What's New | Decker

Large randomized trials of Pap and HPV cotesting found that after extended follow-up, the incidence of invasive cervical cancer was significantly lower in women initially screened with HPV-based testing compared with cytology alone.
Screening that includes assessment of HPV status provides 60 to 70% greater protection against invasive cervical carcinomas compared with cytology alone.
Vaccination rates for the HPV vaccine, approved in the United States since 2006, are well below national goals, and provider recommendation has been found to be the most important factor influencing a patient’s or parent’s decision as to whether or not to accept the HPV vaccine.

Ultrasonography criteria for the diagnosis of early pregnancy loss have recently been redefined.
Medical and surgical management are safe and effective, and should be influenced largely by patient preference.
Recommendations regarding interval to next conception have recently shifted away from the traditional 3 months.

Sigal Yawetz, MD

Sigal Yawetz, MD

Zika virus: Delayconception if potential exposure: 8 weeks: females or 3 months: males
Subclinical hypothyroid: Treatment is associated with improved pregnancy outcomes when TSH levels are above 4 mIU/L.
Tubal patency: Hysterosalpingo-contrast sonography was recently introduced as an additional screening method to assess tubal patency.

Cultural sensitivity and openness is more important than cultural ‘competence’ when treating migrants from diverse backgrounds
Guidelines are available for effective and appropriate use of qualified medical interpreters
Mental health screening is not only to assess effects of prior trauma but to determine challenges in acculturation
There is increasing recognition of the need for preventive counseling and chronic care in migrant women

Updating consensus guideline recommendations up to January 2016
Adding a duplex scan image showing a deep vein thrombosis (DVT) in the diagnosis section
Adding a computed tomographic (CT) scan showing a pulmonary embolism (PE)
Showing the various types of approved inferior vena cava filters
Adding five separate flow-chart figures depicting a stepwise management algorithm for the evaluation and treatment of DVT and PE
Adding a section on catheter-associated upper extremity thrombosis
Adding a section on extended prophylaxis, the use of non–vitamin K antagonists, updates on stockings
Writing five new multiple-choice questions based on the review

Many iatrogenic withdrawal syndromes have been identified, the most common of which is opioid or benzodiazepine withdrawal. Generally speaking, the approach to treating opioid and/or benzodiazepine withdrawal is to provide enough medication to saturate target receptors, followed by a period of gradual dose reduction to allow the body to return to a state of homeostasis.
The Neonatal Abstinence Score (NAS) was designed to assess withdrawal symptoms in infants with multiple drug exposure during pregnancy. Because the NAS was validated in infants, it is not applicable in older children with iatrogenic withdrawal. In recent years, withdrawal assessment tools for pediatrics have been developed for iatrogenic withdrawal to provide an objective assessment of withdrawal.
There have been no randomized clinical trials that have compared the efficacy of various weaning strategies. However, a recent multicenter clinical trial, named the RESTORE trial, examined the effects of a standardized sedation protocol in pediatric intensive care units.

Gynecologic Oncology