The Experts below are selected from a list of 1899 Experts worldwide ranked by ideXlab platform
Elisabeth Wikstrom Shemer - One of the best experts on this subject based on the ideXlab platform.
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diagnostic colposcopic accuracy by the gynocular and a stationary Colposcope
International Journal of Technology Assessment in Health Care, 2015Co-Authors: Helena Kopp Kallner, Daniel Altman, Malin Thorsell, Marcus Thuresson, Isaac Shemer, Maria Persson, Elisabeth Wikstrom ShemerAbstract:OBJECTIVES: The aim of this study was to evaluate the diagnostic accuracy of sensitivity and specificity of cervical lesions by the low-cost, portable Gynocular Colposcope and a stationary Colposcope, in women referred for colposcopy with abnormal cervical cytology. METHODS: A randomized cross-over clinical trial for evaluating the diagnostic accuracy in detecting cervical lesions by the Gynocular and a stationary Colposcope. The Swede score systematic colposcopy system was used for evaluation of colposcopic abnormalities. Directed punch biopsy and excisional cone biopsy were used as the "gold-standard" by histologically confirmed high grade cervical lesions CIN2+ (CIN2, CIN3, CIN3+). In total, 123 women referred for colposcopy due to abnormal cervical cytology were recruited at the Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden. The percentage agreement and the kappa statistic were calculated for Swede score by the Gynocular and a stationary Colposcope. Swede scores were compared with the results from directed punch biopsy and excisional cone biopsy. RESULTS: The Gynocular and the stationary Colposcope had a high agreement of Swede scores with a Kappa statistic of 0.947, p < .0001. Punch biopsy diagnosed CIN2+ (CIN2, CIN3, and invasive cancer) in 44 (35.7 percent) women while cytology detected CIN2+ in 34 (27.6 percent) women. There were no significant differences of the sensitivity and specificity for different Swede scores by the Gynocular or a stationary Colposcope in detecting CIN 2+. CONCLUSIONS: There were no significant differences in sensitivity or specificity in detecting cervical lesions by the Gynocular or stationary Colposcope. The Gynocular is as accurate in diagnosing cervical lesions as a stationary Colposcope.
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evaluation of the accuracy in detecting cervical lesions by nurses versus doctors using a stationary Colposcope and gynocular in a low resource setting
BMJ Open, 2014Co-Authors: Ashrafun Nessa, Charlotte Wistrand, Malin Thorsell, Most Afroza Chowdhury, Quayuma Khanam, Romena Afroz, Marcus Thuresson, Isaac Shemer, Elisabeth Wikstrom ShemerAbstract:Objectives: Evaluation of the performance of VIA (visual inspection with acetic acid) trained nurses to learn colposcopy and the Swede score method to detect cervical lesions by using stationary Colposcope or a portable, hand-held Colposcope; the Gynocular, as compared to doctors. Design: A crossover randomised clinical trial. Setting: The Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Participants: 932 women attending the clinic as either screening naive for VIA screening (404) or women referred as VIA positive (528) from other VIA screening centres in the Dhaka region. Intervention: VIA trained nurses were trained on-site in colposcopy and in the Swede score systematic colposcopy method. The Swede score grade cervical acetowhiteness, margins plus surface. vessel pattern, lesion size and iodine staining. The women were randomised to start the examination by either a stationary Colposcope or the Gynocular. Swede scores were first obtained by a nurse and the same patient was equally evaluated by a doctor. Primary and secondary outcome measures: Agreement between nurses and doctors in Swede scores was evaluated using the weighted κ statistic for the Gynocular and standard Colposcope. The ability to predict CIN 2+ (CIN 2, CIN 3 and invasive cervical cancer) using Swede scores was evaluated using receiver-operating characteristic curves. Results: The Swede scores obtained by nurses and doctors using the Gynocular and stationary Colposcope showed high agreement with a κ statistic of 0.858 and 0.859, respectively, and no difference in detecting cervical lesions in biopsy. Biopsy detected CIN 2+ in 39 (4.2%) women. Conclusions: Our study showed that VIA nurses can perform colposcopy. There was no significant differences compared to doctors in detecting cervical lesions by stationary Colposcope or the Gynocular using the Swede score system. Swede scores obtained by nurses using the Gynocular could offer an accurate cervical diagnostic approach in low resource settings. Trial registration number: ISRCTN53264564.
