E J Mayeaux

Louisiana State University in Shreveport, Shreveport, Louisiana, United States

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Publications (26)34.23 Total impact

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    ABSTRACT: Cryosurgery is a favored treatment method for cervical intraepithelial neoplasia (CIN) among family physicians, in part because it is inexpensive and requires the least technical training and skill. Although cervical cryosurgery has been used for more than 30 years, the natural history of the postprocedure process has never been described. The primary purpose of our study was to describe the natural history of the healing process after cervical cryosurgery. A secondary purpose was to determine the effect of mechanical debridement of the cervical eschar on the symptoms of healing. We conducted a prospective multicentered trial in which women who had a histologic ally documented CIN lesion underwent cervical cryosurgery. Forty-six women were randomized to undergo eschar debridement at 48 hours after cryosurgey, and 38 women received standard care. All women were followed up and given preweighed sanitary pads for hydrorrhea (watery discharge) collection and a diary to record the severity and number of days of odor, pain, cramping, and hydrorrhea that were experienced. The average total amount of hydrorrhea or discharge was 288 g, which required using an average of 41 sanitary pads during a period of 12.4 days. The duration of odor was 8.9 days, and the pain and cramping experienced after cryosurgery lasted 4.7 days. Women who were obese had greater hydrorrhea and pad usage than nonobese women. Debridement of the cervical eschar did not significantly change the signs and symptoms of healing after cryosurgery. There are significant symptoms patients experience after cryosurgery that are not ameliorated by debridement. The expectations of the cryosurgical healing process should be disclosed to women before the procedure.
    No preview · Article · Sep 2000 · The Journal of family practice
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    ABSTRACT: Most precancerous lesions of the cervix are treated with surgery or ablative therapy. Chemoprevention, using natural and synthetic compounds, may intervene in the early precancerous stages of carcinogenesis and prevent the development of invasive disease. Our trial used indole-3-carbinol (I-3-C) administered orally to treat women with CIN as a therapeutic for cervical CIN. Thirty patients with biopsy proven CIN II-III were randomized to receive placebo or 200, or 400 mg/day I-3-C administered orally for 12 weeks. If persistent CIN was diagnosed by cervical biopsy at the end of the trial, loop electrocautery excision procedure of the transformation zone was performed. HPV status was assessed in all patients. None (0 of 10) of the patients in the placebo group had complete regression of CIN. In contrast 4 of 8 patients in the 200 mg/day arm and 4 of 9 patients in the 400 mg/day arm had complete regression based on their 12-week biopsy. This protective effect of I-3-C is shown by a relative risk (RR) of 0.50 ((95% CI, 0. 25 to 0.99) P = 0.023) for the 200 mg/day group and a RR of 0.55 ((95% CI, 0.31 to 0.99) P = 0.032) for the 400 mg/day group. HPV was detected in 7 of 10 placebo patients, in 7 of 8 in the 200 mg/day group, and in 8 of 9 in the 400 mg/day group. There was a statistically significant regression of CIN in patients treated with I-3-C orally compared with placebo. The 2/16 alpha-hydroxyestrone ratio changed in a dose-dependent fashion.
    No preview · Article · Sep 2000 · Gynecologic Oncology
  • D M Harper · E J Mayeaux · T P Daaleman · CA Johnson
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    ABSTRACT: Treatment for cervical intraepithelial neoplasia with cryosurgery is uncomfortable for many women. The subsequent healing process is also thought to bring discomfort. The purpose of our study was to describe women's experiences after cryosurgery, and how obesity, age, and gravidity affected, the healing process. We developed a survey from focus group results to measure the unpleasantness of hydrorrhea (watery discharge) from cryosurgery, the pad protection required, and the odor associated with the hydrorrhea. The cryosurgical experiences were compared with normal menses for the use and frequency of pad protection, medications used, and any activity restrictions. Cryosurgical experiences were unpleasant for 78.3% of the women because of the pain and cramping of the procedure and the resulting hydrorrhea, odor, and necessity of wearing pads for protection. These experiences after cryosurgery caused 38.6% to restrict their activities and 67.1% to take medications, a significantly greater proportion than the 16.9% whose activities were restricted normal menses and the 26.8% who took medications for normal menses (P=-.004, P <.001, respectively). In addition to these experiences, obese, multigravid, and older women were more bothered by the duration of wearing pads than their counterparts (P=.0246, =.0061, and P=.0159, respectively). Our study showed that the cryosurgical healing process was not pleasant, and was least tolerable for obese, multigravid, and older women. As many as 50% of women undergoing cryosurgery will perceive the hydrorrhea, its odor, and the wearing of pads to be worse than normal menses, especially if their menses are usually light.
