The Experts below are selected from a list of 8427 Experts worldwide ranked by ideXlab platform
Kathy Boutis - One of the best experts on this subject based on the ideXlab platform.
-
prepubescent female Genital Examination images evidence informed learning opportunities
Journal of Pediatric and Adolescent Gynecology, 2021Co-Authors: Sarah Campos, Adrienne L Davis, Martin Pecaric, Martin V Pusic, Tanya Smith, Michelle Shouldice, J Brown, Lori Legano, Kathy BoutisAbstract:Abstract Objectives To determine diagnoses and image features that are associated with difficult prepubescent female Genital image interpretations. Design and Setting This was a mixed-methods study conducted at a tertiary care pediatric center using images from a previously developed education platform. Participants Participants comprised 107 medical students, residents, fellows, and attendings who interpreted 158 cases to derive case difficulty estimates. Interventions This was a planned secondary analysis of participant performance data obtained from a prospective multi-center cross-sectional study. An expert panel also performed a descriptive review of images with the highest frequency of diagnostic error. Main Outcome Measures We derived the proportion of participants who interpreted an image correctly, and features that were common in images with the most frequent diagnostic errors. Results We obtained 16,906 image interpretations. The mean proportion correct scores for each diagnosis were as follows: normal/normal variants 0.84 (95% confidence interval [CI] 0.82, 0.87); infectious/dermatology pathology 0.59 (95% CI 0.45, 0.73); anatomic pathology 0.61 (95% CI 0.41, 0.81); and, traumatic pathology 0.64 (95% CI 0.49, 0.79). The mean proportion correct scores varied by diagnosis (P Conclusions A quantitative and qualitative Examination of prepubescent female Genital Examination image interpretations provided insight into diagnostic challenges for this complex Examination. These data can be used to inform the design of teaching interventions to improve skill in this area.
-
deliberate practice as an educational method for learning to interpret the prepubescent female Genital Examination
Child Abuse & Neglect, 2020Co-Authors: Adrienne L Davis, Martin Pecaric, Martin V Pusic, Tanya Smith, Michelle Shouldice, J Brown, S A Wynter, Lori Legano, Janienne Kondrich, Kathy BoutisAbstract:Abstract Background Correct interpretation of the prepubescent female Genital Examination is a critical skill; however, physician skill in this area is limited. Objective To complement the bedside learning of this Examination, we developed a learning platform for the visual diagnosis of the prepubescent female Genital Examination and examined the amount and rate of skill acquisition. Participants and Setting Medical students, residents, and fellows and attendings participated in an on-line learning platform. Methods This was a multicenter prospective cross-sectional study. Study participants deliberately practiced 158 prepubescent female Genital Examination cases hosted on a computer-based learning and assessment platform. Participants assigned the case normal or abnormal; if abnormal, they identified the location of the abnormality and the specific diagnosis. Participants received feedback after every case. Results We enrolled 107 participants (26 students, 31 residents, 24 fellows and 26 attendings). Accuracy (95 % CI) increased by 10.3 % (7.8, 12.8), Cohen’s d-effect size of 1.17 (1.14, 1.19). The change in specificity was +16.8 (14.1, 19.5) and sensitivity +2.4 (-0.9, 5.6). It took a mean (SD) 46.3 (32.2) minutes to complete cases. There was no difference between learner types with respect to initial (p = 0.2) or final accuracy (p = 0.4) scores. Conclusions This study’s learning intervention led to effective and feasible skill improvement. However, while participants improved significantly with normal cases, which has relevance in reducing unnecessary referrals to child protection teams, learning gains were not as evident in abnormal cases. All levels of learners demonstrated a similar performance, emphasizing the need for this education even among experienced clinicians.
Susan F Pokorny - One of the best experts on this subject based on the ideXlab platform.
-
the Genital Examination of the infant through adolescence
Current Opinion in Obstetrics & Gynecology, 1993Co-Authors: Susan F PokornyAbstract:The Genital Examination of the young female is a relatively new procedure for many clinicians. It was not felt important until physicians became involved with the Examination of survivors of childhood sexual abuse; from these Examinations it is apparent that young females also have a broad array of Genital conditions which need clinical evaluation and intervention. This review of the recent literature on the techniques employed by a variety of clinicians demonstrates the limitations placed on our knowledge of pediatric and adolescent gynecologic conditions by technical and psychosocial parameters. Language: en
Ward A - One of the best experts on this subject based on the ideXlab platform.