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evaluation of stationary Colposcope and the gynocular by the swede score systematic colposcopic system in via positive women a crossover randomized trial
International Journal of Gynecological Cancer, 2014Co-Authors: Ashrafun Nessa, Charlotte Wistrand, Malin Thorsell, Marcus Thuresson, Isaac Shemer, Shirin Akter Begum, Elisabeth Wikstrom ShemerAbstract:ObjectiveThis study aimed to evaluate cervical lesions by the Swede coloscopy system, histologic finding, liquid-based cytology, and human papillomavirus (HPV) in women who resulted positive for visual inspection of the cervix with acetic acid (VIA) by using a pocket-sized battery-driven Colposcope,
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agreement of Colposcope and gynocular in assessment of cervical lesions by swede score a randomized crossover pilot trial
Journal of Lower Genital Tract Disease, 2013Co-Authors: Joseph Ngonzi, Francis Bajunirwe, Charlotte Wistrand, Ronald Mayanja, Daniel Altman, Malin Thorsell, Elisabeth Wikstrom ShemerAbstract:h Abstract Objective. This study aimed to determine if criterion standard colposcopy could be provided by a pocket-sized battery-driven Colposcope, the Gynocular. Materials and Methods. The study was a randomized, crossover, pilot clinical trial for evaluating agreement of diagnosis of cervical lesions by colposcopy using a standard Colposcope and a pocket-sized battery-driven Colposcope, the Gynocular, in 69 women positive for visual inspection with acetic acid. Swede scores were used at the time of colposcopy and compared with the final histological diagnosis after directed cervicalbiopsy. To test the levelof agreement between the colposcopy and Gynocular, we calculated the percentage agreement and the J statistic. We calculated the detection rates of cervical lesions of the Gynocular and a standard Colposcope using biopsy results as criterion standards. All included patients also underwent a Pap smear. Results. The level of agreement of Swede score between the Gynocular and Colposcope was 70.1% and the J statistic was 0.65 (p G .001). Biopsy identified 4 women (6.7%) with cervical intraepithelial neoplasia 1 (CIN 1) and 1 woman (1.7%) with CIN 2; 2 women (3.4%) had CIN 3, and 2 women had invasive cervical cancer (CIN 3+). Pap smear detected 2 women (3.1%) with CIN 1 but did not identify any highgrade cervical lesion. Cervicitis was present in 17 (27.4%) of the Pap smears and in 34 (57.6%) of the biopsies. Conclusions. The study shows that in visual inspection with acetic acidYpositive women, a battery-driven, pocketsized Colposcope has a significant level of agreement with stationary colposcopy in assessing cervical lesions. h
Malin Thorsell - One of the best experts on this subject based on the ideXlab platform.
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Colposcopy telemedicine: live versus static swede score and accuracy in detecting CIN2+, a cross-sectional pilot study
BMC Women's Health, 2018Co-Authors: Katayoun Taghavi, Malin Thorsell, Helena Kopp Kallner, Dipanwita Banerjee, Ranajit Mandal, Therese Friis, Ljiljana Kocoska-maras, Björn Strander, Albert Singer, Elisabeth WikströmAbstract:Background This cross-sectional pilot study evaluates diagnostic accuracy of live colposcopy versus static image Swede-score evaluation for detecting significant precancerous cervical lesions greater than, or equal to grade 2 severity (CIN2+). Methods VIA or HrHPV positive women were examined using a mobile Colposcope, in a rural clinic in Kolkata, India. Live versus static Swede-score colposcopy assessments were made independently. All assessments were by gynecologists, junior or expert. Static image assessors were blinded to live scoring, patient information and final histopathology result. Primary outcome was the ability to detect CIN2+ lesions verified by directed biopsies. Diagnostic accuracy was calculated for live versus static Swede-score in detecting CIN2+ lesions, as well as for interclass correlation. Results 495 images from 94 VIA positive women were evaluated in this study. Thirteen women (13.9%) had CIN2+ on biopsy. No significant difference was found in the detection of CIN2+ lesions between live and static assessors (area under curve = 0.69 versus 0.71, p = 0.63). A Swede-score of 4+, had a sensitivity of 76.9% (95% CI 46.2–95.0%) and 84.6% (95% CI 54.6–98.1%), for live- and static-image assessment respectively. The corresponding positive predictive values were found to be 90.9% (95% CI 75.7–98.1%) and 92.6% (95% CI 75.7–99.1%). The interclass correlation was good (kappa statistic = 0.60) for the senior static assessors. Conclusions Swede-score evaluation of static colposcopy images was found to reliably detect CIN2+ lesions in this study. Larger studies are needed to further develop the colposcopy telemedicine concept which may offer reliable guidance in management where direct specialist input is not available. Trial registration Ethical approval of the study was obtained by the Chittaranjan National Cancer Institute (CNCI) Human Research Ethics Committee (4.311/27/2014). The trial was retrospectively registered in the Clinical Trails Registry of India CTRI/2018/03/012470 .