    No preview · Article · Aug 2000 · The Journal of family practice
  • E.J. Mayeaux
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    ABSTRACT: Nail lesions can be related to a number of disease states. These may be intrinsic to the nail, caused by infection, or reflect systemic disease. Careful history and examination often is necessary for accurate diagnosis. Anatomy and gross changes of the nail are reviewed. The diagnosis and treatment of disease process such as psoriasis, lichen planus, paronychia, onychomycosis, myxoid cysts, and pincer nails are reviewed.
    No preview · Article · Jul 2000 · Primary Care Clinics in Office Practice
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    E J Mayeaux · S D Spigener · JA German
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    ABSTRACT: Cryotherapy is a time-proven ablative method of treating lower grades of dysplasia of the uterine cervix. Women who need cryotherapy typically have had an abnormal Papanicolaou smear tha has led to colposcopy, biopsy, and a diagnosis of cervical dysplasia. The basic procedure, indications, and outcomes of cryotherapy are reviewed. The procedure is easy to learn and perform, and can easily be applied in outpatients settings.
    Preview · Article · Sep 1998 · The Journal of family practice
  • Shannon D. Spigener · E.J. Mayeaux

    No preview · Article · Feb 1998 · Hospital practice (1995)
  • E.J. Mayeaux · Shannon D. Spigener

    No preview · Article · Jan 1998 · Hospital practice (1995)
  • E.J. Mayeaux · Shannon D. Spigener

    No preview · Article · Dec 1997 · Hospital practice (1995)
  • M B Harper · J B Pope · E J Mayeaux · T J Davis · A Myers · A Lirette
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    ABSTRACT: Colonoscopy training is receiving greater emphasis in family practice residencies. However, no standards have been established to measure the adequacy of this training. This study assessed the colonoscopy experience of family practice residents at Louisiana State University Medical Center at Shreveport (LSUMC-S). We included all colonoscopies performed by the family practice service between August 1992 and December 1994 and matched them by gender and age with cases from the gastroenterology (GI) and general surgery (GS) services performed during the same time period. Family practice and GI were compared using 143 cases from each service; 166 cases were used to compare family practice to GS. The cecum was intubated in 87% of patients on all services. The average time to complete the procedure was 35 minutes by the family practice service, 44 minutes by GI, and 25 minutes by GS. No significant differences were found between family practice and GI in the number of patients with polyp, normal colon, or biopsy performed. In comparison to GS, there were significantly fewer patients on the family practice service with normal colon and more with multiple polyps and biopsy performed. Significantly more cancers were found by the family practice service than by either GI or GS. There were no complications reported for any of the services. Results compared favorably with data in the current literature. The colonoscopy experience available to family practice residents at LSUMC-S is acceptable within the parameters studied.
