, 160, 167 Gene Expression, 22, 160 Generator, 92, 160 Genetic Code, 160, 168 Genetic Screening, 19, 160 Genetic testing, 160, 172 Genetics, 14, 160, 170 Genital, 31, 39, 40, 44, 48, 67, 100, 101, 160, 161, 181, 182 Gestation, 160, 171, 178 Gingivitis, 107, 160 Gland, 107, 160, 165, 169, 170, 173, 177, 179, 180 Glucose, 149, 150, 155, 160, 161, 164, 176 Glucose Intolerance, 155, 160 Gonadal, 161, 178 Gonorrhea, 9, 89, 161 Governing Board, 161, 172 Grade, 7, 14, 18, 22, 23, 26, 27, 52, 53, 56, 61, 76, 90, 101, 161, 178 Graft, 161, 162 Gram-negative, 161, 167 Gram-positive, 147, 161 Growth, 11, 78, 95, 96, 149, 152, 161, 162, 164, 166, 168, 178, 180, 182 Gynecology, 10, 15, 19, 30, 36, 38, 39, 43, 52, 57, 79, 80, 101, 161 H Health Behavior, 22, 83, 161 Health Policy, 4, 161 Health Promotion, 5, 131, 132, 133, 161 Health Status, 4, 161 Hemoglobin, 4, 17, 158, 161 Hepatoma, 13, 161 Heredity, 160, 161 Herpes, 108, 112, 126, 147, 162 Herpes virus, 126, 162 Herpes Zoster, 108, 162 Hippocampus, 159, 162 Homologous, 148, 162, 179 Hormonal, 35, 93, 162 Hormone, 162, 164, 173, 180 Host, 24, 151, 162, 181 Human papillomavirus, 9, 11, 14, 18, 22, 26, 27, 34, 39, 40, 44, 48, 66, 135, 162 Humoral, 24, 162 Humour, 162 Hybrid, 7, 48, 162
188 Pap Smear
Hydrogen, 150, 155, 162, 167, 168, 174 Hyperplasia, 54, 162 Hypertension, 3, 162 Hyperthermia, 156, 162 Hypertrophy, 162 Hypotension, 156, 162 Hysterectomy, 11, 32, 40, 58, 118, 162 I Id, 72, 80, 130, 131, 136, 142, 144, 162 Image Cytometry, 95, 162 Immune response, 14, 24, 149, 150, 163, 181, 182 Immune system, 8, 163, 166, 181, 182 Immunity, 24, 76, 163 Immunoassay, 24, 163 Immunodeficiency, 8, 61, 107, 111, 163 Immunodeficiency syndrome, 107, 111, 163 Immunofluorescence, 35, 163 Immunohistochemistry, 103, 163 Immunologic, 9, 152, 163, 170, 175 Immunology, 14, 159, 163 Implant radiation, 163, 164, 174 In situ, 14, 20, 37, 67, 95, 163 In vitro, 6, 10, 87, 88, 90, 95, 157, 163, 172, 177 In vivo, 10, 13, 18, 90, 163 Incision, 163, 164, 173 Incontinence, 118, 163 Indicative, 98, 99, 108, 163, 170, 182 Induction, 156, 163 Infarction, 155, 163, 166 Infiltrating cancer, 164 Inflammation, 81, 158, 160, 162, 164, 170, 171, 172, 182 Inorganic, 164, 167 Insulin, 11, 164 Insulin-dependent diabetes mellitus, 164 Insulin-like, 11, 164 Internal radiation, 164, 174 Intestinal, 152, 164 Intestine, 153, 156, 162, 164, 165 Intoxication, 164, 183 Intracellular, 87, 163, 164 Intraepithelial, 14, 22, 23, 26, 55, 67, 90, 164 Invasive, 7, 10, 11, 13, 14, 18, 20, 22, 23, 41, 45, 51, 98, 101, 104, 152, 163, 164 Invasive cancer, 13, 20, 22, 41, 51, 104, 164 Invasive cervical cancer, 10, 11, 14, 22, 45, 98, 164 Involuntary, 164, 167, 175