-
Macroscopically detected female Genital injury after consensual and non-consensual vaginal penetration: a prospective comparison study.
'Elsevier BV', 2013Co-Authors: Lincoln C, Perera R, Ward AAbstract:OBJECTIVE: The aim of this study was to compare the prevalence, type and pattern of macroscopically detected female Genital injury after consensual and non-consensual vaginal penetration to further an understanding of the forensic significance of Genital injury in women reporting sexual assault. A secondary aim was to identify any effect of a range of possible variables upon the likelihood of Genital injury resulting from vaginal penetrative sexual intercourse. STUDY DESIGN: Two groups of reproductive age women (aged 18-45 years) were prospectively recruited within 72 h of a single episode of vaginal penetrative sex, and macroscopically examined for the presence of bruises, abrasions and lacerations at twelve external and internal Genital sites. Forty one women who presented for forensic Examination after reporting a sexual assault to police were recruited to the non-consensual group and 81 women who presented for routine cervical screening or with sexual health concerns to a primary health care service to the consensual group. Each group was examined by a different group of doctors, all of whom were experienced in both forensic Genital Examination and gynaecological Examination of healthy and diseased sexually active women. Data collection and Examination protocols were the same for both groups. RESULTS: The key finding was a statistically significant difference in Genital injury prevalence between women who were vaginally penetrated non-consensually and consensually; 53.7% of the non-consensual group (22/41) and 9.9% of the consensual group (8/81) were found to have at least one Genital injury [OR 10.57, CI (4.07, 27.42), p
-
Macroscopically detected female Genital injury after consensual and non-consensual vaginal penetration: A prospective comparison study
'Elsevier BV', 2013Co-Authors: Lincoln C, Perera R, Jacobs Ian, Ward AAbstract:Objective: The aim of this study was to compare the prevalence, type and pattern of macroscopicallydetected female Genital injury after consensual and non-consensual vaginal penetration to further anunderstanding of the forensic significance of Genital injury in women reporting sexual assault. A secondaryaim was to identify any effect of a range of possible variables upon the likelihood of Genital injuryresulting from vaginal penetrative sexual intercourse.Study design: Two groups of reproductive age women (aged 18e45 years) were prospectively recruitedwithin 72 h of a single episode of vaginal penetrative sex, and macroscopically examined for the presenceof bruises, abrasions and lacerations at twelve external and internal Genital sites. Forty one women whopresented for forensic Examination after reporting a sexual assault to police were recruited to the nonconsensualgroup and 81 women who presented for routine cervical screening or with sexual healthconcerns to a primary health care service to the consensual group. Each group was examined by adifferent group of doctors, all of whom were experienced in both forensic Genital Examination andgynaecological Examination of healthy and diseased sexually active women. Data collection and Examinationprotocols were the same for both groups.Results: The key finding was a statistically significant difference in Genital injury prevalence betweenwomen who were vaginally penetrated non-consensually and consensually; 53.7% of the non-consensualgroup (22/41) and 9.9% of the consensual group (8/81) were found to have at least one Genital injury [OR10.57, CI (4.07, 27.42), p < 0.00001]. Penetration with finger/s and possible pre-existing Genital ‘infection’were found to be significantly associated with the presence of injury in the univariate analysis afteradjusting for consent. Logistic regression demonstrated that women penetrated without consent were19.5 times more likely to sustain at least one Genital injury, than those penetrated consensually [OR19.53, CI (6.03, 63.24)] and that a penetration scenario that included finger/s was 4.2 times more likely toresult in at least one Genital injury than penetration without finger involvement [OR 4.25, CI (1.42,12.78)], when controlling for other variables in the model. Whilst a comparatively low injury prevalencein the consensual group limited interpretation, results revealed possible differences in Genital injurytypology and pattern resulting from non-consensual and consensual vaginal penetration. Lacerationswere seen after both consensual and non-consensual vaginal penetration, while abrasions and bruiseswere seen exclusively in the non-consensual group.Conclusion: This study demonstrated a significant consent group difference in Genital injury prevalenceand the highest macroscopically detected Genital injury prevalence rate resulting from non-consensualvaginal penetration identified to date. Results also indicate that vaginal penetration with finger/s increasesthe likelihood of sex-related injury. The difference in type of injury sustained as a result of nonconsensualand consensual vaginal penetration was an unexpected finding, and warrants further investigation. These results highlight the importance of a standardised means of detecting Genital injurybased on consistent injury definitions, Examination protocols, and examiner experience and suggest thatmacroscopic Genital Examination may be uniquely placed to detect consent group differences in injurytypology and pattern if they exist
-
Macroscopically detected female Genital injury after consensual and non-consensual vaginal penetration: a prospective comparison study.
