Subject(s)
COVID-19 , COVID-19/prevention & control , Health Personnel , Humans , Masks , SARS-CoV-2ABSTRACT
The practice of colposcopy, a diagnostic procedure to evaluate for vaginal, vulvar, and cervical dysplasia, has evolved to incorporate patient risk factors for high-grade cervical intraepithelial neoplasia (CIN) and cancer. Changes in cervical cancer screening and guidelines, human papillomavirus (HPV) vaccination recommendations, and colposcopy standards from the American Society for Colposcopy and Cervical Pathology (ASCCP) have implications for all primary care clinicians, not only those who perform colposcopies. Primary care clinicians should offer HPV vaccination to all patients between the ages of nine and 26, in addition to cervical cancer screening and follow-up guidance. Primary care clinicians should recognize the degrees of risk of high-grade CIN and cancer conferred by cytology, HPV subtype, and persistence of HPV infection. Clinicians should address modifiable risk factors such as tobacco use, and provide counseling to patients about colposcopy based on their individual risks. Clinicians should conduct shared decision-making about immediate loop electrosurgical excision procedure vs. colposcopy with multiple biopsies and endocervical sampling for patients with the highest risk of cervical cancer, and for patients who are older than 25 years with at least two of the following: HPV-16, HPV-18, and high-grade squamous intraepithelial lesion cytology. Primary care clinicians should be familiar with the 2019 ASCCP guidelines and develop clinic-based systems to ensure appropriate follow-up of abnormal cytology, positive high-risk HPV testing, diagnosed CIN, and cervical cancer. Patients with an abnormal cervical cancer screening history require surveillance, which differs from routine screening for patients with normal prior screening results. Long-term surveillance is recommended for patients with CIN 2 or worse.
Subject(s)
Biopsy/methods , Colposcopy , Primary Health Care , Uterine Cervical Dysplasia , Uterine Cervical Neoplasms , Adult , Age Factors , Colposcopy/methods , Colposcopy/standards , Early Detection of Cancer/methods , Female , Humans , Middle Aged , Papillomavirus Infections/diagnosis , Papillomavirus Infections/epidemiology , Patient Care Management/methods , Patient Care Management/standards , Primary Health Care/methods , Primary Health Care/standards , Risk Assessment/methods , Risk Factors , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/epidemiology , Watchful Waiting/methods , Uterine Cervical Dysplasia/diagnosis , Uterine Cervical Dysplasia/epidemiologyABSTRACT
Seven validated prospective scoring systems, and one unvalidated system, predict a successful TOLAC based on a variety of clinical factors. The systems use different outcome statistics, so their predictive accuracy can't be directly compared.
Subject(s)
Cesarean Section , Clinical Decision-Making/methods , Decision Support Techniques , Trial of Labor , Female , Humans , Nomograms , PregnancyABSTRACT
The birth of an infant is one of the most memorable experiences a family shares. Pediatric health care professionals are privileged to participate in this experience and recognize it as a time to promote the health of the newborn and family. Ideally, a well-designed care system would be replete with comprehensive supports during the prenatal period, birth, and transition to home. Opportunities exist to improve the care we deliver with universal screening of all pregnant women; coordinated assessments of family health, including mental health; and access to coordinated supports and services for mother and infant. If 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, it is estimated the United States would save billions of dollars per year and prevent more than 900 deaths, nearly all of which would be in infants. All infants, whether breastfed or formula fed, should receive 400 IU supplemental vitamin D. Influenza and TdaP vaccination of postpartum mothers and other caregivers helps cocoon the vulnerable infant from influenza and pertussis until he or she can be fully vaccinated. When children reach the highest weight or length allowed by the manufacturer of their infant-only seat, they should continue to ride rear-facing in a convertible seat. It is best for children to ride rear-facing as long as possible to the highest weight and height allowed by the manufacturer of their convertible seat.
Subject(s)
Infant Care/methods , Infant, Newborn , Breast Feeding , Female , Humans , Infant, Newborn/growth & development , Pregnancy , Prenatal Care/methodsABSTRACT
Cervical cancer and its dysplasia precursors account for significant morbidity and mortality in women worldwide. Human papillomavirus infection is common, preventable, and now widely accepted as the causative agent with oncogenic potential in the development of cervical cancer. Screening via Papanicolaou testing is critical, and interpretation of test results with knowledge of patient risk factors is imperative. Many evidence-based guidelines for screening, interpretation, and management have been developed and are widely available for use.