Ionizing, 148, 164, 175 Ions, 150, 162, 164 K Kb, 124, 164 Kidney Disease, 4, 124, 164 L Labile, 153, 164 Large Intestine, 153, 156, 164, 165, 175 Lavage, 9, 24, 25, 165 Lens, 104, 165, 175 Lethal, 11, 165 Leukemia, 165 Leukocytes, 8, 150, 151, 152, 157, 165, 167, 168 Leukoplakia, 107, 165 Library Services, 142, 165 Ligament, 158, 165, 173 Ligation, 165 Linkages, 161, 165 Lipid, 164, 165 Liver, 147, 150, 157, 159, 161, 165 Lobe, 97, 165 Localization, 26, 163, 165 Localized, 22, 159, 163, 165 Loop, 23, 55, 104, 131, 165 Lymph, 13, 152, 162, 165 Lymph node, 13, 152, 165 Lymphatic, 164, 165, 180 Lymphatic system, 165, 180 Lymphoblastic, 165 Lymphoblasts, 147, 166 Lymphocyte, 149, 166 Lymphoid, 149, 166 M Malignancy, 11, 23, 44, 96, 166, 170 Malignant, 12, 26, 91, 92, 93, 95, 99, 111, 147, 149, 163, 166, 168, 175, 176, 180 Mammogram, 3, 5, 11, 30, 59, 67, 166 Mammography, 4, 7, 11, 12, 16, 19, 29, 30, 32, 38, 52, 64, 66, 117, 166 Mass Screening, 61, 166 Medical Records, 31, 166 MEDLINE, 125, 166 Membrane, 154, 158, 161, 166, 167, 169, 171, 172, 176, 181 Menopause, 81, 116, 166, 172 Menstruation, 148, 166 Mental, iv, 4, 6, 124, 127, 152, 158, 166, 174, 176 Mental Health, iv, 4, 6, 124, 127, 166, 174 Mercury, 159, 166 MI, 104, 146, 166
Index 189
Microbiology, 14, 18, 37, 150, 166 Microorganism, 153, 166, 182 Microscopy, 78, 95, 166 Migration, 95, 166 Mitochondria, 166, 169 Modeling, 10, 17, 166 Modification, 5, 148, 167, 174 Molecular, 18, 22, 26, 47, 125, 128, 148, 150, 154, 167, 176 Molecule, 149, 150, 153, 154, 156, 158, 167, 175, 180 Monitor, 11, 167, 168 Monoclonal, 167, 174 Monocytes, 165, 167 Monogenic, 14, 167 Morphological, 17, 92, 157, 160, 167 Mucins, 167, 176 Mucopurulent, 57, 167 Mucus, 97, 167 Mycoplasma, 126, 167 Myocardium, 166, 167 N Naloxone, 167 Naltrexone, 126, 167 Narcotic, 167 Nausea, 156, 167 NCI, 1, 11, 20, 123, 131, 132, 133, 153, 167, 170 Neoplasia, 11, 23, 35, 54, 67, 90, 102, 111, 168 Neoplasm, 11, 168, 170, 176 Neoplastic, 22, 91, 151, 168 Nephropathy, 164, 168 Nerve, 148, 152, 158, 168, 176, 179 Nervous System, 168, 179 Networks, 13, 163, 168 Neural, 54, 162, 168 Neurons, 168, 179 Neuropathy, 126, 168 Neutrons, 148, 168, 174 Neutrophils, 165, 168 Nicotine, 24, 168 Nitrogen, 148, 159, 168 Nuclear, 55, 92, 158, 160, 168 Nuclei, 92, 95, 148, 168, 173 Nucleic acid, 37, 160, 168 Nucleus, 91, 92, 150, 153, 155, 157, 158, 160, 167, 168, 173, 179 Nurse Practitioners, 134, 168 O Observational study, 21, 169