    No preview · Article · Oct 1997 · Family medicine
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    ABSTRACT: Medical information pamphlets often are written using language that requires a reading level higher than parents of many pediatric patients have achieved. Anecdotal reports suggest that many parents may not readily understand the federally mandated Public Health Service vaccine information pamphlets prepared by the Centers for Disease Control and Prevention (CDC) in 1991. The level at which the pamphlets need to be written for low-reading-level parents is undetermined, as is whether parents reading at higher levels will accept low-reading-level materials. To determine whether a simple pamphlet prepared at a low reading level using qualitative and adult education techniques would be preferable to the available CDC polio vaccine information pamphlet, we conducted an integrated qualitative-quantitative study. We compared the parent reading time and comprehension of a simplified pamphlet (Louisiana State University, LSU) comprising 4 pages, 322 words, 7 instructional graphics, and a text requiring a 6th grade reading ability with the equivalent 1991 CDC vaccine information pamphlet comprising 16 pages, 18,177 words, no graphics, and a text requiring a 10th grade reading level. We measured the reading ability of 522 parents of pediatric patients from northwest Louisiana seen at public clinics (81%) and in a private office (19%). Of the entire group, 39% were white, 60% African-American, and 1% Hispanic; the mean age was 29 years; the mean highest grade completed was 12th grade 3 months; and the reading level was less than 9th grade in 47% of parents and less than 7th grade in 20%. After parents were given one of the pamphlets to read, their reading time, comprehension, and attitude toward the pamphlet were measured. Mean comprehension was 15% lower for CDC than for LSU (56% vs 72% correct; P < .001) and reading time was three times longer for CDC than for LSU (13 minutes 47 seconds vs 4 minutes 20 seconds; P < .0001). These trends were significant for parents reading at all but the lowest levels. Mean comprehension and reading time did not differ among parents reading at the third grade level or less. However, mean comprehension was greater and reading time lower for LSU among parents at all reading abilities greater than the third grade. Parents in the private practice setting took the longest time to read the CDC (20 minutes 59 seconds vs 5 minutes 46 seconds, LSU), yet their comprehension on the LSU was significantly higher than on the CDC (94% vs 71%; P < .0001). Two focus groups of high-income parents were unanimous in preferring the LSU. A short, simply written pamphlet with instructional graphics was preferred by high- and low-income parents seen in private and public clinics. The sixth grade reading level appears to be too high for many parents in public clinics; new materials aimed at third to fourth grade levels may be required. The new 1994 CDC immunization materials, written at the eighth grade level, may still be inappropriately high. The American medical community should adopt available techniques for the development of more effective patient-parent education materials.
    No preview · Article · Jun 1996 · Pediatrics
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    ABSTRACT: Health care reform has mandated that hospitals and health care professionals restructure or redefine their roles in health care and the community. Patient education is shifting from a crisis-medicine focus to a prevention and health promotion strategy. One area for growth and development in the nursing profession is community health promotion and education. Adult basic education sites have the potential of providing exciting new possibilities in promotion, prevention, and nutrition education for patients. Adults with low literacy skills often lack basic information about nutrition and have poor eating behaviors. Focus groups conducted at an adult learning center revealed that these adults had misconceptions about nutrition, yet they had a strong desire to learn about good dietary practices so they could serve better meals and snacks to their children. Utilizing focus group information, health care providers designed, taught, and evaluated a nutrition education curriculum for adult basic education students. Students' knowledge of food measurements and portion sizes increased significantly (p < .05) as did their ability to read labels and recipes (p < .01). However, eating behaviors were not altered significantly. Long-term comprehensive family and community systems approaches may be required to ensure behavior change. Adult learning centers offer a unique setting for linking literacy, health care, and community efforts.
    No preview · Article · Feb 1996 · Journal of Community Health Nursing
  • E J Mayeaux · P W Murphy · C Arnold · T C Davis · R H Jackson · T Sentell
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    ABSTRACT: Patients who misunderstand their diagnosis and treatment plans usually exhibit poor compliance. The 90 million adult Americans with low literacy skills struggle to understand such essential health information as discharge instructions, consent forms, oral instructions and drug labels. The Joint Commission on Accreditation of Health Organizations (JCAHO) now requires that instructions be given on a level understandable to the patient. Most physicians tend to give too much information on too high a level for many patients to understand. Physicians who speak in simpler language, repeat their instructions and demonstrate key points, while avoiding too many directives, enhance their patients' understanding. Combining easy-to-read written patient education materials with oral instructions has been shown to greatly enhance patient understanding. To be effective with patients whose literacy skills are low, patient education materials should be short and simple, contain culturally sensitive graphics and encourage desired behavior. Compliance with therapy also may be improved by including family members in the patient education process.