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diagnostic colposcopic accuracy by the gynocular and a stationary Colposcope
International Journal of Technology Assessment in Health Care, 2015Co-Authors: Helena Kopp Kallner, Daniel Altman, Malin Thorsell, Marcus Thuresson, Isaac Shemer, Maria Persson, Elisabeth Wikstrom ShemerAbstract:OBJECTIVES: The aim of this study was to evaluate the diagnostic accuracy of sensitivity and specificity of cervical lesions by the low-cost, portable Gynocular Colposcope and a stationary Colposcope, in women referred for colposcopy with abnormal cervical cytology. METHODS: A randomized cross-over clinical trial for evaluating the diagnostic accuracy in detecting cervical lesions by the Gynocular and a stationary Colposcope. The Swede score systematic colposcopy system was used for evaluation of colposcopic abnormalities. Directed punch biopsy and excisional cone biopsy were used as the "gold-standard" by histologically confirmed high grade cervical lesions CIN2+ (CIN2, CIN3, CIN3+). In total, 123 women referred for colposcopy due to abnormal cervical cytology were recruited at the Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden. The percentage agreement and the kappa statistic were calculated for Swede score by the Gynocular and a stationary Colposcope. Swede scores were compared with the results from directed punch biopsy and excisional cone biopsy. RESULTS: The Gynocular and the stationary Colposcope had a high agreement of Swede scores with a Kappa statistic of 0.947, p < .0001. Punch biopsy diagnosed CIN2+ (CIN2, CIN3, and invasive cancer) in 44 (35.7 percent) women while cytology detected CIN2+ in 34 (27.6 percent) women. There were no significant differences of the sensitivity and specificity for different Swede scores by the Gynocular or a stationary Colposcope in detecting CIN 2+. CONCLUSIONS: There were no significant differences in sensitivity or specificity in detecting cervical lesions by the Gynocular or stationary Colposcope. The Gynocular is as accurate in diagnosing cervical lesions as a stationary Colposcope.