2013Co-Authors: Lincoln C, Perera R, Ward AAbstract:OBJECTIVE: The aim of this study was to compare the prevalence, type and pattern of macroscopically detected female Genital injury after consensual and non-consensual vaginal penetration to further an understanding of the forensic significance of Genital injury in women reporting sexual assault. A secondary aim was to identify any effect of a range of possible variables upon the likelihood of Genital injury resulting from vaginal penetrative sexual intercourse. STUDY DESIGN: Two groups of reproductive age women (aged 18-45 years) were prospectively recruited within 72 h of a single episode of vaginal penetrative sex, and macroscopically examined for the presence of bruises, abrasions and lacerations at twelve external and internal Genital sites. Forty one women who presented for forensic Examination after reporting a sexual assault to police were recruited to the non-consensual group and 81 women who presented for routine cervical screening or with sexual health concerns to a primary health care service to the consensual group. Each group was examined by a different group of doctors, all of whom were experienced in both forensic Genital Examination and gynaecological Examination of healthy and diseased sexually active women. Data collection and Examination protocols were the same for both groups. RESULTS: The key finding was a statistically significant difference in Genital injury prevalence between women who were vaginally penetrated non-consensually and consensually; 53.7% of the non-consensual group (22/41) and 9.9% of the consensual group (8/81) were found to have at least one Genital injury [OR 10.57, CI (4.07, 27.42), p < 0.00001]. Penetration with finger/s and possible pre-existing Genital 'infection' were found to be significantly associated with the presence of injury in the univariate analysis after adjusting for consent. Logistic regression demonstrated that women penetrated without consent were 19.5 times more likely to sustain at least one Genital injury, than those penetrated consensually [OR 19.53, CI (6.03, 63.24)] and that a penetration scenario that included finger/s was 4.2 times more likely to result in at least one Genital injury than penetration without finger involvement [OR 4.25, CI (1.42, 12.78)], when controlling for other variables in the model. Whilst a comparatively low injury prevalence in the consensual group limited interpretation, results revealed possible differences in Genital injury typology and pattern resulting from non-consensual and consensual vaginal penetration. Lacerations were seen after both consensual and non-consensual vaginal penetration, while abrasions and bruises were seen exclusively in the non-consensual group. CONCLUSION: This study demonstrated a significant consent group difference in Genital injury prevalence and the highest macroscopically detected Genital injury prevalence rate resulting from non-consensual vaginal penetration identified to date. Results also indicate that vaginal penetration with finger/s increases the likelihood of sex-related injury. The difference in type of injury sustained as a result of non-consensual and consensual vaginal penetration was an unexpected finding, and warrants further investigation. These results highlight the importance of a standardised means of detecting Genital injury based on consistent injury definitions, Examination protocols, and examiner experience and suggest that macroscopic Genital Examination may be uniquely placed to detect consent group differences in injury typology and pattern if they exist
Robert A Shapiro - One of the best experts on this subject based on the ideXlab platform.
-
Genital Examinations for alleged sexual abuse of prepubertal girls findings by pediatric emergency medicine physicians compared with child abuse trained physicians
Child Abuse & Neglect, 2002Co-Authors: Kathi L Makoroff, Jamie L Brauley, Ann M Brandner, Patricia A Myers, Robert A ShapiroAbstract:Abstract Objective: This study compares abnormal Genital Examination findings made by pediatric emergency medicine (PEM) physicians to Examinations by physicians with training in child sexual abuse in the evaluation of prepubertal girls for suspected sexual abuse. Method: A prospective study was performed following the Genital Examination by a PEM physician of prepubertal girls suspected of being sexually abused. A physician with training in child sexual abuse re-examined those girls whose Examinations were interpreted as abnormal by the PEM physicians. The findings and interpretations of the PEM physician were then compared to those by the physicians with training in child abuse. Results: Between October 1994 and October 1998, 46 patients diagnosed by PEM physicians with nonacute Genital findings indicative of sexual abuse were re-examined by a physician with training in child abuse. The follow-up Examinations were done 2 days–16 weeks (mean 2.1 weeks) after the emergency department visit. The physicians with training in child abuse concluded that only eight of these children (17%) showed clear evidence of abuse. Normal findings were noted in 32 children (70%), nonspecific changes were noted in 4 children (9%), and 2 children (4%) had findings that are more commonly seen in abused children than nonabused children but are not diagnostic for abuse (concerning for abuse). Conclusions: There was poor agreement between the pediatric emergency medicine physicians and the physicians with training in child sexual abuse. This study suggests that emergency medicine physicians should consider additional training in this area. In addition, all children with abnormal ED Examinations should have follow-up Examinations by a child abuse trained physician.