    No preview · Article · Feb 1996 · American family physician
  • E J Mayeaux · S A Maddox · M Baudoin

    No preview · Article · Jan 1996 · The Journal of the American Board of Family Practice / American Board of Family Practice
  • E J Mayeaux · M B Harper · W Barksdale · J B Pope
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    ABSTRACT: The incidence of human papillomavirus infection is increasing. More than 60 types of human papillomavirus have been isolated; some types are known to have malignant potential. Differential diagnosis of the lesions includes condyloma latum, seborrheic keratoses, nevi, pearly penile papules and neoplasms. The goal in treating noncervical human papillomavirus infection is the elimination of lesions; eradication of the virus is not yet possible. Current forms of treatment include cryotherapy, podophyllum resin, podophilox, trichloroacetic acid, laser ablation, loop electrosurgical excision procedure (LEEP), fluorouracil and alpha interferon. Success in treating condyloma may be increased if the area is first soaked with 5 percent acetic acid to more clearly show the extent of the local infection. Recurrence is a problem no matter what form of therapy is used.
    No preview · Article · Oct 1995 · American family physician
  • J B Pope · E J Mayeaux · M B Harper
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    ABSTRACT: As the use of esophagogastroduodenoscopy (EGD) by family physicians increases, a need exists to further demonstrate the procedure's clinical effectiveness and safety and the general experience of family physicians performing the procedure. This study examines the general experience of a group of family physicians performing EGDs in the university setting. An analysis was done of all patients undergoing EGDs performed by family physicians at a university hospital during a consecutive 27-month period. Demographics, indications, findings, diagnoses, therapy, complications, and biopsies were analyzed. Clinical effectiveness was measured by recording whether an EGD resulted in changes in diagnosis, medical therapy, or clinical management. Endoscopic diagnoses also were correlated with biopsy pathological diagnoses. During the study period, 188 EGDs were performed. Clinical management of patients was changed in 88.6% of cases. The diagnosis was changed in 81.8% of cases, and drug therapy was changed in 55.7% of cases. Endoscopic impressions were confirmed by biopsy in 93.2% of cases. Procedures were completed in 98.3% of cases with no complications. This study demonstrates the clinical effectiveness of EGDs performed by family physicians. The feasibility of family practice endoscopy in the university medical center setting has been demonstrated, and continued benefits from this practice are anticipated.
    No preview · Article · Oct 1995 · Family medicine
  • M B Harper · E J Mayeaux · J B Pope · R Goel
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    ABSTRACT: Although procedural training in family practice has recently received greater emphasis, the current status of this training in residency programs has not been reported. Considerable variation in procedural training among family practice residencies is allowed by the American Board of Family Practice and accreditation requirements. This study was performed to report the current status of procedural training in family practice residencies and to determine whether a correlation exists between the number of procedures taught in family practice residencies and successful resident recruitment. A one-page questionnaire was developed to determine availability of teaching and type of instructor for 24 selected procedures. This questionnaire was mailed to all 398 family practice residency directors in the United States. Data from the survey were compared with the published residency match results in 1993 and 1994. Questionnaires were received from 363 programs, for a response rate of 91 percent. The current status of training in these procedures, presented by program type and geographic region, reflects considerable regional variation. Training in colposcopy and in cardiac stress testing was reported to be available in a greater percentage of programs than in previous studies. A significant positive correlation was found between the number of procedures taught by family physicians and residency match results. The 91 percent response rate lends credibility to this status report and indicates that family practice program directors recognize procedural training as an important issue. The trend toward greater availability of procedural training in family practice residencies is confirmed for selected procedures. Emphasis on procedural training by family physicians has a positive correlation with successful resident recruiting. The impact on medical student interest in family practice deserves further study.
    No preview · Article · May 1995 · The Journal of the American Board of Family Practice / American Board of Family Practice
  • E J Mayeaux · M B Harper · F Abreo · J B Pope · G S Phillips
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    ABSTRACT: To determine the reliability of repeat cervical smears (Papanicolaou smears) in patients who have had an abnormal initial smear, prospective data were collected on patients being followed up for a previously abnormal cervical smear. All 428 patients who were referred for colposcopy because of abnormal cervical smears underwent simultaneous cervical smears and coloposcopy with directed biopsy. Patients with colposcopic evidence of invasive carcinoma or a history of prior colposcopy were excluded. Cervical smear results were compared with the histologic findings on colposcopically directed biopsy. The ability of cervical smears to identify cervical intraepithelial neoplasia (CIN) and high-grade lesions (CIN 2 and 3) were also calculated for the repeat cervical smear. The sensitivity of repeat Papanicolau screening for CIN was 48%. When differentiating high-grade lesions from low-grade and benign biopsies, the sensitivity of the repeat cervical smear was only 25%. Of 110 patients with biopsy-proven high-grade lesions, 68% had low-grade initial cervical smears and 73% had low-grade or benign repeat cervical smear cytology. This study demonstrates that repeated Pap smears often fail to identify high-grade lesions and that the sensitivity of a repeat cervical smear is very low in patients with low-grade abnormalities found on routine screening examinations. Using follow-up cervical smears to monitor patients who have low-grade squamous intraepithelial lesions (LGSIL) carries unacceptable risks. A more reliable diagnostic test such as colposcopy is indicated.