Obstetrics, 10, 19, 29, 30, 36, 38, 39, 43, 48, 56, 57, 61, 66, 169 Occult, 158, 169 Occult Blood, 169 Odds Ratio, 169, 175 Office Visits, 15, 169 Oncogenic, 7, 15, 23, 39, 169 On-line, 31, 145, 169 Opacity, 155, 169 Ophthalmology, 159, 169 Opportunistic Infections, 126, 169 Oral Manifestations, 107, 169 Organelles, 95, 155, 167, 169, 171 Outpatient, 19, 33, 169 Ovaries, 60, 169, 181 Overweight, 72, 117, 169 P Palliative, 96, 169, 180 Palliative therapy, 96, 169 Pancreas, 147, 150, 164, 169, 181 Pap test, 7, 11, 21, 43, 48, 87, 88, 89, 91, 93, 99, 104, 116, 170 Papilloma, 20, 77, 88, 89, 90, 111, 154, 170 Papillomavirus, 18, 170 Parotid, 108, 170 Parturition, 169, 170 Patch, 165, 170 Pathologic, 150, 151, 155, 170, 182 Pathologies, 18, 170 Pathologist, 22, 87, 99, 170 Patient Compliance, 44, 170 Patient Education, 44, 134, 140, 142, 146, 170 Patient Satisfaction, 16, 23, 170 PDQ, 131, 133, 170 Pelvic, 9, 23, 34, 80, 97, 104, 112, 113, 118, 135, 170, 173 Pelvis, 169, 170, 181 Pentoxifylline, 126, 170 Peptide, 126, 148, 170, 173 Perception, 87, 88, 154, 170, 176 Perianal, 154, 170 Perinatal, 108, 171 Periodontal disease, 107, 171 Periodontitis, 160, 171 Peripheral blood, 8, 171 Peritoneal, 38, 171 Peritoneum, 171 Phallic, 159, 171 Pharmacologic, 148, 171, 180 Phosphodiesterase, 170, 171 Phospholipids, 158, 171
190 Pap Smear
Phosphorylated, 153, 171 Physiology, 157, 161, 171 Pigments, 152, 171 Pilot study, 23, 76, 171 Pineal Body, 171 Pineal gland, 78, 171 Plasma, 24, 149, 160, 161, 167, 171, 177, 182 Plasma cells, 149, 171 Plastids, 169, 171 Platelet Aggregation, 148, 170, 171 Platinum, 165, 172 Pneumonia, 155, 172 Polymerase, 24, 172 Polymerase Chain Reaction, 24, 172 Polymorphism, 14, 172 Polyposis, 153, 172 Polysaccharide, 149, 172 Port, 103, 172 Port-a-cath, 172 Posterior, 87, 148, 156, 169, 171, 172, 182 Postmenopausal, 62, 78, 172 Practice Guidelines, 127, 172 Precancerous, 10, 13, 96, 172, 173 Preclinical, 41, 172 Precursor, 26, 90, 156, 157, 172 Pregnancy Outcome, 57, 172 Premalignant, 23, 26, 93, 172, 173 Prenatal, 156, 160, 173 Prevalence, 6, 9, 16, 26, 86, 169, 173 Probe, 90, 93, 173 Progesterone, 173, 178 Progression, 11, 20, 22, 23, 148, 173 Progressive, 161, 173 Projection, 97, 103, 104, 173 Prolapse, 118, 173 Prophylaxis, 173, 181 Prospective study, 24, 173 Prostate, 4, 13, 150, 173, 181 Prostatectomy, 118, 173 Protein S, 109, 150, 160, 173, 176 Proteins, 11, 148, 149, 151, 153, 167, 168, 170, 171, 173, 177, 180 Proteolytic, 154, 173 Protocol, 6, 8, 10, 26, 126, 173 Protons, 148, 162, 164, 173, 174 Proximal, 104, 156, 174 Psychiatry, 159, 174 Psychic, 166, 174 Psychoactive, 174, 183
