Histologic follow-up of patients with the Bethesda system cervicalvaginal diagnosis of atypical glandular cells of undetermined significance (AGUS), "favor endocervical origin", or "not otherwise specified" (NOS) shows a high percentage of clinically significant (neoplastic or preneoplastic) lesions. Using the criteria of atypical single cells, irregular nuclear membranes, and decreased cytoplasm, eight observers retrospectively reclassified 88 AGUS, "favor endocervical", or NOS smears using a probabilistic scheme. Follow-up showed 46 clinically significant and 42 benign lesions. The mean accuracy for all observers and the experienced observers was 65% and 72%, respectively. For the experienced observers, the mean specificity of a "favor clinically significant" category was 72%; the mean sensitivity of a "favor benign" category was 90%. For the less experienced observers, subclassification had poor predictive value. We conclude that experienced observers may use specific criteria to correctly subclassify AGUS lesions, and this may aid in patient management. (Key words: Cytology; Accuracy; Cervical-vaginal smear; Dysplasia; Probability; Carcinoma) Am J Clin Pathol 1997,107:299-307.The Bethesda system diagnostic category of atypical glandular cells of undetermined significance (AGUS) is important for two reasons: (1) AGUS has a relatively high incidence that reportedly ranges from 0.46% to 2.5% of all cervical-vaginal smears 1-3 ; and (2) a high percentage (42%-83%) of patients with an AGUS diagnosis have a clinically significant lesion. [1][2][3][4][5][6][7][8] Surprisingly, histologic follow-up has shown that some of the clinically significant lesions are pure squamous dysplasias without glandular neoplasia.Problems with the AGUS diagnosis are that its defining criteria are somewhat nebulous, and it is used as a wastebasket for lesions that cannot be definitely classified as reactive or neoplastic.9-11 The Bethesda system recommends subclassification of AGUS into the categories of "favor endocervical origin", "favor endometrial origin", and "not otherwise specified" (NOS); "favor endocervical origin" lesions are further classified into the categories of "favor neoplastic" and "favor reactive". [9][10][11] This classification scheme is supposed to aid in patient triage, which, given the AGUS incidence and the high rate of clinically significant lesions, is exceedingly important. However, subclassification of AGUS has yet to be proved clinically effective, and although the Bethesda Committee and many others have studied cytologic criteria important in subclassification, these criteria have not been tested rigorously. This has resulted in the AGUS category being confusing for the pathologist and the clinician.To more thoroughly investigate the utility of AGUS subclassification, our laboratory used a rigorous statistical technique known as logistic regression analysis to identify cytologic criteria important in differentiating a clinically significant AGUS lesion from a benign AGUS lesion.3 The presence of the crit...
This paper describes the experiences of psychotherapists who, as part of a practice research network (PRN), collaborated with researchers in designing and conducting a psychotherapy study within their own clinical practices. A qualitative analysis of interviews conducted with these psychotherapists led to the delineation of several benefits (e.g., learning information that improved their work with clients and feeling that they were contributing to research that would be useful for psychotherapists) and difficulties for them and their clients (e.g., time and effort required to integrate research protocol into routine clinical practice) that psychotherapists associated with their participation in the PRN. Also identified were a number of strategies used by psychotherapists to address obstacles that they encountered, as well as general recommendations for future PRN studies. As a whole, the experiences of these psychotherapists are likely to provide valuable lessons for the survival and growth of what is viewed by many as a promising pathway for building a stronger bridge between practice and research.
Countertransference (CT) can provide psychotherapists with important information about relationship dynamics with clients, the therapy process, and clinical decisions. CT also can lead therapists to view clients and sessions inaccurately, feel unduly anxious, and behave in ways that primarily meet their own needs at the expense of clients. In summarizing existing scholarship on CT, Fauth (2006) noted the need for further research on therapists' subjective experiences of CT to enhance current understanding of this pantheoretical construct. To this end, we interviewed 18 therapists about their experiences of CT in a recently terminated case; half of the therapists described CT in a case they judged to be successful, and half described a case they thought was unsuccessful. Interview questions were designed to address the 5 components of CT proposed by Hayes (1995): origins, triggers, manifestations, effects, and management. A grounded theory analysis was conducted and a model describing therapists' experiences of CT in successful and unsuccessful therapy was developed. Implications for practice, training, and research are discussed.
Increasingly, many psychotherapists identify with an integrative approach to psychotherapy. In recent years, more attention has been directed toward the operationalization and evaluation of competence in professional psychology and health care service delivery. Aspects of integrative psychotherapy competency may differ from competency in other psychotherapy orientations, although convergence is more often the case. Despite the potential differences, there exist very few formal training programs or guidelines to systematically guide clinicians in developing a competent integrative practice. This paper attempts to distill the essential elements of competent integrative psychotherapy practice and focuses on how these might be developed in training and supervision. We address most of these complex issues from a specific integrative perspective: principle-based assimilative integration.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.