BOOK
Primary Care of Adult Women, An Issue of Obstetrics and Gynecology Clinics of North America, E-Book
James N. Woodruff | Anita K. Blanchard
(2016)
Additional Information
Book Details
Abstract
Obstetrician Gynecologists are frequently responsible for management of the primary care needs of their patients. A survey performed in 2005 found an estimated 37% of, non-pregnant patients, relies on gynecologists for routine primary care. The same study found that almost a quarter of gynecologists reported they needed additional primary care training across a broad set of medical topics (Acad Med. 2007; 82:602–607). The impetus for training in primary care skills is increasing. In response to language in the Affordable Care Act, the Institute of Medicine developed a report on clinical preventative services necessary for women (Clinical Preventative Services for Women: Closing the Gaps IOM. 2011; also Current Opinion in Obstetrics and Gynecology 2011, 23:471–480). The US Department of Health and Human services has adopted these IOM recommendations and, as a result, health plans are required to include these services. While initiatives such as the American Congress of Obstetricians and Gynecologists’ Well-Woman Task Force and recent cross-specialty ACOG educational collaborations have begun to address supplemental educational needs, additional resources covering key primary care topics are necessary. This issue of Obstetrics and Gynecology Clinics is an ideal means for accomplishing this important goal.
Table of Contents
Section Title | Page | Action | Price |
---|---|---|---|
Front Cover | Cover | ||
Primary Care of Adult Women\r | i | ||
Copyright\r | ii | ||
Contributors | iii | ||
CONSULTING EDITOR | iii | ||
EDITORS | iii | ||
AUTHORS | iii | ||
Contents | vii | ||
Foreword: Are Obstetrician-Gynecologists Primary Care Physicians?\r | vii | ||
Preface: Primary Care of Adult Women\r | vii | ||
Preventive Care in Women’s Health\r | vii | ||
Primary Care of Adult Women: Common Dermatologic Conditions\r | vii | ||
Clinical Management of Obesity in Women: Addressing a Lifecycle of Risk\r | vii | ||
Evaluation and Management of Behavioral Health Disorders in Women: An\rOverview of Major Depression, Bipolar Disorder, Anxiety Disorders, and Sleep in\rthe Primary Care Setting\r | viii | ||
Evaluation of Anemia\r | viii | ||
Cardiovascular Disease in Women: Primary and Secondary Cardiovascular Disease Prevention\r | viii | ||
Hypertension in Women: Evaluation and Management\r | viii | ||
Women’s Health and Lung Development and Disease\r | ix | ||
Primary Care Endocrinology in the Adult Woman\r | ix | ||
Primary Care Evaluation and Management of Gastroenterologic Issues in Women\r | ix | ||
Primary Care for the Older Adult Patient: Common Geriatric Issues and Syndromes\r | x | ||
OBSTETRICS AND GYNECOLOGY CLINICS\r | xi | ||
FORTHCOMING ISSUES | xi | ||
September 2016 | xi | ||
December 2016 | xi | ||
March 2017 | xi | ||
RECENT ISSUES | xi | ||
March 2016 | xi | ||
December 2015 | xi | ||
September 2015 | xi | ||
Foreword: Are Obstetrician-Gynecologists Primary Care Physicians?\r | xiii | ||
Preface: Primary Care of Adult Women\r | xv | ||
REFERENCES | xvi | ||
Preventive Care in Women’s Health | 165 | ||
Key points | 165 | ||
INTRODUCTION | 165 | ||
BEHAVIORAL COUNSELING: UNINTENTIONAL INJURIES, SUICIDE, AND HOMICIDE | 168 | ||
Incidence and Mortality | 168 | ||
Screening Modalities and Recommendations | 168 | ||
Motor vehicle accidents | 168 | ||