Public Health, 11, 15, 18, 25, 30, 38, 41, 44, 46, 52, 58, 59, 63, 68, 69, 109, 127, 134, 174 Public Policy, 125, 174 Puerperium, 169, 174 Pulse, 95, 167, 174 Q Quality of Life, 7, 19, 131, 169, 174, 179 R Race, 134, 166, 174 Radiation, 56, 158, 159, 160, 162, 164, 174, 175, 183 Radiation therapy, 56, 158, 164, 174 Radio Waves, 156, 174 Radioactive, 162, 163, 164, 168, 169, 174, 175, 181 Radioimmunotherapy, 174, 175 Radiolabeled, 174 Radiology, 12, 174 Radiopharmaceutical, 160, 175 Radiotherapy, 100, 151, 174, 175 Randomized, 6, 8, 12, 13, 25, 27, 47, 49, 57, 64, 76, 156, 175 Receptor, 149, 154, 175 Recombinant, 126, 175 Rectum, 149, 153, 156, 160, 163, 165, 173, 175 Recurrence, 11, 15, 175 Red blood cells, 91, 158, 175, 176 Refer, 1, 69, 153, 159, 162, 165, 168, 174, 175 Reflex, 22, 175 Regimen, 156, 170, 175 Relapse, 77, 175 Relative risk, 20, 147, 175 Relaxation Techniques, 80, 175 Reliability, 20, 60, 90, 175 Remission, 175 Reproduction Techniques, 172, 175 Research Design, 20, 175 Resolving, 25, 175 Respiration, 151, 166, 167, 175 Retina, 165, 176 Retropubic, 173, 176 Retrospective, 10, 55, 176 Rheology, 170, 176 Ribosome, 176, 181 Risk factor, 6, 25, 61, 70, 75, 173, 175, 176 Rod, 104, 147, 176 Rubber, 97, 104, 147, 176 S Saliva, 21, 107, 176
Index 191
Salivary, 158, 176 Salivary glands, 158, 176 Saponins, 176, 179 Sarcoma, 107, 176 Schizoid, 176, 183 Schizophrenia, 176, 183 Schizotypal Personality Disorder, 176, 183 Scrotum, 177, 180 Secretion, 162, 164, 167, 177, 182 Segmentation, 94, 177 Semen, 31, 156, 173, 177 Sequencing, 172, 177 Serologic, 163, 177 Serology, 8, 24, 177 Serous, 38, 177 Serum, 8, 11, 148, 153, 177 Sexual Partners, 108, 177 Sexually Transmitted Diseases, 50, 58, 108, 112, 135, 177 Side effect, 147, 177, 179, 180 Signs and Symptoms, 175, 177 Silicon, 98, 177 Silicon Dioxide, 177 Skeleton, 48, 177 Smoking Cessation, 21, 23, 177 Social Environment, 174, 177 Social Support, 79, 177 Socioeconomic Factors, 22, 177 Soft tissue, 151, 177 Soma, 177, 178 Somatic, 26, 162, 178, 180 Sound wave, 156, 178 Specialist, 136, 178 Species, 65, 147, 151, 162, 166, 167, 174, 178, 179, 180, 183 Specificity, 10, 15, 26, 88, 90, 91, 178 Spectrum, 152, 174, 178 Sperm, 178, 180 Spinal cord, 153, 168, 175, 178 Spontaneous Abortion, 172, 178 Squamous, 8, 11, 14, 18, 23, 26, 32, 39, 46, 51, 55, 56, 61, 63, 90, 98, 100, 102, 108, 116, 157, 178 Squamous cell carcinoma, 26, 100, 108, 157, 178 Squamous cells, 14, 18, 26, 51, 55, 98, 178 Squamous Epithelium, 18, 178 Squamous intraepithelial lesion, 14, 23, 26, 39, 56, 61, 90, 178 Stabilization, 94, 178 Standardize, 23, 178 Steroid, 78, 176, 178