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evaluation of the accuracy in detecting cervical lesions by nurses versus doctors using a stationary Colposcope and gynocular in a low resource setting
BMJ Open, 2014Co-Authors: Ashrafun Nessa, Charlotte Wistrand, Malin Thorsell, Most Afroza Chowdhury, Quayuma Khanam, Romena Afroz, Marcus Thuresson, Isaac Shemer, Elisabeth Wikstrom ShemerAbstract:Objectives: Evaluation of the performance of VIA (visual inspection with acetic acid) trained nurses to learn colposcopy and the Swede score method to detect cervical lesions by using stationary Colposcope or a portable, hand-held Colposcope; the Gynocular, as compared to doctors. Design: A crossover randomised clinical trial. Setting: The Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Participants: 932 women attending the clinic as either screening naive for VIA screening (404) or women referred as VIA positive (528) from other VIA screening centres in the Dhaka region. Intervention: VIA trained nurses were trained on-site in colposcopy and in the Swede score systematic colposcopy method. The Swede score grade cervical acetowhiteness, margins plus surface. vessel pattern, lesion size and iodine staining. The women were randomised to start the examination by either a stationary Colposcope or the Gynocular. Swede scores were first obtained by a nurse and the same patient was equally evaluated by a doctor. Primary and secondary outcome measures: Agreement between nurses and doctors in Swede scores was evaluated using the weighted κ statistic for the Gynocular and standard Colposcope. The ability to predict CIN 2+ (CIN 2, CIN 3 and invasive cervical cancer) using Swede scores was evaluated using receiver-operating characteristic curves. Results: The Swede scores obtained by nurses and doctors using the Gynocular and stationary Colposcope showed high agreement with a κ statistic of 0.858 and 0.859, respectively, and no difference in detecting cervical lesions in biopsy. Biopsy detected CIN 2+ in 39 (4.2%) women. Conclusions: Our study showed that VIA nurses can perform colposcopy. There was no significant differences compared to doctors in detecting cervical lesions by stationary Colposcope or the Gynocular using the Swede score system. Swede scores obtained by nurses using the Gynocular could offer an accurate cervical diagnostic approach in low resource settings. Trial registration number: ISRCTN53264564.
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evaluation of stationary Colposcope and the gynocular by the swede score systematic colposcopic system in via positive women a crossover randomized trial
International Journal of Gynecological Cancer, 2014Co-Authors: Ashrafun Nessa, Charlotte Wistrand, Malin Thorsell, Marcus Thuresson, Isaac Shemer, Shirin Akter Begum, Elisabeth Wikstrom ShemerAbstract:ObjectiveThis study aimed to evaluate cervical lesions by the Swede coloscopy system, histologic finding, liquid-based cytology, and human papillomavirus (HPV) in women who resulted positive for visual inspection of the cervix with acetic acid (VIA) by using a pocket-sized battery-driven Colposcope,
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agreement of Colposcope and gynocular in assessment of cervical lesions by swede score a randomized crossover pilot trial
Journal of Lower Genital Tract Disease, 2013Co-Authors: Joseph Ngonzi, Francis Bajunirwe, Charlotte Wistrand, Ronald Mayanja, Daniel Altman, Malin Thorsell, Elisabeth Wikstrom ShemerAbstract:h Abstract Objective. This study aimed to determine if criterion standard colposcopy could be provided by a pocket-sized battery-driven Colposcope, the Gynocular. Materials and Methods. The study was a randomized, crossover, pilot clinical trial for evaluating agreement of diagnosis of cervical lesions by colposcopy using a standard Colposcope and a pocket-sized battery-driven Colposcope, the Gynocular, in 69 women positive for visual inspection with acetic acid. Swede scores were used at the time of colposcopy and compared with the final histological diagnosis after directed cervicalbiopsy. To test the levelof agreement between the colposcopy and Gynocular, we calculated the percentage agreement and the J statistic. We calculated the detection rates of cervical lesions of the Gynocular and a standard Colposcope using biopsy results as criterion standards. All included patients also underwent a Pap smear. Results. The level of agreement of Swede score between the Gynocular and Colposcope was 70.1% and the J statistic was 0.65 (p G .001). Biopsy identified 4 women (6.7%) with cervical intraepithelial neoplasia 1 (CIN 1) and 1 woman (1.7%) with CIN 2; 2 women (3.4%) had CIN 3, and 2 women had invasive cervical cancer (CIN 3+). Pap smear detected 2 women (3.1%) with CIN 1 but did not identify any highgrade cervical lesion. Cervicitis was present in 17 (27.4%) of the Pap smears and in 34 (57.6%) of the biopsies. Conclusions. The study shows that in visual inspection with acetic acidYpositive women, a battery-driven, pocketsized Colposcope has a significant level of agreement with stationary colposcopy in assessing cervical lesions. h
Marlee S Krieger - One of the best experts on this subject based on the ideXlab platform.