Suicide | 168 | ||
Homicide | 170 | ||
IMMUNIZATIONS | 170 | ||
Impact of Immunizations on Disease Incidence and Mortality | 170 | ||
Recommendations | 172 | ||
Human Papilloma Virus Vaccine and Cervical Cancer Prevention | 172 | ||
Incidence and mortality of cervical cancer | 172 | ||
Immunization and primary prevention | 172 | ||
CANCER SCREENING | 173 | ||
Breast Cancer | 173 | ||
Incidence and mortality | 173 | ||
Screening modalities and recommendations | 174 | ||
Identifying women at high risk for breast cancer | 174 | ||
Screening Adjuncts | 174 | ||
MRI | 174 | ||
Ultrasound | 174 | ||
Three-dimensional mammography | 175 | ||
CHEMOPREVENTION | 175 | ||
SUMMARY | 177 | ||
REFERENCES | 177 | ||
Primary Care of Adult Women | 181 | ||
Key points | 181 | ||
MELASMA | 181 | ||
Epidemiology | 181 | ||
Presentation | 182 | ||
Diagnosis | 182 | ||
Treatment | 182 | ||
Prognosis | 183 | ||
ROSACEA | 183 | ||
Epidemiology | 183 | ||
Presentation | 183 | ||
Diagnosis | 184 | ||
Treatment | 185 | ||
Prognosis | 185 | ||
VITILIGO | 185 | ||
Epidemiology | 185 | ||
Presentation | 186 | ||
Diagnosis | 186 | ||
Treatment | 186 | ||
Prognosis | 187 | ||
ACNE | 187 | ||
Epidemiology | 187 | ||
Presentation | 187 | ||
Diagnosis | 187 | ||
Treatment | 188 | ||
Prognosis | 188 | ||
ALOPECIA | 189 | ||
Epidemiology | 189 | ||
Presentation | 189 | ||
Diagnosis | 190 | ||
Treatment | 191 | ||
Prognosis | 191 | ||
BASAL CELL CARCINOMA AND SQUAMOUS CELL CARCINOMA | 192 | ||
Epidemiology | 192 | ||
Presentation | 192 | ||
Diagnosis | 192 | ||
Clinical Management of Obesity in Women | 201 | ||
Key points | 201 | ||
THE GENDER GAP | 202 | ||
CONSEQUENCES | 203 | ||
WHAT IS OBESITY? | 203 | ||
BIOLOGICAL BASIS OF EXCESS ADIPOSITY | 204 | ||
DEVELOPMENTAL CONSIDERATIONS | 205 | ||
LIFESTYLE DRIVERS | 206 | ||
BEHAVIORAL DRIVERS | 206 | ||
PSYCHOLOGICAL DRIVERS | 207 | ||
ENVIRONMENTAL DRIVERS | 207 | ||
DIAGNOSIS | 207 | ||
Nonpregnant Women | 210 | ||
Pregnant Women | 210 | ||
ASSESSMENT | 211 | ||
TREATMENT STRATEGY | 211 | ||
STEP 1: REMOVAL OF WEIGHT GAIN–PROMOTING MEDICATIONS | 211 | ||
STEP 2: LIFESTYLE THERAPIES | 212 | ||
DIET | 212 | ||
EXERCISE | 215 | ||
SLEEP | 216 | ||
STRESS | 216 | ||
STEP 3: PHARMACOTHERAPY | 216 | ||
STEP 4: SURGERY | 217 | ||
WEIGHT LOSS DEVICES | 223 | ||
REFERRAL | 223 | ||
SUMMARY | 224 | ||
ACKNOWLEDGMENTS | 224 | ||
REFERENCES | 224 | ||
Evaluation and Management of Behavioral Health Disorders in Women | 231 | ||
Key points | 231 | ||
INTRODUCTION | 231 | ||
ASSESSMENT AND DIFFERENTIAL DIAGNOSIS | 232 | ||
MAJOR DEPRESSIVE DISORDER | 233 | ||
Nonpharmacologic Treatments | 233 | ||
Psychotherapy | 233 | ||
Other nonpharmacologic treatments | 233 | ||
Pharmacotherapy | 233 | ||
Major Depression and the Female Reproductive Life Cycle | 234 | ||
Menstrual cycle | 234 | ||
Perinatal | 234 | ||
Menopause and perimenopause | 234 | ||
BIPOLAR DISORDER | 235 | ||
Nonpharmacologic Treatments | 235 | ||
Psychotherapy | 236 | ||
Other nonpharmacologic treatments | 236 | ||
Pharmacotherapy for bipolar disorder | 236 | ||
Bipolar Disorder and the Female Reproductive Life Cycle | 236 | ||
Menstrual cycle | 236 | ||
Perinatal | 236 | ||
Menopause and perimenopause | 238 | ||
ANXIETY DISORDERS | 238 | ||
Generalized Anxiety Disorder | 238 | ||
Panic Disorder | 239 | ||
Evaluation and Management | 239 | ||
Nonpharmacologic Treatment | 239 | ||
Pharmacotherapy for Anxiety Disorders | 239 | ||
