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Clinical Obstetrics and Gynecology

Robert S Egerman
Between 70 and 170 million people worldwide are infected with hepatitis C virus (HCV) which frequently causes chronic liver disease and cirrhosis. There are several genotypes and many subtypes of HCV. Direct-acting antiviral agents are effective at eradicating HCV in the vast majority of patients, producing much higher cure rates than were seen with interferon and ribavirin regimens only a few years ago. The chapter reviews the epidemiology and virology of HCV infection. Treatment regimens are complex but a straightforward approach to selection of patients, choice of direct-acting antiviral agents and follow-up is presented...
May 13, 2019: Clinical Obstetrics and Gynecology
Olivia Moumne, Patrick Duff
Streptococcus pneumoniae, a gram-positive diplococcus, is the most common cause of bacterial pneumonia. The diagnosis of pneumococcal pneumonia is usually confirmed by chest x-ray and gram stain. The most appropriate antibiotics for treatment pneumococcal infection are macrolides, beta-lactams, and quinolones. Two vaccines, PPSV23 and PCV13, are highly effective in preventing infection.
April 18, 2019: Clinical Obstetrics and Gynecology
Monica Hagan Vetter, Ritu Salani, Thomas E Williams, Christopher Ellison, Bhagwan Satiani
Although there has been discussion of a shortage of surgical specialties including OB/GYN, consensus is difficult because of the multiple variables involved in estimating both supply and demand. In addition, burnout has become more recognized as a variable that has not been taken into account in estimating a shortage of OB/GYNs. We estimate OB/GYN physician shortages of 17%, 24%, and 31% by 2030, 2040, and 2050, respectively. Here, we examine the impact of burnout on the OB/GYN workforce. Specifically, we address the associations of burnout, reduction in clinical productivity as well as early retirement...
April 18, 2019: Clinical Obstetrics and Gynecology
Hugh C G Nadeau, Rodney K Edwards
Group B Streptococcus (GBS) infection remains a significant cause of neonatal morbidity and mortality. Adoption of screening for maternal genital tract colonization and intrapartum antibiotic prophylaxis has significantly reduced early-onset neonatal GBS infections. For women with an allergy to penicillin, recommended agents for prophylaxis have been well-outlined, but compliance with guideline recommendations is poor. There have been ongoing efforts in vaccine development, but no vaccination currently is available for either preconception or antenatal administration...
April 16, 2019: Clinical Obstetrics and Gynecology
Nigel Pereira, Zev Rosenwaks
No abstract text is available yet for this article.
April 3, 2019: Clinical Obstetrics and Gynecology
Jeffrey M Fowler, Steven G Gabbe
No abstract text is available yet for this article.
April 3, 2019: Clinical Obstetrics and Gynecology
Helane Fronek, Linda Brubaker
This summary will address important information on women physicians, focusing on those practicing OG. We will review traits more commonly found in women, societal influences that make women physicians more susceptible to burnout, as well as the unique features of the medical profession that affect women differently. We conclude with a discussion of the shared responsibilities of both individuals and institutions for implementing interventions that will effectively improve women's resilience, identification of and recovery from burnout...
April 3, 2019: Clinical Obstetrics and Gynecology
Scarlett Karakash, Michelle Solone, Jordan Chavez, Tait Shanafelt
Increasing evidence shows physician well-being is linked to patient outcomes, patient and physician satisfaction, and workforce retention. Physician well-being is a broad construct that includes various dimensions of distress (stress, anxiety, fatigue, burnout) and professional fulfillment (meaning in work, engagement). Work-life integration (WLI) is one important component of physician well-being. We will review the current state of WLI among physicians as well as some strategies to improve this aspect of physician well-being...
April 3, 2019: Clinical Obstetrics and Gynecology
Kendra R Sylvester-Armstrong, William Patrick Duff
Perinatal transmission of hepatitis B virus continues to be a serious global public health concern. Transmission failures are related to high maternal viremia. Several antiviral therapies reduce maternal viremia around the time of delivery and decrease maternal-to-child-transmission. This chapter is a review of current studies that, ultimately, have provided strong evidence for the efficacy and safety of 3 antiviral drugs in pregnancy-lamivudine, telbivudine and tenofovir. The latter drug is the particular focus of this chapter which will show that tenofovir is the preferred antiviral therapy in pregnant women because of its potency, safety profile, and low risk of resistance...
