The intraepithelial lesion: A spectrum of problems

Article Abstract:

The new classification and reporting system The Bethesda System, which has just been developed for communicating the results of Pap smears to the attending physician, is an improvement. When a routine pap smear is reported as abnormal, a chain of events is put into place that can become complex and that are critical. From a quality assurance viewpoint, each element must be controlled if this 'episode' can be properly handled. All too often the physician and his financial advisor seek low-price providers of Pap smears that can provide rapid service. While the cost to physicians has been declining, the cost to patients has been escalating. All too often the physician has become a broker more concerned with profit than with the quality of service provision. Laboratories providing cytopathology respond to the marketing pressures by cutting corners. False-negative rates for Pap smears are extremely dangerous. Every year a number of women die from cervical cancer because the quality of their Pap smear was allowed to decline. The current level of reimbursement offered by most insurers for Pap smears should be adequate to fund optimum levels of quality. Why doesn't it? In part the answer is contained in the business adage, 'buy low, sell high.' The Bethesda report also carries with it the statement that a Pap smear should carry the authority of a medical consultation, although the reason for this statement is not clear. Perhaps its purpose is to enhance reimbursement without adding value. In this case the author strongly disagrees. Insurers must take responsibility to reduce the incentives of their payment mechanisms, and physicians must take the responsibility for establishing standards for appropriate care and treatment.

Standards, Ethical aspects, Pap test, Cytodiagnosis, Diagnostic services, editorial, Exfoliative cytology

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Treatment for cervical Intraepithelial neoplasia and risk of preterm delivery

Article Abstract:

The determination whether cervical laser and loop electrosurgical excision procedure treatments increase risk of preterm delivery and its subtypes is elaborated. LEEP and laser cone treatments which are associated with significantly increased risk of pPROM is also explained.

Health aspects, Pregnant women, Premature labor, Cervix dysplasia, Premature labour

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Does this patient have instability of the shoulder or a labrum lesion?

Article Abstract:

The accuracy of clinical tests and history taking for shoulder instability or intraarticular pathology is analyzed. Shoulder complaints are frequently recurrent and instability might cause some of these complaints.

Shoulder pain

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