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an integrated strategy for improving contrast durability and portability of a pocket Colposcope for cervical cancer screening and diagnosis
PLOS ONE, 2018Co-Authors: Jenna L. Mueller, Mercy Nyamewaa Asiedu, Betsy Asma, Marlee S Krieger, Rhea Chitalia, Denali Dahl, Peyton Taylor, John W Schmitt, Nimmi RamanujamAbstract:Introduction We have previously developed a portable Pocket Colposcope for cervical cancer screening in resource-limited settings. In this manuscript we report two different strategies (cross-polarization and an integrated reflector) to improve image contrast levels achieved with the Pocket Colposcope and evaluate the merits of each strategy compared to a standard-of-care digital Colposcope. The desired outcomes included reduced specular reflection (glare), increased illumination beam pattern uniformity, and reduced electrical power budget. In addition, anti-fogging and waterproofing features were incorporated to prevent the Pocket Colposcope from fogging in the vaginal canal and to enable rapid disinfection by submersion in chemical agents. Methods Cross-polarization (Generation 3 Pocket Colposcope) and a new reflector design (Generation 4 Pocket Colposcope) were used to reduce glare and improve contrast. The reflector design (including the angle and height of the reflector sidewalls) was optimized through ray-tracing simulations. Both systems were characterized with a series of bench tests to assess specular reflection, beam pattern uniformity, and image contrast. A pilot clinical study was conducted to compare the Generation 3 and 4 Pocket Colposcopes to a standard-of-care Colposcope (Leisegang Optik 2). Specifically, paired images of cervices were collected from the standard-of-care Colposcope and either the Generation 3 (n = 24 patients) or the Generation 4 (n = 32 patients) Pocket Colposcopes. The paired images were blinded by device, randomized, and sent to an expert physician who provided a diagnosis for each image. Corresponding pathology was obtained for all image pairs. The primary outcome measures were the level of agreement (%) and κ (kappa) statistic between the standard-of-care Colposcope and each Pocket Colposcope (Generation 3 and Generation 4). Results Both generations of Pocket Colposcope had significantly higher image contrast when compared to the standard-of-care Colposcope. The addition of anti-fog and waterproofing features to the Generation 3 and 4 Pocket Colposcope did not impact image quality based on qualitative and quantitative metrics. The level of agreement between the Generation 3 Pocket Colposcope and the standard-of-care Colposcope was 75.0% (kappa = 0.4000, p = 0.0028, n = 24). This closely matched the level of agreement between the Generation 4 Pocket Colposcope and the standard-of-care Colposcope which was also 75.0% (kappa = 0.4941, p = 0.0024, n = 32). Conclusion Our results indicate that the Generation 3 and 4 Pocket Colposcopes perform comparably to the standard-of-care Colposcope, with the added benefit of being low-cost and waterproof, which is ideal for use in resource-limited settings. Additionally, the reflector significantly reduces the electrical requirements of the Generation 4 Pocket Colposcope enhancing portability without altering performance compared to the Generation 3 system.
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international image concordance study to compare a point of care tampon Colposcope with a standard of care Colposcope
Journal of Lower Genital Tract Disease, 2017Co-Authors: Jenna L. Mueller, Alaattin Erkanli, Marlee S Krieger, Lisa C. Muasher, Jennifer Gallagher, Elizabeth Asma, Roopa Hariprasad, J S Malliga, Bariki Mchome, Olola OnekoAbstract:ObjectiveBarriers to cervical cancer screening in low-resource settings include lack of accessible, high-quality services, high cost, and the need for multiple visits. To address these challenges, we developed a low-cost, intravaginal, optical cervical imaging device, the point-of-care tampon (POCke
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Clinical evaluation of a portable pocket Colposcope for cervical cancer screening in the United States, Perú, and Tanzania
2017 IEEE Healthcare Innovations and Point of Care Technologies (HI-POCT), 2017Co-Authors: Jenna L. Mueller, Alaattin Erkanli, Marlee S Krieger, Mark Kellish, Jenna Peters, Mercy Asiedu, Jennifer E. Gallagher, Ernesto J. Ortiz, Lisa C. Muasher, Peyton T. TaylorAbstract:Cervical cancer is the second leading cause of cancer related deaths for women worldwide, despite being both preventable and treatable if detected early enough. The burden of disease persists in part due to a lack of access to early diagnostics and the fact that a significant proportion of women do not return for follow-up care. To address this need, we developed a low-cost, portable Pocket Colposcope that can be used in remote settings for cervical cancer screening and prevention. We evaluated whether the Pocket Colposcope performs comparably to the standard-of-care Colposcope in Durham, North Carolina, Lima, Perú, and Moshi, Tanzania. Concordant image pairs obtained from this device and the current standard imaging was sent to physician experts from high, middle, and low-income countries. They were blinded as to diagnosis, device, and peer response. Each image was critically evaluated for quality and presumptive findings and compared. Corresponding pathology was obtained for each patient. Physician interpretation agreed 76.8% of the time between the Pocket Colposcope and standard-of-care Colposcope. Physician interpretation agreed with pathology 59.4% and 63.0% for the Pocket and standard-of-care Colposcopes, respectively. The primary outcome of this study was to show reasonable concordance between the Pocket Colposcope and state of the art imaging in terms of individual examiners, pathologic diagnosis, and image quality. In all areas the Pocket Colposcope showed comparable results to country-specific standard-of-care screening.