Anxiety Disorders and the Female Reproductive Life Cycle | 239 | ||
Menstrual cycle | 239 | ||
Perinatal | 240 | ||
Menopause and perimenopause | 240 | ||
SLEEP DISORDERS | 240 | ||
Evaluation and Management | 240 | ||
Nonpharmacologic Interventions | 241 | ||
Pharmacologic Treatments | 241 | ||
Insomnia and the Female Reproductive Life Cycle | 241 | ||
Menstrual cycle | 241 | ||
Perinatal | 241 | ||
Menopause and perimenopause | 242 | ||
REFERENCES | 243 | ||
Evaluation of Anemia | 247 | ||
Key points | 247 | ||
GENERAL CONSIDERATIONS | 247 | ||
MACROCYTIC ANEMIA | 248 | ||
Causes | 249 | ||
Megaloblastic anemia | 249 | ||
Medications | 249 | ||
Myelodysplastic disorders | 249 | ||
Alcohol abuse | 249 | ||
Liver disease | 250 | ||
Reticulocytosis | 250 | ||
Hypothyroidism | 250 | ||
Spurious macrocytosis | 250 | ||
Evaluation | 250 | ||
MICROCYTIC ANEMIA | 251 | ||
Causes | 251 | ||
Iron deficiency anemia | 251 | ||
Thalassemia | 253 | ||
β-Thalassemia | 253 | ||
α-Thalassemia | 253 | ||
Cardiovascular Disease in Women | 265 | ||
Key points | 265 | ||
INTRODUCTION | 265 | ||
PRIMARY PREVENTION | 266 | ||
Nonmodifiable Risk Factors | 266 | ||
Age | 266 | ||
Race | 267 | ||
Family history | 267 | ||
Modifiable Cardiovascular Disease Risk Factors | 267 | ||
Smoking | 267 | ||
Hypertension | 267 | ||
Diabetes mellitus | 269 | ||
Elevated body mass index | 270 | ||
Physical inactivity | 271 | ||
Diet | 271 | ||
Alcohol | 271 | ||
Vitamins | 271 | ||
Risk prediction models | 272 | ||
Cholesterol/statin therapy | 273 | ||
Aspirin | 273 | ||
Hormonal therapy | 274 | ||
CEREBROVASCULAR DISEASE | 274 | ||
PERIPHERAL VASCULAR DISEASE | 274 | ||
SEX-SPECIFIC RISK FACTORS | 275 | ||
Gestational Hypertension and Pre-Eclampsia | 275 | ||
Gestational Diabetes | 275 | ||
Other Pregnancy-Related Risk Factors | 275 | ||
Polycystic Ovary Syndrome | 275 | ||
Functional Hypothalamic Amenorrhea | 275 | ||
Breast Cancer Therapy | 275 | ||
Risk assessment with sex-specific risk factors | 276 | ||
DISEASE MANAGEMENT AND SECONDARY PREVENTION | 276 | ||
Coronary Heart Disease | 276 | ||
Medications | 277 | ||
Antiplatelet agents | 277 | ||
Renin-angiotensin-aldosterone blockers | 277 | ||
β-blockers | 277 | ||
Nitrates | 278 | ||
Other considerations | 278 | ||
Cardiac rehabilitation | 278 | ||
Depression screening | 278 | ||
Influenza vaccination | 278 | ||
Hormonal therapy | 278 | ||
Oral contraceptives | 278 | ||
Hormonal replacement therapy | 278 | ||
Cerebrovascular Disease | 278 | ||
Peripheral Vascular Disease | 279 | ||
SUMMARY | 280 | ||
REFERENCES | 280 | ||
Hypertension in Women | 287 | ||
Key points | 287 | ||
INTRODUCTION | 287 | ||
HYPERTENSION AND CARDIOVASCULAR RISK IN WOMEN | 288 | ||
SPECIAL CONSIDERATIONS FOR WOMEN | 289 | ||
Role of Obesity | 289 | ||
Hypertension and Combined Oral Contraceptives | 290 | ||
Hypertension and Polycystic Ovarian Syndrome | 290 | ||
Role of Menopause | 291 | ||
DIAGNOSIS OF HYPERTENSION | 291 | ||
White Coat Hypertension | 292 | ||
Ambulatory and Home Blood Pressure Monitoring | 293 | ||
INITIAL EVALUATION OF HYPERTENSION | 293 | ||
History and Physical Examination | 293 | ||
MANAGEMENT OF HYPERTENSION | 298 | ||
Lifestyle Interventions | 298 | ||
Maintenance of a Healthy Body Weight | 299 | ||
Physical Activity | 299 | ||
Cigarette Smoke Exposure | 299 | ||
Pharmacotherapy | 300 | ||
General principles | 300 | ||
Individualized treatment plan | 300 | ||
Ongoing Management Considerations | 300 | ||
