Reference Manual - IARC Screening Group

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<strong>Screening</strong> Test Qualities and Their InterpretationIndependence ofTest Assessments• This means that evaluators (particularly of the reference test) shouldbe unaware of the results of previous tests, because these results mayinfluence their assessment of the test being evaluated.Study Sample Size • Sample size affects the precision (i.e., width of the confidenceinterval) of test quality estimates and the statistical power to detect adifference in comparative test studies.• Quality diagnostic test studies should report not only the calculatedpoint estimates, but also sample sizes involved in each calculationand confidence limits for each estimate.• Summary measures across studies can best be done using metaanalysis.To qualify for meta-analysis, studies must report the rawdata and they should be free from verification bias. 6REFERENCESFahey MT, L Irwig and P Macaskill. 1995. American Journal ofEpidemiology 141(7): 680–689.Hulley SB and SR Cummings (eds). 1988. Designing Clinical Research.Lippincott Williams and Wilkins: Baltimore, Maryland.Jaeschke R, G Guyatt and DL Sackett. 1994. Users’ guide to the medicalliterature. III. How to use an article about a diagnostic test. A. Are theresults of the study valid? Journal of the American Medical Association271(5): 389–391.Last JM (ed). 1983. A Dictionary of Epidemiology. Oxford MedicalPublications: London.Rothman KJ. 1986. Modern Epidemiology. Little, Brown and Company:Boston, Massachusetts.Vogt WP. 1983. Dictionary of Statistics and Methodology. SagePublications: London.Weiss NS. 1986. Clinical Epidemiology: The Study of the Outcome ofIllness. Oxford University Press: New York.6 Meta-analysis: A quantitative approach whereby data from individual (different) research projects measuring thesame thing are used collectively as data points in a statistical analysis of that same measure (Last 1983; Vogt 1983).B-4 Cervical Cancer Prevention Guidelines for Low-Resource Settings
APPENDIX CINFECTION PREVENTION PROCESSES 1The three basic steps for processing instruments, surgical gloves andother reusable items are:• decontamination,• cleaning, and either• sterilization or high-level disinfection (HLD).Details on how to process instruments, gloves and other items for reuseare provided in this appendix. (See Appendix F for the specific steps forsterilizing surgical gloves.)The sequence for performing each of these processes is summarized inTable C-1.Table C-1. Infection Prevention Guidelines for Processing Instruments, SurgicalGloves and Other ItemsWASTE DISPOSAL AND DECONTAMINATIONSTEP 1 After completing VIA or cryotherapy of the cervix, and while stillwearing gloves, dispose of contaminated objects (swabs and other wasteitems) in a properly marked leakproof container (with a tight-fitting lid)or plastic bag.STEP 2 Fully submerge the speculum in a plastic container filled with a 0.5%chlorine solution for 10 minutes before allowing staff and cleaningpersonnel to handle or clean it. Before submerging assembled needlesand syringes, fill with chlorine solution. (This step is necessary to helpprevent transmission of HBV and HIV/AIDS to clinic staff.)STEP 3 All surfaces (such as the procedure table or instrument stand) that couldhave been contaminated by blood or other body fluids also should bedecontaminated by wiping down with chlorine solution.STEP 4 Immerse both gloved hands in the bucket containing 0.5% chlorinesolution and then carefully remove gloves by turning them inside out. Ifdisposing of gloves, place them in the leakproof container or plastic bag.If the gloves will be reused, submerge them in the chlorine solution for10 minutes for decontamination.(table continued on reverse)1 Adapted from: Tietjen L, W Cronin and N McIntosh. 1992. Infection Prevention for Family Planning ServicePrograms: A Problem-Solving <strong>Manual</strong>. Essential Medical Information Systems, Inc.: Durant, Oklahoma.Cervical Cancer Prevention Guidelines for Low-Resource Settings C-1
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Cervical Cancer PreventionGuideline
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TABLE OF CONTENTSPREFACE AND ACKNOW
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How to High-Level Disinfect Surgica
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Table C-2Figure C-1Preparing a Dilu
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PREFACE AND ACKNOWLEDGMENTSThis ref
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ONEINTRODUCTIONMAGNITUDE OF THE PRO
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IntroductionFigure 1-3. Incidence o
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Introductionprevalence areas, a sta
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Table 1-2. Reduction in Cumulative
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Introductiontheir performance was t
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Introductionlesions, or a false pos
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IntroductionCompared to other metho
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Introductionsignificantly to women
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IntroductionBelinson JL et al. 2001
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IntroductionMitchell MF et al. 1998
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IntroductionYlitalo N et al. 1999.
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TWOHUMAN PAPILLOMAVIRUS AND CERVICA
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Human Papillomavirus and Cervical C
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THREEPATHOPHYSIOLOGY OF CERVICAL CA
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With the onset of puberty, whichis
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Pathophysiology of Cervical Cancerp
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Pathophysiology of Cervical CancerP
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Pathophysiology of Cervical CancerI
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Pathophysiology of Cervical CancerR
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FOURTALKING WITH WOMEN ABOUTCERVICA
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Talking with Women About Cervical C
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FIVEPREVENTING INFECTIONS INHEALTHC
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Preventing Infections in Healthcare
Page 73 and 74: Preventing Infections in Healthcare
Page 79 and 80: SIXCLIENT ASSESSMENT AND VIA TESTIN
Page 81 and 82: Client Assessment and VIA TestingFi
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Page 91 and 92: SEVENTREATMENT AND FOLLOWUPBACKGROU
Page 93 and 94: Treatment and Followupregardless of
Page 95 and 96: Treatment and FollowupFigure 7-1. L
Page 97 and 98: Treatment and FollowupTable 7-6. Co
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Page 101 and 102: Treatment and Followup• Regulator
Page 103 and 104: Treatment and FollowupCRYOTHERAPY P
Page 105 and 106: Treatment and FollowupStep 6 Point
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Page 109 and 110: Treatment and FollowupStep 5Advise
Page 111 and 112: Treatment and FollowupBerget A, B A
Page 113 and 114: APPENDIX ATESTS FOR CERVICAL CANCER
Page 115 and 116: Tests for Cervical Cancer Screening
Page 121 and 122: APPENDIX BSCREENING TEST QUALITIES
Page 123: Screening Test Qualities and Their
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Page 133 and 134: Table C-4. Preparing and Using Chem
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Page 139 and 140: APPENDIX DTECHNICAL OVERVIEW OF THE
Page 141 and 142: Technical Overview of the Cryothera
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Page 149 and 150: APPENDIX ETROUBLESHOOTING WITH THEC
Page 151 and 152: Table E-1. Following-Up on Commonly
Page 153 and 154: APPENDIX FPROCESSING SURGICAL GLOVE
Page 155 and 156: Processing Surgical GlovesTable F-1
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Page 159 and 160: APPENDIX GPERFORMING BREAST AND PEL
Page 161 and 162: Performing Breast and Pelvic Examin
Page 163 and 164: Figure G-2. Breast Puckering or Dim
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Performing Breast and Pelvic Examin
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Figure G-18. Speculum in Place with
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APPENDIX HPERCEIVED BARRIERS TO PRO
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AVAILABILITY OF BASIC SUPPLIES AND
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GLOSSARYAcetic AcidAcetowhite Chang
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PatulousSquamocolumnarJunction (SCJ
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ADDITIONAL READINGAlliance for Cerv
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innovating to save liveswww.jhpiego
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Reference Manual - IARC Screening Group

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