Stillbirth, 172, 179 Stimulus, 158, 175, 179, 180 Stomach, 100, 147, 156, 158, 160, 162, 165, 167, 179 Stool, 153, 158, 163, 165, 179 Strand, 172, 179 Stress, 3, 47, 116, 126, 159, 167, 176, 179 Styrene, 176, 179 Subacute, 163, 179 Subclinical, 163, 179 Subspecies, 178, 179 Substrate, 95, 179 Suction, 97, 104, 179 Supplementation, 76, 179 Supportive care, 170, 179 Surgical Instruments, 104, 179 Survival Rate, 112, 179 Symphysis, 152, 173, 179 Synaptic, 168, 179 Synaptic Transmission, 168, 179 Systemic, 8, 150, 151, 156, 164, 174, 180 Systolic, 162, 180 T Telomerase, 26, 180 Testicles, 13, 177, 180 Therapeutics, 78, 180 Thermal, 168, 172, 180 Threshold, 92, 162, 180 Thrombosis, 173, 180 Thrush, 151, 180 Thymidine, 151, 180 Thymus, 126, 165, 180 Thyroid, 13, 180 Tolerance, 147, 161, 180 Topical, 8, 180 Toxic, iv, 163, 168, 179, 180 Toxicity, 156, 166, 180 Toxicology, 126, 180 Toxins, 149, 157, 163, 174, 180 Trace element, 177, 180 Trachea, 180 Transcriptase, 180 Transfection, 150, 181 Translating, 10, 181 Translation, 15, 148, 181 Translational, 18, 181 Transurethral, 173, 181 Transurethral resection, 173, 181 Transurethral Resection of Prostate, 173, 181 Trees, 176, 181 Triage, 7, 15, 31, 35, 48, 66, 181
192 Pap Smear
Tubal ligation, 76, 181 Tumor marker, 150, 181 Tumorigenic, 18, 181 U Unconscious, 162, 181 Urban Population, 30, 50, 181 Urethra, 173, 181 Urinary, 118, 163, 173, 176, 181 Urine, 9, 150, 163, 181 Urogenital, 161, 181 Uterus, 96, 98, 147, 152, 155, 157, 162, 166, 169, 173, 181, 182 V Vaccination, 8, 181 Vaccine, 8, 14, 126, 173, 181 Vacuoles, 169, 181 Vagina, 87, 89, 93, 95, 96, 97, 100, 145, 151, 152, 153, 166, 182 Vaginal, 9, 15, 24, 25, 29, 32, 67, 78, 81, 89, 93, 96, 99, 101, 104, 108, 111, 118, 126, 130, 182 Vaginal Smears, 78, 182 Vaginitis, 67, 81, 151, 182 Vascular, 163, 164, 182 Vasodilation, 156, 182
VE, 33, 182 Vein, 168, 170, 182 Venous, 173, 182 Ventricle, 162, 171, 174, 180, 182 Vesicular, 162, 182 Veterinary Medicine, 125, 182 Vial, 14, 182 Viral, 7, 9, 20, 90, 169, 181, 182 Viral Load, 20, 182 Virus, 7, 8, 14, 20, 24, 34, 61, 77, 88, 89, 107, 111, 117, 132, 135, 162, 182 Vitreous, 165, 176, 182 Vitro, 7, 10, 95, 182 Vivo, 10, 13, 182 Vulva, 10, 100, 182 W Wart, 8, 117, 182 White blood cell, 147, 149, 165, 166, 167, 171, 182 Windpipe, 180, 182 Withdrawal, 24, 182 Womb, 181, 183 X Xenograft, 148, 183 X-ray, 159, 160, 166, 168, 174, 175, 183
Index 193
194 Pap Smear
Index 195
196 Pap Smear