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design of a novel low cost point of care tampon pocket Colposcope for use in resource limited settings
PLOS ONE, 2015Co-Authors: Marlee S Krieger, Betsy Asma, John W Schmitt, Lisa C. Muasher, Jennifer Gallagher, Nimmi RamanujamAbstract:The image data and support information that is published in the article "Design of a Novel Low Cost Trans-Vaginal Digital Colposcope for use in Resource Limited Settings" are available at: http://dukespace.lib.duke.edu/dspace/handle/10161/8357.
Nimmi Ramanujam - One of the best experts on this subject based on the ideXlab platform.
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an integrated strategy for improving contrast durability and portability of a pocket Colposcope for cervical cancer screening and diagnosis
PLOS ONE, 2018Co-Authors: Jenna L. Mueller, Mercy Nyamewaa Asiedu, Betsy Asma, Marlee S Krieger, Rhea Chitalia, Denali Dahl, Peyton Taylor, John W Schmitt, Nimmi RamanujamAbstract:Introduction We have previously developed a portable Pocket Colposcope for cervical cancer screening in resource-limited settings. In this manuscript we report two different strategies (cross-polarization and an integrated reflector) to improve image contrast levels achieved with the Pocket Colposcope and evaluate the merits of each strategy compared to a standard-of-care digital Colposcope. The desired outcomes included reduced specular reflection (glare), increased illumination beam pattern uniformity, and reduced electrical power budget. In addition, anti-fogging and waterproofing features were incorporated to prevent the Pocket Colposcope from fogging in the vaginal canal and to enable rapid disinfection by submersion in chemical agents. Methods Cross-polarization (Generation 3 Pocket Colposcope) and a new reflector design (Generation 4 Pocket Colposcope) were used to reduce glare and improve contrast. The reflector design (including the angle and height of the reflector sidewalls) was optimized through ray-tracing simulations. Both systems were characterized with a series of bench tests to assess specular reflection, beam pattern uniformity, and image contrast. A pilot clinical study was conducted to compare the Generation 3 and 4 Pocket Colposcopes to a standard-of-care Colposcope (Leisegang Optik 2). Specifically, paired images of cervices were collected from the standard-of-care Colposcope and either the Generation 3 (n = 24 patients) or the Generation 4 (n = 32 patients) Pocket Colposcopes. The paired images were blinded by device, randomized, and sent to an expert physician who provided a diagnosis for each image. Corresponding pathology was obtained for all image pairs. The primary outcome measures were the level of agreement (%) and κ (kappa) statistic between the standard-of-care Colposcope and each Pocket Colposcope (Generation 3 and Generation 4). Results Both generations of Pocket Colposcope had significantly higher image contrast when compared to the standard-of-care Colposcope. The addition of anti-fog and waterproofing features to the Generation 3 and 4 Pocket Colposcope did not impact image quality based on qualitative and quantitative metrics. The level of agreement between the Generation 3 Pocket Colposcope and the standard-of-care Colposcope was 75.0% (kappa = 0.4000, p = 0.0028, n = 24). This closely matched the level of agreement between the Generation 4 Pocket Colposcope and the standard-of-care Colposcope which was also 75.0% (kappa = 0.4941, p = 0.0024, n = 32). Conclusion Our results indicate that the Generation 3 and 4 Pocket Colposcopes perform comparably to the standard-of-care Colposcope, with the added benefit of being low-cost and waterproof, which is ideal for use in resource-limited settings. Additionally, the reflector significantly reduces the electrical requirements of the Generation 4 Pocket Colposcope enhancing portability without altering performance compared to the Generation 3 system.