Adrienne L Davis - One of the best experts on this subject based on the ideXlab platform.
-
prepubescent female Genital Examination images evidence informed learning opportunities
Journal of Pediatric and Adolescent Gynecology, 2021Co-Authors: Sarah Campos, Adrienne L Davis, Martin Pecaric, Martin V Pusic, Tanya Smith, Michelle Shouldice, J Brown, Lori Legano, Kathy BoutisAbstract:Abstract Objectives To determine diagnoses and image features that are associated with difficult prepubescent female Genital image interpretations. Design and Setting This was a mixed-methods study conducted at a tertiary care pediatric center using images from a previously developed education platform. Participants Participants comprised 107 medical students, residents, fellows, and attendings who interpreted 158 cases to derive case difficulty estimates. Interventions This was a planned secondary analysis of participant performance data obtained from a prospective multi-center cross-sectional study. An expert panel also performed a descriptive review of images with the highest frequency of diagnostic error. Main Outcome Measures We derived the proportion of participants who interpreted an image correctly, and features that were common in images with the most frequent diagnostic errors. Results We obtained 16,906 image interpretations. The mean proportion correct scores for each diagnosis were as follows: normal/normal variants 0.84 (95% confidence interval [CI] 0.82, 0.87); infectious/dermatology pathology 0.59 (95% CI 0.45, 0.73); anatomic pathology 0.61 (95% CI 0.41, 0.81); and, traumatic pathology 0.64 (95% CI 0.49, 0.79). The mean proportion correct scores varied by diagnosis (P Conclusions A quantitative and qualitative Examination of prepubescent female Genital Examination image interpretations provided insight into diagnostic challenges for this complex Examination. These data can be used to inform the design of teaching interventions to improve skill in this area.
-
deliberate practice as an educational method for learning to interpret the prepubescent female Genital Examination
Child Abuse & Neglect, 2020Co-Authors: Adrienne L Davis, Martin Pecaric, Martin V Pusic, Tanya Smith, Michelle Shouldice, J Brown, S A Wynter, Lori Legano, Janienne Kondrich, Kathy BoutisAbstract:Abstract Background Correct interpretation of the prepubescent female Genital Examination is a critical skill; however, physician skill in this area is limited. Objective To complement the bedside learning of this Examination, we developed a learning platform for the visual diagnosis of the prepubescent female Genital Examination and examined the amount and rate of skill acquisition. Participants and Setting Medical students, residents, and fellows and attendings participated in an on-line learning platform. Methods This was a multicenter prospective cross-sectional study. Study participants deliberately practiced 158 prepubescent female Genital Examination cases hosted on a computer-based learning and assessment platform. Participants assigned the case normal or abnormal; if abnormal, they identified the location of the abnormality and the specific diagnosis. Participants received feedback after every case. Results We enrolled 107 participants (26 students, 31 residents, 24 fellows and 26 attendings). Accuracy (95 % CI) increased by 10.3 % (7.8, 12.8), Cohen’s d-effect size of 1.17 (1.14, 1.19). The change in specificity was +16.8 (14.1, 19.5) and sensitivity +2.4 (-0.9, 5.6). It took a mean (SD) 46.3 (32.2) minutes to complete cases. There was no difference between learner types with respect to initial (p = 0.2) or final accuracy (p = 0.4) scores. Conclusions This study’s learning intervention led to effective and feasible skill improvement. However, while participants improved significantly with normal cases, which has relevance in reducing unnecessary referrals to child protection teams, learning gains were not as evident in abnormal cases. All levels of learners demonstrated a similar performance, emphasizing the need for this education even among experienced clinicians.