    No preview · Article · Feb 1995 · The Journal of family practice
  • E J Mayeaux · T C Davis · R H Jackson · D Henry · P Patton · L Slay · T Sentell
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    ABSTRACT: Because of its brevity and ease of use, the Mini-mental State Examination (MMSE) is commonly used to screen and follow patients with cognitive impairment. This pilot study attempted to determine the relationships between literacy, age, and self-reported educational level and the total MMSE score. Cross-sectional analysis of all patients was followed by a family practice group at five local nursing homes. The associations between the patients' MMSE scores; literacy, as measured by the Rapid Estimate of Adult Literacy in Medicine (REALM); self-reported educational level; and age were determined using Pearson's correlation coefficient and stepwise multivariate linear regression. A total of 105 patients completed the study. Linear regression analysis showed that MMSE scores were significantly predicted by REALM score (P < .001) and the patient's age (P < .02). However, after accounting for REALM score and age, the self-reported educational level was not related to the MMSE score (P < .8). A significant relationship was seen between the REALM score and the subjects' self-reported educational levels (r = .44, P < .001) but not the subjects' ages (r = -.17, P < 0.09). A significant linear correlation was found between the MMSE and REALM scores (r = .71, P < .0001) and a significant inverse correlation was seen between MMSE scores and the patients' ages (r = -.28, P < .004). The correlation coefficient between the patients' MMSE scores and the self-reported educational levels was .33 (P < .0007). Practitioners who rely on the MMSE should be aware that patients may score in the demented range because they cannot read well enough to accurately complete the test. Literacy testing with REALM or other instruments may help identify such patients.
    No preview · Article · Jan 1995 · Family medicine
  • T J Hudspeth · E J Mayeaux · F Abreo

    No preview · Article · Sep 1994 · The Journal of the American Board of Family Practice / American Board of Family Practice
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    ABSTRACT: To test the reading ability of parents of pediatric outpatients and to compare their reading ability with the ability necessary to read commonly used educational materials; to compare individual reading grade levels with the levels of the last grade completed in school; and to further validate a new literacy screening test designed specifically for medical settings. Prospective survey. Pediatrics outpatient clinic in a large, public university, teaching hospital. Three hundred ninety-six parents or other caretakers accompanying pediatric outpatients. Demographics and educational status were assessed using a structured interview. Reading ability was tested using the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Wide Range Achievement Test-Revised. Written educational materials were assessed for readability levels with a computer program (Grammatik IV). The mean score on the REALM for all parents placed them in the seventh to eighth grade reading range, despite the mean self-reported last grade completed in school being 11th grade 5th month. Wide Range Achievement Test-Revised scores correlated well with REALM scores (0.82). Eighty percent of 129 written materials from the American Academy of Pediatrics, the Centers for Disease Control, the March of Dimes, pharmaceutical companies, and commercially available baby books required at least a 10th grade reading level. Only 25% of 60 American Academy of Pediatrics items and 19% of all materials tested were written at less than a ninth grade level, and only 2% of all materials were written at less than a seventh grade level. This study demonstrates that parents' self-reported education level will not accurately indicate their reading ability. Testing is needed to screen at-risk parents for low reading levels. In a public health setting, a significant amount of available parent education materials and instructions require a higher reading level than most parents have achieved. In such settings, all materials probably should be written at less than a high school level if most parents are to be expected to read them. The REALM can easily be used in busy public health clinics to screen parents for reading ability.
    No preview · Article · Apr 1994 · Pediatrics