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design of a novel low cost point of care tampon pocket Colposcope for use in resource limited settings
PLOS ONE, 2015Co-Authors: Marlee S Krieger, Betsy Asma, John W Schmitt, Lisa C. Muasher, Jennifer Gallagher, Nimmi RamanujamAbstract:The image data and support information that is published in the article "Design of a Novel Low Cost Trans-Vaginal Digital Colposcope for use in Resource Limited Settings" are available at: http://dukespace.lib.duke.edu/dspace/handle/10161/8357.
Ashrafun Nessa - One of the best experts on this subject based on the ideXlab platform.
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evaluation of the accuracy in detecting cervical lesions by nurses versus doctors using a stationary Colposcope and gynocular in a low resource setting
BMJ Open, 2014Co-Authors: Ashrafun Nessa, Charlotte Wistrand, Malin Thorsell, Most Afroza Chowdhury, Quayuma Khanam, Romena Afroz, Marcus Thuresson, Isaac Shemer, Elisabeth Wikstrom ShemerAbstract:Objectives: Evaluation of the performance of VIA (visual inspection with acetic acid) trained nurses to learn colposcopy and the Swede score method to detect cervical lesions by using stationary Colposcope or a portable, hand-held Colposcope; the Gynocular, as compared to doctors. Design: A crossover randomised clinical trial. Setting: The Colposcopy Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Participants: 932 women attending the clinic as either screening naive for VIA screening (404) or women referred as VIA positive (528) from other VIA screening centres in the Dhaka region. Intervention: VIA trained nurses were trained on-site in colposcopy and in the Swede score systematic colposcopy method. The Swede score grade cervical acetowhiteness, margins plus surface. vessel pattern, lesion size and iodine staining. The women were randomised to start the examination by either a stationary Colposcope or the Gynocular. Swede scores were first obtained by a nurse and the same patient was equally evaluated by a doctor. Primary and secondary outcome measures: Agreement between nurses and doctors in Swede scores was evaluated using the weighted κ statistic for the Gynocular and standard Colposcope. The ability to predict CIN 2+ (CIN 2, CIN 3 and invasive cervical cancer) using Swede scores was evaluated using receiver-operating characteristic curves. Results: The Swede scores obtained by nurses and doctors using the Gynocular and stationary Colposcope showed high agreement with a κ statistic of 0.858 and 0.859, respectively, and no difference in detecting cervical lesions in biopsy. Biopsy detected CIN 2+ in 39 (4.2%) women. Conclusions: Our study showed that VIA nurses can perform colposcopy. There was no significant differences compared to doctors in detecting cervical lesions by stationary Colposcope or the Gynocular using the Swede score system. Swede scores obtained by nurses using the Gynocular could offer an accurate cervical diagnostic approach in low resource settings. Trial registration number: ISRCTN53264564.
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evaluation of stationary Colposcope and the gynocular by the swede score systematic colposcopic system in via positive women a crossover randomized trial
International Journal of Gynecological Cancer, 2014Co-Authors: Ashrafun Nessa, Charlotte Wistrand, Malin Thorsell, Marcus Thuresson, Isaac Shemer, Shirin Akter Begum, Elisabeth Wikstrom ShemerAbstract:ObjectiveThis study aimed to evaluate cervical lesions by the Swede coloscopy system, histologic finding, liquid-based cytology, and human papillomavirus (HPV) in women who resulted positive for visual inspection of the cervix with acetic acid (VIA) by using a pocket-sized battery-driven Colposcope,