Resistant Hypertension | 302 | ||
SUMMARY AND DISCUSSION | 303 | ||
REFERENCES | 303 | ||
Women’s Health and Lung Development and Disease | 307 | ||
Key points | 307 | ||
INTRODUCTION | 307 | ||
SEX-BASED DIFFERENCES IN PULMONARY PHYSIOLOGY | 307 | ||
OBSTRUCTIVE LUNG DISEASE | 308 | ||
Chronic Obstructive Pulmonary Disease | 308 | ||
Asthma | 310 | ||
INTERSTITIAL LUNG DISEASE | 312 | ||
Lymphangioleiomyomatosis | 312 | ||
LUNG CANCER | 314 | ||
PULMONARY ARTERIAL HYPERTENSION | 315 | ||
VENOUS THROMBOEMBOLISM | 317 | ||
THORACIC COMPLICATIONS OF ENDOMETRIOSIS | 318 | ||
REFERENCES | 319 | ||
Primary Care Endocrinology in the Adult Woman | 325 | ||
Key points | 325 | ||
DIABETES MELLITUS | 325 | ||
Background | 325 | ||
Pathophysiology and Classification | 326 | ||
Prevention | 326 | ||
Assessment of Overall Risk and Screening Recommendations | 326 | ||
Clinical Presentation | 327 | ||
Management | 327 | ||
Summary | 329 | ||
THE THYROID GLAND | 329 | ||
Background | 329 | ||
Thyroid hormone synthesis and action | 329 | ||
Perturbations of Thyroid Function and Structure | 332 | ||
Hypothyroidism | 332 | ||
Clinical manifestations and diagnosis of hypothyroidism | 333 | ||
Management in nonpregnant women | 333 | ||
Management in pregnant women | 334 | ||
Thyrotoxicosis | 334 | ||
Thyroid nodules and thyroid cancer | 336 | ||
Summary | 336 | ||
OSTEOPOROSIS | 336 | ||
Background | 336 | ||
Assessment of Overall Risk | 336 | ||
Screening for Osteoporosis | 338 | ||
Diagnosis of Osteoporosis and Low Bone Mineral Density | 339 | ||
Management | 343 | ||
Summary | 344 | ||
REFERENCES | 344 | ||
Primary Care Evaluation and Management of Gastroenterologic Issues in Women | 347 | ||
Key points | 347 | ||
INTRODUCTION | 347 | ||
COLORECTAL CANCER | 348 | ||
Current Screening Modalities and Guidelines | 348 | ||
High-Risk Populations | 349 | ||
Colorectal Cancer in Women | 349 | ||
IRRITABLE BOWEL SYNDROME | 351 | ||
Diagnosis | 351 | ||
Pathophysiology | 351 | ||
Management | 352 | ||
Management of Irritable Bowel Syndrome with Constipation | 352 | ||
Management of Irritable Bowel Syndrome with Diarrhea | 352 | ||
PEPTIC ULCER DISEASE | 353 | ||
Clinical Presentation | 353 | ||
Risk Factors | 353 | ||
Endoscopic Evaluation and Management | 354 | ||
GALLBLADDER DISORDERS | 355 | ||
Biliary Colic | 355 | ||
Cholelithiasis and Cholecystitis | 355 | ||
Gallbladder Disease and Pregnancy | 356 | ||
INFLAMMATORY BOWEL DISEASE | 356 | ||
Inflammatory Bowel Disease Therapy | 357 | ||
Inflammatory Bowel Disease and Pregnancy | 358 | ||
GASTROESOPHAGEAL REFLUX DISEASE | 359 | ||
Gastroesophageal Reflux Disease Therapy | 360 | ||
Gastroesophageal Reflux Disease and Pregnancy | 360 | ||
Barrett’s Esophagus | 361 | ||
REFERENCES | 362 | ||
Primary Care for the Older Adult Patient | 367 | ||
Key points | 367 | ||
INTRODUCTION | 367 | ||
COGNITIVE IMPAIRMENT AND DEMENTIA | 368 | ||
Epidemiology | 368 | ||
Diagnosis | 368 | ||
Risk Factors and Screening | 368 | ||
Evaluation | 369 | ||
Management | 370 | ||
FALLS | 371 | ||
Epidemiology | 371 | ||
Screening | 371 | ||
Evaluation | 372 | ||
Treatment and Prevention | 372 | ||
POLYPHARMACY | 372 | ||
Definition and Epidemiology | 372 | ||
Risks | 373 | ||
Evaluation and Management | 373 | ||
LATE LIFE AND END-OF-LIFE PLANNING AND CARE | 374 | ||
Care Planning for Multimorbid Patients | 374 | ||
Delivering Bad News | 374 | ||
Advance Care Planning | 375 | ||
SUMMARY | 376 | ||
REFERENCES | 376 | ||
Index | 381 |