March 27, 2019: Clinical Obstetrics and Gynecology
Roger P Smith
Professional burnout threatens all high-functioning professionals and affects not only the individual, but, by extension, the patients they serve. The characteristics that make someone competitive for medical school, residency, or successful in academics or practice, make us particularly vulnerable to burnout: compulsive dedication to goals (and patients), motivation to succeed, self-reliance, leadership experience, delayed gratification, and others. Estimates of the prevalence of burnout in medicine vary widely but are consistently >40% and often as high as 75%...
March 27, 2019: Clinical Obstetrics and Gynecology
Ting Zhang, Jody Madeira, Yao Lu, Yun Sun, Heidi Mertes, Guido Pennings, Steven R Lindheim
In the last 10 years, expanded preconception carrier screening has become widely available and helps patients/couples make more informed decisions with regard to their reproductive options and facilitates more effective preconception planning, prenatal diagnosis, condition-specific counseling, and condition-specific care. This review provides an overview of expanded preconception carrier screening's high-throughput genotyping and sequencing approaches, current guidelines, implementation challenges and evolving ethical quandaries...
March 22, 2019: Clinical Obstetrics and Gynecology
Scott A Sullivan
No abstract text is available yet for this article.
March 18, 2019: Clinical Obstetrics and Gynecology
(no author information available yet)
No abstract text is available yet for this article.
March 8, 2019: Clinical Obstetrics and Gynecology
Caroline T Nguyen, Jorge H Mestman
Postpartum thyroiditis (PPT) is an autoimmune-mediated destructive thyroiditis that occurs in the first year postpartum with a prevalence of 5%. In order to appropriately counsel and treat the patient, physicians need to recognize the signs and symptoms of PPT and distinguish PPT from Graves hyperthyroidism. This review of PPT will discuss the etiology, clinical course, risk factors, prognosis, and treatment of PPT. Understanding PPT is important for all physicians taking care of women in the peripartum period as women who have had PPT are at an increased risk of subsequent episodes of PP and at risk of permanent hypothyroidism...
March 5, 2019: Clinical Obstetrics and Gynecology
Alison K Chapman, Zachary J Farmer, Lucy D Mastrandrea, Kristal A Matlock
Thyroid hormone is essential for normal fetal brain development in utero and for the first 2 years of life. The developing fetus is initially reliant upon maternal thyroid hormones that cross the placenta, until the fetal thyroid begins to supply thyroid hormone for the fetus. Maternal thyroid status affects fetal thyroid function and maternal thyroid dysfunction can have a significant impact on the fetus and neonate. There are also several neonatal factors that can influence thyroid function. Here, we describe thyroid function in the fetus and neonate and discuss the most common thyroid disorders seen in neonates...
June 2019: Clinical Obstetrics and Gynecology
Ryan D Cuff
Hyperthyroidism is relatively uncommon during pregnancy. However, those caring for pregnant patients should be versed in the evaluation and management of hyperthyroidism, as there are potential maternal and fetal implications that are related to the disease and to treatment. The differential diagnosis of hyperthyroidism includes clinical and subclinical entities, as well as transient laboratory findings that are related to the pregnancy itself. The clinical management, including the indications for the use of thioamide or antithyroid medications, will be discussed in the context of pregnancy...
June 2019: Clinical Obstetrics and Gynecology
Mary Sterrett
This study was a brief review of maternal and fetal thyroid function and pathology during pregnancy.
June 2019: Clinical Obstetrics and Gynecology
(no author information available yet)
No abstract text is available yet for this article.
June 2019: Clinical Obstetrics and Gynecology
Christine Hur, Jenna Rehmer, Rebecca Flyckt, Tommaso Falcone
Uterine factor infertility (UFI) may affect up to 1 in 500 reproductive age women. The uterus is an essential component of achieving pregnancy and carrying a pregnancy to term successfully. There are many etiologies of UFI which may be categorized into either congenital or acquired causes. In this review, we discuss the different causes of UFI as well as the treatment options, which now includes uterine transplant.
June 2019: Clinical Obstetrics and Gynecology
Nigel Pereira, Zev Rosenwaks
No abstract text is available yet for this article.
June 2019: Clinical Obstetrics and Gynecology
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