Latest Updates

Oppositional Defiant Disorder and Its Clinical Management

    • Oppositional defiant disorder (ODD) has a high prevalence and substantial morbidity
    • Diagnosis of ODD is based on a careful history, interview, mental status examination, and collateral information from school.
    • Disruptive mood dysregulation disorder is a new DSM-5 diagnosis that should be carefully considered in the differential diagnosis of children and adolescents with ODD
    • Genetic and neuroimaging studies have examined the possible neurobiological basis of ODD, but to date there is no definitive biomarker or biological findings in ODD.
    • Parent behavioral management training and psychosocial interventions are the cornerstone of treatment planning for ODD. 

Oppositional Defiant Disorder and Its Clinical Management

    • Oppositional defiant disorder (ODD) has a high prevalence and substantial morbidity
    • Diagnosis of ODD is based on a careful history, interview, mental status examination, and collateral information from school.
    • Disruptive mood dysregulation disorder is a new DSM-5 diagnosis that should be carefully considered in the differential diagnosis of children and adolescents with ODD
    • Genetic and neuroimaging studies have examined the possible neurobiological basis of ODD, but to date there is no definitive biomarker or biological findings in ODD.
    • Parent behavioral management training and psychosocial interventions are the cornerstone of treatment planning for ODD. 

Cervical Dysplasia and Human Papillomavirus

    • 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.

Early Pregnancy Loss

    • 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.

Urinary Tract Infections 

    • Latest IDSA clinical practice guideline for management

Urinary Tract Infections 

    • Latest IDSA clinical practice guideline for management

Evaluation of Infertility

    • 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.

Clinical Evaluation of Immigrant and Refugee Women

 

    • 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
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